‘Who’s Afraid of the Big Bad Birth’: Childbirth Trauma, Fear and Tokophobia

  • Kathryn Gutteridge
  • Yana Richens


Women today have made many choices before even meeting with a midwife in their early pregnancy. When a midwife makes that contact it may already be evident that she is worried and certainly anxious about the changes that are happening to her body. How do these women approach pregnancy? What do they say? What kind of things are they worried about? What is it that midwives and doctors can be alerted to which may show that woman is vulnerable to stressful situations that may cause her more anxiety? The services that are currently being developed in response to these women will be discussed together with an overview of how women respond. What is this and how is it recognised and managed. This chapter uses the experiences of two consultant midwives who have developed care pathways to identify, support and treat such women. Both are based in the UK, one in London and the other in Birmingham serving a wide range of childbearing women.


Fearfulness Nightmares Dread and extreme behaviours 


  1. Ayers S (2004) Delivery as a traumatic event: prevalence, risk factors and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 47(3):552–567PubMedCrossRefGoogle Scholar
  2. Ayers S, Eagle A, Waring H (2006) The effects of postnatal PTSD on women and their relationships: a qualitative study. Psychol Health Med 11(4):389–398PubMedCrossRefGoogle Scholar
  3. Ballard C, Stanley K, Brockington I (1995) Post traumatic stress disorder after childbirth. Br J Psychiatry 166:525–528PubMedCrossRefGoogle Scholar
  4. Benedict M, Paine L, Paine LA, Brandt D, Stallings R (1999) The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes. Child Abuse Negl 23(7):659–670PubMedCrossRefGoogle Scholar
  5. Birth Trauma Association. Accessed 18 Mar 2019
  6. Bydlowski M, Raoul-Duval A (1978) Un avatar psychique meconnu de la puerperalite: la nevrose traumatique post-obstetricale [A psychological manifestation unknown within paediatrics: the post-traumatic obstetric neurosis]. Perpect Psychiat 4:321–328Google Scholar
  7. Charles J, Curtis L (1994) Birth afterthoughts: a listening and information service. Br J Midwifery 2(7):331–334CrossRefGoogle Scholar
  8. Coppen R (1995) Mothers, women, clients or patients: which term should midwives use? Br J Midwifery 3(10):518–519CrossRefGoogle Scholar
  9. Creedy D, Shochet I, Horsfall J (2000) Childbirth and the development of acute trauma symptoms. Birth 27(2):104–111PubMedCrossRefGoogle Scholar
  10. Crompton J (1996) Post-traumatic stress disorder and childbirth. Br J Midwifery 4(6):290–294CrossRefGoogle Scholar
  11. De Vries RG, Barroso R (1997) Midwives among the machines: recreating midwifery in the late twentieth century. In: Marland H, Rafferty AM (eds) Midwives, society and childbirth: debates and controversies, 1850–1995. Routledge, LondonGoogle Scholar
  12. Dekel S, Stuebe C, Dishy G (2017) Childbirth induced posttraumatic stress syndrome: a systematic review of prevalence and risk factors. Front Psychol 8:560PubMedPubMedCentralCrossRefGoogle Scholar
  13. Donnison J (1988) Midwives and medical men: a history of struggle for control of childbirth. Historical Publications, LondonGoogle Scholar
  14. Drauker CB (1995) Counselling survivors of childhood sexual abuse: counselling in practice. Sage, LondonGoogle Scholar
  15. Ekblad M (1961) The prognosis after sterilization on social-psychiatric grounds. A follow-up study on 225 women. Acta Psychiatr Scand 37:9–162Google Scholar
  16. Eriksson C, Jansson L, Hamberg K (2006) Women’s experiences of intense fear related to childbirth investigated in a Swedish qualitative study. Midwifery 22(3):240–248PubMedPubMedCentralCrossRefGoogle Scholar
  17. Fawdry R (1994) Midwives and the care of ‘normal’ childbirth. Br J Midwifery 2(7):302–303CrossRefGoogle Scholar
  18. Fenech G, Thomson G (2014) Tormented by ghosts from their past’: a meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being. Midwifery 30(2):185–193. Scholar
  19. Field T, Diego M, Hernandez-Reif M, Gil K, Vera Y (2005) Prenatal maternal cortisol, fetal activity and growth. Int J Neurosci 115:423–429PubMedCrossRefGoogle Scholar
