Skip to main content
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2003 Sep;79(935):505–510. doi: 10.1136/pmj.79.935.505

Fear of pregnancy and childbirth

K Hofberg 1, M Ward 1
PMCID: PMC1742837  PMID: 13679545

Abstract

Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known.

Full Text

The Full Text of this article is available as a PDF (132.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abraham S. F., Bendit N., Mason C., Mitchell H., O'Connor N., Ward J., Young S., Llewellyn-Jones D. The psychosexual histories of young women with bulimia. Aust N Z J Psychiatry. 1985 Mar;19(1):72–76. doi: 10.3109/00048678509158816. [DOI] [PubMed] [Google Scholar]
  2. Alehagen S., Wijma K., Wijma B. Fear during labor. Acta Obstet Gynecol Scand. 2001 Apr;80(4):315–320. doi: 10.1034/j.1600-0412.2001.080004315.x. [DOI] [PubMed] [Google Scholar]
  3. Areskog B., Kjessler B., Uddenberg N. Identification of women with significant fear of childbirth during late pregnancy. Gynecol Obstet Invest. 1982;13(2):98–107. doi: 10.1159/000299490. [DOI] [PubMed] [Google Scholar]
  4. Areskog B., Uddenberg N., Kjessler B. Experience of delivery in women with and without antenatal fear of childbirth. Gynecol Obstet Invest. 1983;16(1):1–12. doi: 10.1159/000299205. [DOI] [PubMed] [Google Scholar]
  5. Areskog B., Uddenberg N., Kjessler B. Fear of childbirth in late pregnancy. Gynecol Obstet Invest. 1981;12(5):262–266. doi: 10.1159/000299611. [DOI] [PubMed] [Google Scholar]
  6. Baker A. W., Duncan S. P. Child sexual abuse: a study of prevalence in Great Britain. Child Abuse Negl. 1985;9(4):457–467. doi: 10.1016/0145-2134(85)90054-7. [DOI] [PubMed] [Google Scholar]
  7. Ballard C. G., Stanley A. K., Brockington I. F. Post-traumatic stress disorder (PTSD) after childbirth. Br J Psychiatry. 1995 Apr;166(4):525–528. doi: 10.1192/bjp.166.4.525. [DOI] [PubMed] [Google Scholar]
  8. Bennett D. L., Bauman A. Adolescent mental health and risky sexual behaviour. Young people need health care that covers psychological, sexual, and social areas. BMJ. 2000 Jul 29;321(7256):251–252. doi: 10.1136/bmj.321.7256.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Benoit D., Parker K. C. Stability and transmission of attachment across three generations. Child Dev. 1994 Oct;65(5):1444–1456. doi: 10.1111/j.1467-8624.1994.tb00828.x. [DOI] [PubMed] [Google Scholar]
  10. Beumont P. J., Abraham S. F., Simson K. G. The psychosexual histories of adolescent girls and young women with anorexia nervosa. Psychol Med. 1981 Feb;11(1):131–140. doi: 10.1017/s0033291700053344. [DOI] [PubMed] [Google Scholar]
  11. Brinch M., Isager T., Tolstrup K. Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatr Scand. 1988 May;77(5):611–617. doi: 10.1111/j.1600-0447.1988.tb05175.x. [DOI] [PubMed] [Google Scholar]
  12. Bryer J. B., Nelson B. A., Miller J. B., Krol P. A. Childhood sexual and physical abuse as factors in adult psychiatric illness. Am J Psychiatry. 1987 Nov;144(11):1426–1430. doi: 10.1176/ajp.144.11.1426. [DOI] [PubMed] [Google Scholar]
  13. Bulik C. M., Sullivan P. F., Fear J. L., Pickering A., Dawn A., McCullin M. Fertility and reproduction in women with anorexia nervosa: a controlled study. J Clin Psychiatry. 1999 Feb;60(2):130–137. doi: 10.4088/jcp.v60n0212. [DOI] [PubMed] [Google Scholar]
  14. Crowe K., von Baeyer C. Predictors of a positive childbirth experience. Birth. 1989 Jun;16(2):59–63. doi: 10.1111/j.1523-536x.1989.tb00862.x. [DOI] [PubMed] [Google Scholar]
