Tocophobic men can find hope in psychoprophylaxis

New research presented in a doctoral thesis from Karolinska Institutet shows that psychoprophylaxis can help men with tocophobia (fear of childbirth). The thesis, which is to be presented on 12 November, also shows that although psychoprophylaxis generally has no effect on the experience of childbirth for women or men, its actual use during delivery seems to reduce the risk of emergency C-section.

Seventy per cent of all maternity clinics in Sweden now offer practical preparatory childbirth training, which often involve psychoprophylaxis. Malin Bergstrom, doctoral student at the Department of Woman and Child Health at Karolinska Institutet has previously shown that there is no correlation between antenatal psychoprophylactic training and women's and men's experiences of the actual delivery, the use of epidurals or the labor process. Her present study, however, shows that psychoprophylaxis does have some benefit - for tocophobic men.

"These men make up a group that we have very scarce knowledge about, one that can actually benefit from psychoprophylaxis," says Ms Bergstrom. "This is important, as these men are easily neglected, and if they don't receive help the chances are that they won't tell anyone about their fears. Apart from the personal effect this has, it is also possible that this affects their relationship with the mother and child."

Men were categorized as tocophobic or not, by answering a questionnaire about their feelings in the middle of the term of pregnancy. The study applied the same instrument formerly used for tocophobic women, the content adapted to the men's circumstances. It contained 25 questions and statements about their feelings and thoughts ahead of delivery. Of the 762 respondents, 83 (approximately 11 per cent) were classified as tocophobic.

"This is a significant proportion of the men," says Ms Bergstrom. "Our study shows that these men also had a higher level of general anxiety during their partners' pregnancy, and lower self-confidence about becoming good parents."

Men suffering from tocophobia during pregnancy were more likely to find delivery more alarming than men without such a fear. However, parental training involving psychoprophylaxis had a positive impact on their experiences of childbirth.

"Through a program of structured drills and counselling, they learn what the woman needs during labour and how the men can help. They seem to feel more prepared for the delivery process and this presumably alleviates their fear and anxiety."

Her research also shows that one in three tocophobic men have a partner with a similar fear. A particularly vulnerable group, and they can, at worst, drag each other down, she means, stressing how important it is for modern parental courses to be offered to those most in need of them, which is currently not the case.

"Psychoprophylaxis is currently an incredibly popular part of parental training," she says. "However, our research has shown that it is of no benefit to the vast majority of expectant parents. On the contrary, in fact, as it risks reinforcing the pattern that already exists by not appealing to socially disadvantaged groups, since psychoprophylaxis is most popular amongst the better-off. But people have different needs, as my and other research shows. And it's a method that might prove well suited to fathers with a fear of childbirth."