  20. Geissbuehler V, Eberhard J (2002) Fear of childbirth during pregnancy: a study of more than 8000 pregnant women. J Psychosom Obstet Gynaecol 23(4):229–235PubMedPubMedCentralCrossRefGoogle Scholar
  21. Gonda B (1998) Postnatal depression or childbirth trauma? Psychother Aust 4(4):36Google Scholar
  22. Green J, Baston H (2003) Feeling in control during labour: concepts, correlates, and consequences. Birth 30:235–247PubMedCrossRefGoogle Scholar
  23. Green J, Coupland V, Kitsinger J (1990) Expectations, experiences, and psychological outcomes of childbirth: a prospective study of 825 women. Birth 17:15–24PubMedPubMedCentralCrossRefGoogle Scholar
  24. Gutteridge KEA (2000) Thesis: from me to mother—a phenemenological exploration of womens’ journey into motherhood influenced by feminist theory. MSc Counselling & Psychotherapy. University of Central England, BirminghamGoogle Scholar
  25. Gutteridge KEA (2002) From me to mother; a descriptive phenomenological exploration of women’s journey into motherhood, influenced by feminist theory. University of Central England. Masters of Science Psychotherapy, BirminghamGoogle Scholar
  26. Gutteridge KEA (2016) What impact does fearfulness of childbearing have upon parturient women? Unpublished ThesisGoogle Scholar
  27. Hofberg K, Ward MR (2003) Fear of pregnancy and childbirth. Postgrad Med J 79(935):505–510PubMedPubMedCentralCrossRefGoogle Scholar
  28. Hofberg K, Brockington I (2000) Tokophobia: an unreasoning dread of childbirth: a series of 26 cases. Br J Psychiatry 176:83–85PubMedPubMedCentralCrossRefGoogle Scholar
  29. Howard LM, Piot P, Stein A (2014) No health without perinatal mental health. Lancet 384(9956):1723–1724PubMedCrossRefGoogle Scholar
  30. Kendall-Tackett KA (2005) Depression in New Mothers: Causes, Consequences and Treatment Options. Haworth Press, BinghamtonGoogle Scholar
  31. Kendall-Tackett KA, Kaufman-Kantor G (1993) Postpartum depression- a comprehensive approach for nurses. Sage, Newbury ParkGoogle Scholar
  32. King CR (1992) The ideological and technological shaping of motherhood. Women Health 19(2/3):1–12PubMedCrossRefGoogle Scholar
  33. Kirkham M (1989) Midwives and information giving during labour. In: Robinson S, Thomson A (eds) Midwives research and childbirth, vol 1. Chapman and Hall, LondonGoogle Scholar
  34. Kitzinger S (1992) Birth and violence against women. In: Roberts H (ed) Womens health matters. Routledge, LondonGoogle Scholar
  35. Lewis L (2018) Fear of childbirth, mental health and delivery outcomes: a cohort study of women in an inner city maternity service. BSc dissertation. Kings College, LondonGoogle Scholar
  36. Melender H (2002) Fears and coping strategies associated with pregnancy and childbirth in Finland. J Midwifery Womens Health 47(4):256–263PubMedCrossRefGoogle Scholar
  37. Melender HL, Lauri S (1999) Fears associated with pregnancy and childbirth. Midwifery 15:177–182PubMedCrossRefGoogle Scholar
  38. Miller GA (1973) Communication, language and meaning. Basic Books, LondonGoogle Scholar
  39. Murphy P (1993) Birth trauma. Nurs Times 89(39):50–51PubMedGoogle Scholar
  40. National Institute of Clinical Excellence (2019) Caesarean section clinical guideline 132. Updated April 2019. Accessed 19 June 2019
  41. National Maternity Review (2016) BETTER BIRTHS, Improving outcomes of maternity services in England. [online]. Accessed 19 June 2019)
  42. Nerum H, Halvorsen L, Sørlie T, Øian P (2006) Maternal request for cesarean section: can it be changed through crises-oriented counseling? Birth 33:221–228PubMedCrossRefGoogle Scholar
  43. Olde E, van der Hart O, Kleber R, van Son M (2006) Posttraumatic stress following childbirth: a review. Clin Psychol Rev 26(2006):1–16PubMedCrossRefGoogle Scholar
  44. Orchbach S, Eichenbaum L (1995) From objects to subjects. Br J Pyschother 12(1):89–996CrossRefGoogle Scholar
  45. Penna L, Arulkumaran S (2003) Cesarean section for non-medical reasons. Int J Gynaecol Obstet 82:399–340PubMedCrossRefGoogle Scholar
  46. Powell A (1995) Class and ethnicity. Br J Midwifery 3(3):162–167CrossRefGoogle Scholar
  47. Raphael-Leff J (1990) Psychological processes of childbearing. Chapman and Hall, LondonGoogle Scholar
  48. Ribbens J (1994) Mothers and their children: a feminist sociology of childrearing. Sage, LondonGoogle Scholar
  49. Rose A (1992) Effects of childhood sexual abuse on childbirth: one woman’s story. Birth 19(44):214–218PubMedCrossRefGoogle Scholar