  15. Evans J., Heron J., Francomb H., Oke S., Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001 Aug 4;323(7307):257–260. doi: 10.1136/bmj.323.7307.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Fairburn C. G., Norman P. A., Welch S. L., O'Connor M. E., Doll H. A., Peveler R. C. A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Arch Gen Psychiatry. 1995 Apr;52(4):304–312. doi: 10.1001/archpsyc.1995.03950160054010. [DOI] [PubMed] [Google Scholar]
  17. Farquharson R. F., Hyland H. H. Anorexia nervosa: the course of 15 patients treated from 20 to 30 years previously. Can Med Assoc J. 1966 Feb 26;94(9):411–419. [PMC free article] [PubMed] [Google Scholar]
  18. Fava G. A., Grandi S., Michelacci L., Saviotti F., Conti S., Bovicelli L., Trombini G., Orlandi C. Hypochondriacal fears and beliefs in pregnancy. Acta Psychiatr Scand. 1990 Jul;82(1):70–72. doi: 10.1111/j.1600-0447.1990.tb01358.x. [DOI] [PubMed] [Google Scholar]
  19. Franko D. L., Blais M. A., Becker A. E., Delinsky S. S., Greenwood D. N., Flores A. T., Ekeblad E. R., Eddy K. T., Herzog D. B. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry. 2001 Sep;158(9):1461–1466. doi: 10.1176/appi.ajp.158.9.1461. [DOI] [PubMed] [Google Scholar]
  20. George D. T., Ladenheim J. A., Nutt D. J. Effect of pregnancy on panic attacks. Am J Psychiatry. 1987 Aug;144(8):1078–1079. doi: 10.1176/ajp.144.8.1078. [DOI] [PubMed] [Google Scholar]
  21. Goldbeck-Wood S. Post-traumatic stress disorder may follow childbirth. BMJ. 1996 Sep 28;313(7060):774–774. doi: 10.1136/bmj.313.7060.774. [DOI] [PubMed] [Google Scholar]
  22. Green J. M., Coupland V. A., Kitzinger J. V. Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth. 1990 Mar;17(1):15–24. doi: 10.1111/j.1523-536x.1990.tb00004.x. [DOI] [PubMed] [Google Scholar]
  23. Greer H. S., Lal S., Lewis S. C., Belsey E. M., Beard R. W. Psychosocial consequences of therapeutic abortion King's termination study III. Br J Psychiatry. 1976 Jan;128:74–79. doi: 10.1192/bjp.128.1.74. [DOI] [PubMed] [Google Scholar]
  24. Hall R. C., Beresford T. P., Quinones J. E. Grief following spontaneous abortion. Psychiatr Clin North Am. 1987 Sep;10(3):405–420. [PubMed] [Google Scholar]
  25. Hofberg K., Brockington I. Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Br J Psychiatry. 2000 Jan;176:83–85. doi: 10.1192/bjp.176.1.83. [DOI] [PubMed] [Google Scholar]
  26. Jenkins M. W., Pritchard M. H. Hypnosis: practical applications and theoretical considerations in normal labour. Br J Obstet Gynaecol. 1993 Mar;100(3):221–226. doi: 10.1111/j.1471-0528.1993.tb15234.x. [DOI] [PubMed] [Google Scholar]
  27. Kendler K. S., MacLean C., Neale M., Kessler R., Heath A., Eaves L. The genetic epidemiology of bulimia nervosa. Am J Psychiatry. 1991 Dec;148(12):1627–1637. doi: 10.1176/ajp.148.12.1627. [DOI] [PubMed] [Google Scholar]
  28. Kohmura H., Miyake A., Aono T., Tanizawa O. Recovery of reproductive function in patients with anorexia nervosa: a 10-year follow-up study. Eur J Obstet Gynecol Reprod Biol. 1986 Sep;22(5-6):293–296. doi: 10.1016/0028-2243(86)90117-6. [DOI] [PubMed] [Google Scholar]
  29. Kumar R., Robson K. M. A prospective study of emotional disorders in childbearing women. Br J Psychiatry. 1984 Jan;144:35–47. doi: 10.1192/bjp.144.1.35. [DOI] [PubMed] [Google Scholar]
  30. Lacey J. H., Smith G. Bulimia nervosa. The impact of pregnancy on mother and baby. Br J Psychiatry. 1987 Jun;150:777–781. doi: 10.1192/bjp.150.6.777. [DOI] [PubMed] [Google Scholar]
