Tokophobia is defined by extreme fear that childbirth will be painful or result in harm to the woman or baby, and is considered a psychological risk factor for negative perinatal outcomes. Where structural issues for healthcare provision and deep-rooted cultural influences are present, like Najaf City, Iraq, the relationship between maternal psychological distress and obstetric decision making is largely unknown.
Objectives: To assess the effect of child birth anxiety on the mode of giving birth (spontaneous vaginal delivery or elective cesarean delivery) and place of receiving health care services (public or private sector) among women of reproductive age in Najaf City.
Methods: This study was a community-based cross-sectional study with purposive sampling of 419 reproductive age women (15-45 years). Structured electronic questionnaire was used for assessing sociodemographic characteristics, obstetric history, fear level (1–5) and psychological triggers and choices of health care facilities. Pearson's chi square (χ²) test was used to test for associations and statistical significance was achieved at p < 0.05.
Results: There were 419 participants, 250 (59.7%) of whom had a high level of fear of childbirth (scores 4–5). The high fear group had a significantly higher elective cesarean section preference (69.6% vs. 46.2%, χ² = 22.185, p = 2.51 × 10⁻⁶). There was also a significant relationship between high fear and preference for the private-sector facilities (79.2% vs. 66.9%; χ² = 8.051, p = 0.018). The most common psychological triggers were severe labor pain (n = 95) and fear of episiotomy or perineal tearing (n = 41). There was no significant difference in fear of childbirth between the primiparas and multiparas (62.7% and 58.0%, respectively; p = 0.406), indicating that it is universal irrespective of parity.
Conclusion: In Najaf City, psychological factors are one of the most important reasons for the increase in elective cesarean rate and preference for private obstetric care. These findings suggest that psychological screening should be made part of standard antenatal care, there should be more pain management facilities (including epidural analgesia) in public hospitals and structured perinatal education programmes should be implemented.