  50. Ryding EL (1993) Investigation of 33 women who demanded a caesarean section for personal reasons. Acta Obstet Gynecol Scand 72:280–285PubMedCrossRefGoogle Scholar
  51. Ryding EL, Wijma K, Wijma B (1998) Experiences of emergency cesarean section: a phenomenological study of 53 women. Birth 25(4):246–251PubMedCrossRefGoogle Scholar
  52. Ryding EL, Wirfelt E, Wangborg IB, Sjogren B, Edman G (2007) Personality and fear of childbirth. Acta Obstet Gynecol Scand 86(7):814–820PubMedCrossRefGoogle Scholar
  53. Saisto T, Halmesmäki E (2003) Fear of childbirth: a neglected dilemma. Acta Obstet Gynecol Scand 82(3):201–208CrossRefGoogle Scholar
  54. Saisto T, Salmela-Aro K, Nurmi J, Halmesmãki E (2001) Psychosocial characteristics of women and their partners fearing vaginal childbirth. Br J Obstet Gynaecol 108:492–498Google Scholar
  55. Save the Children (2013) Surviving the first day: state of the world’s mothers 2013. Save the Children, LondonGoogle Scholar
  56. Scott G, Niven C (1996) Pregnancy: a bio-psychosocial event. (cited in) conception, pregnancy and birth. Butterworth-Heinemann, OxfordGoogle Scholar
  57. Scott MJ, Stradling S (1995) Counselling and posttraumatic stress disorder. Sage, LondonGoogle Scholar
  58. Shirley KE, Mander R (1996) The power of language. Br J Midwifery 4(6):298–318CrossRefGoogle Scholar
  59. Silverton L (1993) The art and science of midwifery. Appleton and Lange publishers, New York ISBN 10:130467073 ISBN 13: 9780130467072Google Scholar
  60. Sjogren B (1997) Reasons for anxiety about childbirth in 100 pregnant women. J Psychosom Obstet Gynaecol 18(4):266–272PubMedCrossRefGoogle Scholar
  61. Sjorgen B, Thomassen P (1997) Obstetric outcome in 100 women with severe anxiety over childbirth. Acta Obstet Gynecol Scand 76:948–952CrossRefGoogle Scholar
  62. Slade P, MacPherson SA, Hume A, Maresh M (1993) Expectations, experiences and satisfaction with labour. Br J Clin Psychol 32:469–484PubMedCrossRefGoogle Scholar
  63. Smith A, Dixon A (2007) The safety of maternity services in England. King’s Fund, London NHS England (2016) Better BirthsGoogle Scholar
  64. Smith JA, Mitchell S (1996) Debriefing after childbirth: a tool for effective risk management. Br J Midwifery 4(11):581–586CrossRefGoogle Scholar
  65. Taylor M (2001) Thoughts on science, randomised controlled trials and midwifery knowledge. Midwifery Matters 91:3–8Google Scholar
  66. The Times. (2006) The trauma of childbirth Carol Midgley talks to Sheila Kitzinger, the author of a book asserting that many women are left psychologically scarred by the West’s conveyor-belt approach to having babiesGoogle Scholar
  67. Tsui MH, Pang MW, Melender H-L, Xu L, Lau TK, Leung TN (2007) Maternal fear associated with pregnancy and childbirth in Hong Kong Chinese women. Women Health 44(4):79–92. Scholar
  68. Turton P, Hughes P, Evans CDH, Fainman D (2001) Incidence, correlates and predictors of posttraumatic stress disorder in the pregnancy after still birth. Br J Psychiatry 178:556–560PubMedCrossRefGoogle Scholar
  69. van der Kolk BA (1994) The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiatry 1:253–265PubMedCrossRefGoogle Scholar
  70. Wagner M (2006) Born in the USA. University of California Press, BerkeleyGoogle Scholar
  71. Wagner M (2000) Choosing caesarean section. Lancet 356(9242):1677–1680. Scholar
  72. Wijma K (2003) Why focus on ‘fear of childbirth’? J Psychosom Obstet Gynaecol 24(3):141–143PubMedCrossRefGoogle Scholar
  73. Wiklund I, Edman G, Ryding E-L, Andolf E (2008) Expectation and experiences of childbirth in primiparae with caesarean section. Br J Obstet Gynaecol 115:324–331CrossRefGoogle Scholar
  74. Zar M, Wijma K, Wijma B (2001) Pre- and postpartum fear of childbirth in nulliparous and parous women. Scand J Behav Ther 30(2):75–84CrossRefGoogle Scholar
  75. Zar M, Wijma K, Wijma B (2002) Relations between anxiety disorders and fear of childbirth during late pregnancy. Clinical Psychol Psychother 9(2):122–130CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Kathryn Gutteridge
    • 1
  • Yana Richens
    • 2
  1. 1.Department of MaternitySandwell and West Birmingham Hospitals NHS TrustBirminghamUK
  2. 2.Department of MaternityMidwifery NHS EnglandLondonUK

Personalised recommendations