There were ideas of hopelessness and worthlessness and also, feeling of guilt and suicidal ideation. Her mood was sad with reduced psychomotor activity and monotonous low volume speech. There were no disturbances in orientation or memory. On mental state examination, she was a tidy, cooperative lady of pyknic build. Her vitals, routine investigations, and physical examination were normal. There was no past or family history of mood disorder, schizophrenia, epilepsy, or drug dependence. Even after being counseled by relatives and two obstetricians, she could not get rid of the fear of pregnancy. She also started having less interaction with husband, parents, and other relatives. On stopping all sexual activity, she gradually developed sad mood, hopelessness, helplessness, worthlessness, difficulty in falling asleep, weeping spells, loss of appetite and suicidal ideation. When also informed that no contraceptive method is fully protective, she started avoiding sexual contact with husband. On hearing the dreaded complications like having a deformed fetus, change in body figure, eclampsia, caesarean, and even death, she developed excessive fear of pregnancy. She asked the physician about the complications of pregnancy. This started 2 years after marriage when she contacted a gynecologist for menstrual irregularity. Fears are more common and more intense in nulliparous than in parous women.Ī 43-year-old married housewife of high socioeconomic status presented to the psychiatry out-patient department with a 2 years history of morbid dread of pregnancy. However, 13% of non-gravid women report fear of childbirth sufficient to postpone or avoid pregnancy. About 20-78% of pregnant women report fears associated with the pregnancy and childbirth. Less commonly, prenatal depression may be present with tokophobia. However, it could also occur after an obstetrically normal delivery, miscarriage, stillbirth, or termination of pregnancy. Secondary tokophobia is defined as morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy. Some suffering women go for abortion, caesarean, or adoption. Generally pregnancy is avoided because of fear of labor. Although sexual relations may be normal, several different methods of contraceptive use to delay the pregnancy is often scrupulous. The dread of childbirth may start in adolescence or early adulthood. Primary tokophobia is morbid fear of childbirth in a woman, who has had no previous experience of pregnancy. It can be classified as primary or secondary. Tokophobia is a pathological fear of pregnancy and can lead to avoidance of childbirth. It is also known as “maieusiophobia” or “parturiphobia.” It was first described in literature by Knauer in 1897. However, when it becomes pathological dread, it is called tokophobia. Majority of women are able to cope up with fear and anxieties by self-help efforts, social support, and medical help. Instead of being a joyful experience, pregnancy may become a worrisome and fearful event in few patients and the fear may assume a pathological dimension and becomes a disorder worth recognition and treatment. Pregnancy is a major physical, psychological, and social event in every woman's life.
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