When I had my babies in the mid 1980’s, giving birth was an anxious time and although I went to antenatal classes, I don’t remember much about the content of the classes and I am fairly sure that it certainly didn’t cover anxiety in any way.  In those days, we didn’t have many choices in terms of how we had our babies, we went into hospital when our contractions got to a certain point and usually had our babies on our backs.  I can’t remember being asked for my thoughts or opinions then – I just did as I was told – including having stitches without any anaesthetic!  I do remember hearing about Michel Odent at that time, about using a birthing pool and giving birth standing, squatting or kneeling but it wasn’t taken seriously.  Looking back and in hindsight, Michel Odent’s quote “To change the world, we must first change the way the babies are being born” is actually so true.  The act of giving birth naturally and looking forward to it really does empower women and being given responsibility for having their babies in the way that they want.

Of course, pregnancy, childbirth and postnatal affect women physically, psychologically and socially.  Pregnancy can affect women in many different ways from the time that she first discovers she is pregnant to the reality of looking after a new baby. 

PsychCentral published an article by Jane Collingwood in 2016 who reported that “Pregnant women experience a range of physical and emotional changes, all of which may trigger anxiety. Fear of the unknown, stress, feelings of insecurity over work or money, and daily pressures add to hormonal changes during pregnancy and may make women feel overwhelmed. Couple this with the constant worry over the baby’s health, and anxiety becomes a real possibility.”  Their statistics showed that more than 20% from their study of 500 pregnant women tested positive for an anxiety disorder and or depressive symptoms prenatally.

Grantley Dick-Reid in his book ‘Childbirth Without Fear’ said that “The influence of chronic anxiety upon pregnant and parturient women is too frequently overlooked and is one of the main indications for careful and efficient antenatal preparation, particularly the elimination of fear.”

Pregnancy is a major life event.  And according to Tommys. org  “Anxiety in pregnancy is very common. More than 1 in 10 pregnant women have it.”

Anxiety is a feeling of unease, worry, fear, sense of dread that can be mild or severe. It may be about being unable to concentrate, or feeling irritable, tetchy and not being able to sleep properly.  Everyone feels anxious sometimes, but some people find it hard to control their worries.   Some pregnant women feel distressed or guilty about feeling anxious or panicky when everyone expects them to be happy. But anxiety is a mental health condition and can be treated.

Tokophobia is at the extreme end and is a severe fear of childbirth which may also affect their decision on how to give birth to their baby.   According to Susan Mayor in ‘Sixty seconds on . . . tokophobia’   “Tokophobia is rare but fear of childbirth is common” 

These more extreme fears are likely to be more common and intense in women who have never been pregnant or given birth (primary tokophobia). Women who have had previous pregnancies (secondary tokophobia) can also experience tokophobia.  Secondary tokophobia is a fear of childbirth developed after a previous traumatic labour or even a normal birth, miscarriage, stillbirth or termination of pregnancy. In a few cases, prenatal depression might be happening alongside tokophobia.

On the NCT (National Childbirth Trust) web-site in their article ‘Tokophobia: how to get over extreme fear of giving birth’, they report that 20% to 78% of pregnant women report fears associated with the pregnancy and childbirth (Bhatia and Jhanjee, 2012) with 13% of women reporting a fear that’s overwhelming enough to make them postpone or avoid getting pregnant altogether.

It is also interesting to note that men can also experience tokophobia.  Researchers have found that men with tokophobia often have a severe fear regarding the health and safety of their partner and child.  In Lizzie Parry’s article in Daily, she talks about the research done by Dr Liana Leach of the Australian National University in that ‘One in 10 new dads’ suffer anxiety around the birth of their baby’.  Dr Leach said: ‘Men can feel left out of the process, because pregnancy and childbirth are so integrally linked to the mother. ‘It can compound the problem’

Many things can play a part in anxiety during pregnancy including the usual horror stories from friends & families about their ‘pregnancies & childbirths’, difficult childhood experiences, poor self-esteem, previous miscarriages or own difficult birth experiences.  It could be a sense of isolation, poor support, stressful living conditions or major life events.  The pregnancy may not have been planned.  It could be about struggling with a pressure to ‘do things right’.

Dr Grantly Dick-Read in his book, ‘Childbirth without Fear’, sums this up by saying, “It is not unnatural, therefore, to presume that very few, if any women can set out upon this great adventure without having some misgivings as to its outcome.”

Some people can also have depression in pregnancy because of anxiety.  The NCT web-site says around 12% of women actually experience antenatal or prenatal depression.  Antenatal depression can be caused by a hormonal imbalance. Although, because women do experience hormonal changes when they’re pregnant, they do say that’s unlikely to be the only cause.

