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Letters to the Editors • Braz. J. Psychiatr. 43 (1) • Jan-Feb 2021 • https://doi.org/10.1590/1516-4446-2020-1252   copy

Tokophobia Assessment Questionnaire: a new instrument

Authorship SCIMAGO INSTITUTIONS RANKINGS

Tokophobia is a pathological fear or avoidance of childbirth, which has received little attention and has been often neglected.11. Aksoy AN, Aydin F, Kucur SK, Gözükara I. Maternal and fetal Doppler velocimetry in women diagnosed with fear of childbirth. Niger J Clin Pract. 2016;19:632-5. This condition negatively influences the pregnant woman’s life or the acceptance of her pregnancy; it leads to the extension of pregnancy duration or motivates requests for caesarean sections. After birth, tokophobia may also delay bonding between the mother and the newborn, leading to breastfeeding difficulties and increasing the risk of puerperal depression.22. Thomson G, Stoll K, Downe S, Hall WA. Negative impressions of childbirth in a North-West England student population. J Psychosom Obstet Gynaecol. 2017;38:37-44. Tokophobia is associated with intrauterine growth restriction, low birth weight, changes in fetal heartbeat, and prematurity, which are probably due to uterine artery dysfunction, a phenomenon that has been identified in pregnant women. However, the long-term effects on the child’s development have not yet been established.33. Hamama-Raz Y, Sommerfeld E, Ken-Dror D, Lacher R, Ben-Ezra M. The role of intra-personal and inter-personal factors in fear of childbirth: a preliminary study. Psychiatr Q. 2017;88:385-96.

Most surgeries are performed electively with no obstetric indication, using the phobia as an excuse. Due to the very peculiar characteristics of the judicialization of medicine, the convenience and financial accessibility of cesarean delivery, as well as the actual fear of childbirth, there has been a reduction in the incidence of vaginal birth, which has increased the cost of giving birth, as well as its complications.44. Smith V, Gallagher L, Carroll M, Hannon K, Begley C. Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: an overview of systematic reviews. PLoS One. 2019;14:e0224313.

The lack of instruments or scales developed or validated in Portuguese for the Brazilian cultural context, as well as the impossibility of objectively identifying and measuring tokophobia, make adequate therapeutic guidance difficult.

A systematic review and meta-analysis was performed of the risk factors. The perception of tokophobia was assessed among pregnant women and prenatal health care professionals to identify the peculiarities of tokophobia in the Brazilian socio-cultural and clinical-obstetric context. The conceptual and psychometric analysis process allowed the development and validation of the Tokophobia Assessment Questionnaire (Questionário de Avaliação da Partofobia) in Brazilian Portuguese, available from the authors upon request. This research project was approved by the Universidade do Sul de Santa Catarina research ethics committee (protocol 87312818.0.0000.5369).

The Tokophobia Assessment Questionnaire has been validated55. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. COSMIN checklist manual [Internet]. 2012 Jn [cited 2020 Jul 13]. http://fac.ksu.edu.sa/sites/default/files/cosmin_checklist_manual_v9.pdf
http://fac.ksu.edu.sa/sites/default/file... ; its reliability was measured with the Pearson correlation coefficient (0.766) and the intraclass correlation coefficient (0.856). Bland-Altman analysis showed a central tendency between the difference and mean of the two Tokophobia Assessment Questionnaire applications in almost the entire sample. The general Cronbach’s alpha was 0.935 (Table 1). The Kappa index was 0.444 and the Pearson correlation coefficient between the first application of the Tokophobia Assessment Questionnaire and the Depression, Anxiety and Stress Scale was 0.607. Exploratory factor analysis identified six factors categorized into conceptual groups: physical repercussions (factor 1); feeling of panic (factor 2); social involvement (factor 3); interference in daily habits (factor 4); pregnancy avoidance (factor 5); self-perception of tokophobia (factor 6) (Table 1). Use of the item response theory demonstrated the suitability of all items (Figure 1).

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Table 1
Distribution of the reliability analysis of the first application of the Tokophobia Assessment Questionnaire (Questionário de Avaliação da Partofobia), Universidade do Sul de Santa Catarina, Santa Catarina, Brazil, 2020 (n = 250)

Figure 1
Distribution curves for possible responses for all items of the Tokophobia Assessment Questionnaire (Questionário de Avaliação da Partofobia), according to item response theory, Universidade do Sul de Santa Catarina, Santa Catarina, Brazil, 2020 (n = 250).

Therefore, the 25-item Tokophobia Assessment Questionnaire is reliable and valid and is the first instrument for assessing the clinical, emotional and psychiatric manifestations of tokophobia. Although developed for the Brazilian population, the instrument may have worldwide applicability.

Acknowledgements

This study was partially funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES; financing code 001).

References

  • 1
    Aksoy AN, Aydin F, Kucur SK, Gözükara I. Maternal and fetal Doppler velocimetry in women diagnosed with fear of childbirth. Niger J Clin Pract. 2016;19:632-5.
  • 2
    Thomson G, Stoll K, Downe S, Hall WA. Negative impressions of childbirth in a North-West England student population. J Psychosom Obstet Gynaecol. 2017;38:37-44.
  • 3
    Hamama-Raz Y, Sommerfeld E, Ken-Dror D, Lacher R, Ben-Ezra M. The role of intra-personal and inter-personal factors in fear of childbirth: a preliminary study. Psychiatr Q. 2017;88:385-96.
  • 4
    Smith V, Gallagher L, Carroll M, Hannon K, Begley C. Antenatal and intrapartum interventions for reducing caesarean section, promoting vaginal birth, and reducing fear of childbirth: an overview of systematic reviews. PLoS One. 2019;14:e0224313.
  • 5
    Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. COSMIN checklist manual [Internet]. 2012 Jn [cited 2020 Jul 13]. http://fac.ksu.edu.sa/sites/default/files/cosmin_checklist_manual_v9.pdf
    » http://fac.ksu.edu.sa/sites/default/files/cosmin_checklist_manual_v9.pdf

Publication Dates

  • Publication in this collection
    07 Aug 2020
  • Date of issue
    Jan-Feb 2021

History

  • Received
    25 May 2020
  • Accepted
    3 July 2020
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