Childhood Trauma as a Risk Factor of Adult Fear of Birth and the Preference of a Caesarean Section

Background: Tokophobia (TP) is linked to negative affect, posttraumatic distress and the request for Caesarean Section. Prior trauma and some corresponding personality features, including typical of borderline personality, contribute to TP. With the conflictual object of this fear being a relational one, TP is amenable to psychodynamic heuristics. We investigate Childhood Trauma (CHT), emotional distress, dissociation and borderline personality organization (BPO) along with TP and the request for Caesarean Section in 153 pregnant women, based on the assumption that CS and TP represent the two sides of the same coin, and that their relationship would be rooted in correlates of trauma such as dissociation or BPO. Method: We used the WIJMA questionnaire, the dissociative experience scale, the childhood trauma screener, the IPO-16, and the BSI-18, as well as Kendall´s tau, linear regression and a mediation analysis. Result: The wish for CS was associated with TP and occurred in 6.3% of the sample. Correlations showed between TP and BPO, emotional distress and CHT. Linear regression revealed the prediction of TP by CHT, and the effect of CHT on the wish for CS was fully mediated by TP. Ambivalence regarding the preferred mode of birth coincided with the greatest emotional distress including TP. Dissociation did not contribute to TP. Discussion: CHT may be a cornerstone of the psychodynamics leading to the preference of CS over natural birth. TP mediates the respective effects on the wish for CS and may reproduce the ambivalence of childhood experiences of interpersonal adversity.