Research carried out on ‘The Causes of Anxiety during Pregnancy’ was reported as part of 6th World Conference on Psychology, Counseling and Guidance.  It showed that from a study of 150 pregnant women, the highest anxiety is about factors connected with the newborn: “possible neonatal development disorder”, “possible birth trauma to newborn” and “newborn’s ability to effectively initiate breathing”. Followed by anxiety causes connected to pregnant woman herself.

And ‘Anxiety Disorders during pregnancy: a systematic review’ revealed high anxiety disorder prevalence in pregnancy was found with a high prevalence of GAD, phobias, and panic disorder being among the most prevalent.

 A study done in 2014 ‘Anxiety in early pregnancy:  prevalence and contributing factors’ revealed that the prevalence of anxiety symptoms in early pregnancy was 15.6% and these symptoms increased the rate of fear of birth.

Other anxieties or fears are around feeling sick as a result of experiencing morning sickness – some women suffer from emetophobia (fear of being sick). A needle phobia may also cause problems in pregnancy because it can cause some women to avoid having important blood tests or treatments.

Other fears include loss of control with many women feeling “trapped” when they find out that they are pregnant and some also feel out of control as a reaction to the effect of pregnancy hormones on the body as previously discussed.  Fears around loss of independence and impending responsibility cause anxiety are common.   Fear about coping with labour is the most obvious and a lot of women worry about how their labour will be, fear of the pain, fear of being in hospital.   There are also fears about caesareans and epidurals which can bring about intense anxiety.  The review ‘Anxiety scales used in pregnancy:  systematic review’ contributes to the existing knowledge by identifying a number of anxiety symptoms that can be considered psychometrically robust indicators of antenatal anxiety.

All women worry about whether their baby will be healthy or whether there will be complications at birth.  This fear is acute and very distressing to the mum-to-be.

Post Natal Depression (PND) can develop 4-6 weeks after birth and result in high levels of depression. It is characterised by despondency, disruptions in sleep patterns and appetite, and feelings of inadequacy. All of this can affect the woman’s ability to carry out daily activities.   In research conducted by SMA Nutrition (2006) it was found that women who scored highly on the Post Natal Depression Scale also displayed high anxiety scores on the Hospital Anxiety and Depression Scale, which suggests significant links between anxiety and PND.

And of course, some women do develop a fear of childbirth because they have had a traumatic birthing experience, miscarriage or neonatal death. In this case, they may have post-traumatic stress disorder (PTSD). say that about one or two in every 100 women have post-traumatic stress after giving birth.

Postnatal anxiety is something that some new mothers experience after having a baby. Having a baby causes huge changes to a woman’s body in terms of the physical shock and hormonal fluctuations (which in turn have an impact on mood), but also has a big impact on family life, sleep levels and stress. All of these things can lead a person to become more anxious than usual.

The ‘Fear of Pregnancy and childbirth Review’ discusses pregnancy and the relationship with depression, pathological fear of childbirth or tokophobia and eating disorders.  It also talks about postnatal depression and the consequences to the child, mother, and family which may include neglect of the child, family breakdown, self-harm, and suicide. Research also suggests that the babies may develop emotional or behavioural problems or cognitive delays in childhood as a result.

In the report ‘Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression’, their aim was to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum, to establish comorbidity of postpartum anxiety and postpartum depression (PPD) and to examine predictors of anxiety 6 weeks postpartum. A sample of 272 women who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum.  The results showed that the estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%.

The Coronavirus pandemic hasn’t made things any easier in terms of anxiety for expecting mothers and according to the pregnancy charity Tommy’s, in an article by Maya Oppenheim, their poll of over 1,000 people revealed that “approximately half of mothers-to-be or women who recently gave birth are feeling anxious, while over three quarters say that COVID-19 has exacerbated their nerves”.

The Guttmacher Institute reports that COVID-19 has caused around a third of people who could become pregnant to delay or rethink how many children they’d like to have. According to an article in NBC news, ‘Pregnant in a pandemic:  How Covid-19 stress may affect growing babies’, anxiety levels in pregnant women have increased from 18% before the pandemic to 50% during, even in the setting of a low-risk pregnancy.   And on top of the usual things that make somebody anxious in the pandemic, there are additional stressors, such as having to attend scans alone, dads not being allowed to stay after the baby has been born and more intense consequences, of contracting Covid.  In the article in PBS NewsHour, ‘How pandemic anxiety is affecting pregnant women’, they say that there is fear that pregnant people are more likely to end up on a ventilator if they contract the Coronavirus.  However, they also say that there is still not enough concrete information about whether or not pregnancy increases the risk of COVID-19 mortality or can be transmitted to a foetus in utero. Although it is important to be aware of these facts in order to be informed and motivated to take necessary safety precautions, it is by no means comforting.

