Friday, October 10, 2014

Conquering Tocophobia with Haptotherapy

Tocophobia or severe fear of childbirth is rising in frequency.  More than 6% of women, and some men, experience tocophobia during pregnancy.  This leads to an increase in obstetric interventions including preterm birth, emergency cesarean section, or cesarean section at maternal request.  Severe postpartum fear of childbirth and trauma anxiety has also been reported.

Studies, primarily in Europe, over the past decade demonstrate an increase in evidence that Haptotherapy might be effective in reducing fear of childbirth in pregnancy women.  What is Haptotherapy and is there a way childbirth educators can incorporate aspects into their classes?

Haptonomy is a typical Dutch form of therapeutic assistance therapy discovered by Dutch physiotherapist Frans Veldman, and first used in oncology.  Haptotherapy is the field of application of Haptonomy.  Haptonomy is being in connection with someone in a non-judgmental way.  Practitioners work to establish an environment of acceptance and calm, peace and tranquility so that the client can let go and begin trusting their own inner wisdom.  It involves listening, accepting, sharing.  In some instances, touch relaxation or simply holding hands leads to the calming of the client and activating their inner resources. The goal is for the client to develop inner security, self-awareness and self-confidence.

The most recent Dutch study is examining a standard haptotherapeutical treatment for pregnant women (and their partners)  with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology.

Included are singleton pregnant women with severe fear of childbirth, age >= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction.

Sessions include a getting to know each other opportunity, awareness and presence in pregnancy, identification of cause of fear of childbirth,  desensitization of body anatomy as well as hospital procedures through education, practicing correct pushing techniques, working with contractions and dealing with labor pain, labor rehearsals, and finally introduction to birth of the placenta and first days postpartum.

Haptotherapy has dynamic similarities to childbirth education classes.  One might even call them “old school” childbirth education where educators had the time to take the time to listen to the clients and their partners and confront fears one by one.

They say you cannot go home again, but it looks like we are….with a different name.

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