  31. Lindberg F. H., Distad L. J. Post-traumatic stress disorders in women who experienced childhood incest. Child Abuse Negl. 1985;9(3):329–334. doi: 10.1016/0145-2134(85)90028-6. [DOI] [PubMed] [Google Scholar]
  32. Lubin B., Gardener S. H., Roth A. Mood and somatic symptoms during pregnancy. Psychosom Med. 1975 Mar-Apr;37(2):136–146. doi: 10.1097/00006842-197503000-00004. [DOI] [PubMed] [Google Scholar]
  33. Lumley J., Austin M. P. What interventions may reduce postpartum depression. Curr Opin Obstet Gynecol. 2001 Dec;13(6):605–611. doi: 10.1097/00001703-200112000-00009. [DOI] [PubMed] [Google Scholar]
  34. Major B., Cozzarelli C., Cooper M. L., Zubek J., Richards C., Wilhite M., Gramzow R. H. Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 2000 Aug;57(8):777–784. doi: 10.1001/archpsyc.57.8.777. [DOI] [PubMed] [Google Scholar]
  35. Melender H. L., Lauri S. Fears associated with pregnancy and childbirth--experiences of women who have recently given birth. Midwifery. 1999 Sep;15(3):177–182. doi: 10.1016/s0266-6138(99)90062-1. [DOI] [PubMed] [Google Scholar]
  36. Miller J. F., Williamson E., Glue J., Gordon Y. B., Grudzinskas J. G., Sykes A. Fetal loss after implantation. A prospective study. Lancet. 1980 Sep 13;2(8194):554–556. doi: 10.1016/s0140-6736(80)91991-1. [DOI] [PubMed] [Google Scholar]
  37. Morgan C. D., Wiederman M. W., Pryor T. L. Sexual functioning and attitudes of eating-disordered women: a follow-up study. J Sex Marital Ther. 1995 Summer;21(2):67–77. doi: 10.1080/00926239508404386. [DOI] [PubMed] [Google Scholar]
  38. Morgan J. F. Eating disorders and reproduction. Aust N Z J Obstet Gynaecol. 1999 May;39(2):167–173. doi: 10.1111/j.1479-828x.1999.tb03364.x. [DOI] [PubMed] [Google Scholar]
  39. Morgan J. F., Lacey J. H., Sedgwick P. M. Impact of pregnancy on bulimia nervosa. Br J Psychiatry. 1999 Feb;174:135–140. doi: 10.1192/bjp.174.2.135. [DOI] [PubMed] [Google Scholar]
  40. Murray L., Sinclair D., Cooper P., Ducournau P., Turner P., Stein A. The socioemotional development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry. 1999 Nov;40(8):1259–1271. [PubMed] [Google Scholar]
  41. Oates M. R., Lee A. Depressed mood during pregnancy and after childbirth. Data do not support idea that depression is more common antenatally than postnatally. BMJ. 2001 Dec 8;323(7325):1367–1368. [PMC free article] [PubMed] [Google Scholar]
  42. Oppenheimer R., Howells K., Palmer R. L., Chaloner D. A. Adverse sexual experience in childhood and clinical eating disorders: a preliminary description. J Psychiatr Res. 1985;19(2-3):357–361. doi: 10.1016/0022-3956(85)90040-8. [DOI] [PubMed] [Google Scholar]
  43. Rachman S. The conditioning theory of fear-acquisition: a critical examination. Behav Res Ther. 1977;15(5):375–387. doi: 10.1016/0005-7967(77)90041-9. [DOI] [PubMed] [Google Scholar]
  44. Ramrakha S., Caspi A., Dickson N., Moffitt T. E., Paul C. Psychiatric disorders and risky sexual behaviour in young adulthood: cross sectional study in birth cohort. BMJ. 2000 Jul 29;321(7256):263–266. doi: 10.1136/bmj.321.7256.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Reardon David C., Cougle Jesse R. Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study. BMJ. 2002 Jan 19;324(7330):151–152. doi: 10.1136/bmj.324.7330.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Ryding E. L. Investigation of 33 women who demanded a cesarean section for personal reasons. Acta Obstet Gynecol Scand. 1993 May;72(4):280–285. doi: 10.3109/00016349309068038. [DOI] [PubMed] [Google Scholar]
