The Relationship Between Fear of Childbirth and Caesarean Section: A Critical Review

Abstract

Introduction: The increase in caesarean section rates for maternal requests has gained growing attention as a common clinical problem worldwide, with tokophobia—an intense fear of childbirth—playing a potentially critical role. Tokophobia can cause serious complications such as termination or avoidance of pregnancy altogether, in addition to the implications on maternal-infant attachment and maternal mental health. It is estimated that approximately one-fifth of pregnant women are affected. This study aims to assess if the literature suggests any association between fear of childbirth and giving birth by caesarean section delivery (elective or emergency) among multiparous and primiparous women. Methods: A critical literature review with a systematic approach using Preferred Reporting Items for Systematic Reviews (PRISMA) of EMBASE, MEDLINE, PsycINFO, and CINAHL databases were identified with peer-reviewed, qualitative studies published between January 2007 and December 2022. A quality appraisal was used to assess the quality of the studies. Results: A total of six articles were included in this critical literature review. Three themes were identified: 1) fear of childbirth and causes; 2) as a mode of birth, caesarean section; and 3) fear of childbirth associated with caesarean section. Conclusion: The findings of this review emphasised that the main reasons for maternal fear and anxiety related to birth are fear of damaging the mother and baby, a lack of confidence in the quality of maternity care, and personal commitment. These findings underscore the complexity of the decision-making process regarding the mode of childbirth and suggest a need for enhanced support and interventions to address childbirth fears, potentially reducing unnecessary C-sections. Further research is recommended to explore effective strategies to mitigate tokophobia and its impact on delivery method choice, aiming for better maternal and infant health outcomes.