Tokophobia,the Fear of Childbirth,and the Decision to Breastfeed

Dear Editor:

About 6–10% of pregnant women experience “fear of childbirth” (FOC), also called tokophobia, ¹ and this can cause a range of complications for both the mother (postnatal depression, ² posttraumatic stress disorder ³ ) and the infant (prolonged labor, dystocia, fetal distress, and hypoxia). ⁴ Many factors are related to this fear, but there is no study in the literature about the effects on breastfeeding. Herein, we discussed a mother with FOC who refused to breastfeed her baby.

Our case was a healthy 37-year-old high school teacher. She was nulliparous and did not want to have children during her 12-year marriage because of FOC. During this time her husband and social environment encouraged her about giving birth, but she was not persuaded until she finally decided to have a child when her husband stated that her doctor and social environment would overcome her fear. During pregnancy no complications developed. The mother was regularly monitored by a gynecologist, and fetal ultrasounds were normal. At the same time, she stated that she was happy to be pregnant and to be a parent. She preferred cesarean section and delivered a 3,400-g male infant at Week 38^4/7 of gestation without any complication.

However, after the birth she refused to breastfeed her baby, arguing that the baby was asked for by her husband and not by herself, and therefore she would not take care of him. She thought that those who had persuaded her about childbearing should take the responsibility. The mother was informed about the importance of breastfeeding by a pediatrician in the first 2 days and on home visits during the first week and was supported in terms of methods and ease of breastfeeding. At the same time psychiatric evaluation did not identify postpartum depression or anxiety disorder.

Social support could not prevent cesarean delivery in our case, but it had reduced FOC to allow pregnancy and related complications for both mother and infant. However, as education about breastfeeding was not given during the pregnancy but in the late period after birth, it was not helpful in convincing the mother to breastfeed.

Social support appears not to be sufficient on this topic, and programs to emphasize the importance of breastfeeding for health of both mother and child during pregnancy might have prevented rejection of breastfeeding. In the literature there is no study found on the breastfeeding rates for children born to women with FOC. In our case we thought that the refusal of breastfeeding may be related to FOC. We believe prospective studies are required to explain this topic and the relationships involved.