And in addition to worries about the baby’s safety in hospital and at home, there is anxiety about giving birth in an overloaded medical system, and concerns about having postpartum depression.

And there is also the disappointment and sadness that comes with missing out on the usual exciting and calming activities such as baby showers, birthing classes, and mum’s groups as discussed in Lola&Lykke’s article on ‘Pregnancy and Covid-19: Dealing with Stress and Anxiety.

A report by the MGH Center for Women’s Mental Health ‘Anxiety During Pregnancy: Options for Treatment’ in 2015 suggested that cognitive-behavioural therapy and relaxation techniques may be very useful for treating anxiety symptoms during pregnancy and may reduce the need for medication.  Various studies have demonstrated the effectiveness of yoga, massage therapy and acupuncture in this setting. 

Dr Grantly Dick-Read (1955) discovered the importance of relaxation, calm and undisturbed labours on the efficiency of birthing.   In 1913, he discovered a woman labouring calmly and meditatively, without pain relief. The woman had not required medication, answering ‘It didn’t hurt. It wasn’t meant to was it, Doctor?’. This questioned many aspects of birth that even now are presumed such as pain, discomfort and a fear of the unknown.

So Dr Grantley Dick-Reid was the pioneer of natural childbirth and he observed that mothers in labour who were free of fear had more relaxed bodies and had a much easier birth.  An American hypnotherapist, Marie Mongan, incorporated his fear-tension-pain theory into hypnobirthing breathing, relaxation and visualisation techniques.

And there is overwhelming and increasing clinical evidence that hypnobirthing and hypnosis helps women during pregnancy, birth and postnatally as follows;

  • Downe et al, (2015) concluded that women receiving self-hypnosis sessions and listening to a hypnosis CD each night versus the control group, scored a significantly lower score 2 weeks postnatally for actual anxiety and fear of childbirth than the anticipated scores given antenatally.
  • 51% of the women who participated in Phillips-Moore’s (2013) ‘Birthing outcomes from an Australian HypnoBirthing programme’ study didn’t use any pain medication at all and the overall discomfort level for labour and birth was 5.8 out of 10 including two women who recorded zero discomfort.  In addition, the average length for both stages of labour was shorter in the HypnoBirthing group compared to general population figures.  Caesarean section rates were lower, as was the use of gas and epidurals
  • Jenkins and Pritchard (2001) concluded that they had demonstrated the benefits of hypnotherapy against the average lengths of the first stage of labour in first-time-mums was 6.4 hours after hypnosis against 9.3 hours without. The average lengths of the second stage of labour were 37 min and 50 min, respectively. For second-time-mothers (and more), the corresponding values were 5.3 hours and 6.2 hours for the first stage and 24 and 22 mins for the second. The use of analgesic agents was significantly reduced in both hypnotised groups compared with their controls.
  • In the study of ‘The Effectiveness of Hypnosis Intervention in Alleviating Postpartum Psychological Symptoms’ by Zuhrah Beevi (2019), the group given hypnosis interventions at weeks 16, 20, 28 and 36 of their pregnancies showed that they had significantly lower postpartum anxiety and depressive symptoms than the control group.
  • McCarthy (1998) studied 600 women who had five 30-minute sessions with almost no postpartum depression diagnoses, compared to the rates of 10-15% within the general population, 50% for those with a history of the condition. 
  • VandeVusse (2007) reported statistical significance when studying 50 women who had taken part in 5 hypnosis sessions antenatally compared to 51 who had not. Higher Apgar scoring (neonatal wellbeing score) was seen at 1 minute postnatally in the hypnosis group along with significantly less use of analgesia and anaesthesia during labour.
  • Higher birth satisfaction, better emotional state (Fink, 2012) and better sleep patterns have also been reported in women who practised Hypnobirthing (Venn, 2008).
  • Fink et al (2012) concluded that hypnobirthing decreased maternal stress which itself aided with a more positive emotional state, improved pregnancy outcomes with fewer admissions to the hospital, fewer obstetric complications including caesarean births, and fewer postnatal complications, Fetal heart rate and fetal motor activity were improved and Higher-birth-weight and improved performance on the Neonatal Behavioral Assessment Scale.

My eldest daughter did hypnobirthing training and gave birth to both her boys at home (as she wanted) without any intervention or medication.  And her youngest son was born before the midwife even arrived!  She is a total advocate of self-hypnosis for childbirth.  As the clinical evidence shows using self-hypnosis, relaxation, visualisation and breathing methods help women to prepare both mind and body for birth and therefore reduce anxiety in respect of pregnancy, labour and postnatally.

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