Clinical report: the joint obstetric and psychiatric management of phobic anxiety disorders in pregnancy

Abstract

Women who struggle with distressing pregnancy-related phobic anxiety disorders are regularly encountered in maternity services, and their management poses particular challenges. Early identification is crucial in order to offer an opportunity to treat and manage their fears and enable a positive birth experience. In this article, women with different phobias (tokophobia, emetophobia and ante-cubital fossa phobia) describe their first pregnancy experience, and the ways in which the Chelsea and Westminster Hospital offered them joint maternity and psychiatric care. A multidisciplinary hospital-based approach can be effective in managing mental health problems in pregnancy. Despite maternal preconceptions and professional misgivings, this approach can work for women with phobias and enable a good birth experience and successful mother and infant bonding. The lead obstetrician for mental health and perinatal psychiatrist describe their roles in enabling successful outcomes for both the current and subsequent pregnancies. The case is made for training of maternity staff in both the identification of severe pregnancy phobias and the prompt referral for shared psychiatric and maternity care. Even if previous treatments have failed, adequate coping strategies for childbirth may be achieved in a short time frame. Long-term improvements in the phobia itself may also be found.

• Anxiety
• body-mind influences
• childbirth
• fear of childbirth
• perinatal mental health

Acknowledgements

This has been obtained from the patients who have contributed to this article. One patient author wishes to remain anonymous. Ethical approval has not been separately sought. All patients have signed patient consent forms.

Declaration of interest

The authors report no conflicts of interest.

Current knowledge on this subject

• Phobias and phobic anxiety disorders are very common.

• In pregnancy, phobic anxiety disorders can appear purely physical in nature, yet may have psychological causes, contributing factors or triggers.

• Secondary tokophobia may be associated with post-traumatic stress disorder, postnatal depression, bonding difficulties with the baby and avoidance of future pregnancies.

What this study adds

• A multidisciplinary hospital-based approach can be effective in managing severe phobic anxiety disorders in pregnancy, despite maternal preconceptions and professional misgivings, enabling a good birth experience and successful bonding between mother and infant.

• Training is needed of maternity staff to identify the range of severe phobic anxiety disorders in pregnancy and to understand the importance of referral for shared psychiatric and obstetric care.

• Even if previous treatments have failed, adequate coping strategies for childbirth may be achieved in a short time frame, in addition to unexpected long-term improvements in the phobia itself.