  47. Ryding E. L., Wijma B., Wijma K. Posttraumatic stress reactions after emergency cesarean section. Acta Obstet Gynecol Scand. 1997 Oct;76(9):856–861. doi: 10.3109/00016349709024365. [DOI] [PubMed] [Google Scholar]
  48. Ryding E. L., Wijma K., Wijma B. Experiences of emergency cesarean section: A phenomenological study of 53 women. Birth. 1998 Dec;25(4):246–251. doi: 10.1046/j.1523-536x.1998.00246.x. [DOI] [PubMed] [Google Scholar]
  49. Ryding E. L., Wijma K., Wijma B. Psychological impact of emergency cesarean section in comparison with elective cesarean section, instrumental and normal vaginal delivery. J Psychosom Obstet Gynaecol. 1998 Sep;19(3):135–144. doi: 10.3109/01674829809025691. [DOI] [PubMed] [Google Scholar]
  50. Schneider L., Heard I., Bréart G., Henrion R. Maigreur maternelle et grossesse. Arch Fr Pediatr. 1979 Dec;36(10):1068–1074. [PubMed] [Google Scholar]
  51. Searle J. Fearing the worst--why do pregnant women feel 'at risk'? Aust N Z J Obstet Gynaecol. 1996 Aug;36(3):279–286. doi: 10.1111/j.1479-828x.1996.tb02711.x. [DOI] [PubMed] [Google Scholar]
  52. Simkin P. Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experiences. Birth. 1992 Jun;19(2):64–81. doi: 10.1111/j.1523-536x.1992.tb00382.x. [DOI] [PubMed] [Google Scholar]
  53. Sinclair D., Murray L. Effects of postnatal depression on children's adjustment to school. Teacher's reports. Br J Psychiatry. 1998 Jan;172:58–63. doi: 10.1192/bjp.172.1.58. [DOI] [PubMed] [Google Scholar]
  54. Sjögren B. Fear of childbirth and psychosomatic support. A follow up of 72 women. Acta Obstet Gynecol Scand. 1998 Sep;77(8):819–825. doi: 10.1080/j.1600-0412.1998.770807.x. [DOI] [PubMed] [Google Scholar]
  55. Sjögren B. Reasons for anxiety about childbirth in 100 pregnant women. J Psychosom Obstet Gynaecol. 1997 Dec;18(4):266–272. doi: 10.3109/01674829709080698. [DOI] [PubMed] [Google Scholar]
  56. Stewart D. E., Raskin J., Garfinkel P. E., MacDonald O. L., Robinson G. E. Anorexia nervosa, bulimia, and pregnancy. Am J Obstet Gynecol. 1987 Nov;157(5):1194–1198. doi: 10.1016/s0002-9378(87)80293-4. [DOI] [PubMed] [Google Scholar]
  57. Szeverényi P., Póka R., Hetey M., Török Z. Contents of childbirth-related fear among couples wishing the partner's presence at delivery. J Psychosom Obstet Gynaecol. 1998 Mar;19(1):38–43. doi: 10.3109/01674829809044219. [DOI] [PubMed] [Google Scholar]
  58. Teixeira J. M., Fisk N. M., Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ. 1999 Jan 16;318(7177):153–157. doi: 10.1136/bmj.318.7177.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Tuiten A., Panhuysen G., Everaerd W., Koppeschaar H., Krabbe P., Zelissen P. The paradoxical nature of sexuality in anorexia nervosa. J Sex Marital Ther. 1993 Winter;19(4):259–275. doi: 10.1080/00926239308404370. [DOI] [PubMed] [Google Scholar]
  60. Wallerstein J. S., Kurtz P., Bar-Din M. Psychosocial sequelae of therapeutic abortion in young unmarried women. Arch Gen Psychiatry. 1972 Dec;27(6):828–832. doi: 10.1001/archpsyc.1972.01750300090017. [DOI] [PubMed] [Google Scholar]
  61. Watson J. P., Elliott S. A., Rugg A. J., Brough D. I. Psychiatric disorder in pregnancy and the first postnatal year. Br J Psychiatry. 1984 May;144:453–462. doi: 10.1192/bjp.144.5.453. [DOI] [PubMed] [Google Scholar]
  62. Wijma K., Söderquist J., Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study. J Anxiety Disord. 1997 Nov-Dec;11(6):587–597. doi: 10.1016/s0887-6185(97)00041-8. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES