The aims of the study were to uncover the major psychological factors underlying tokophobia, their impacts, and whether there is likely to be a role for psychological counselling to help women and their families. Nine women who indicated that they fear and avoid childbirth despite wanting a baby, volunteered and participated in a semi-structured interview. Six of these interviews were transcribed and analysed using the guidelines provided by Smith, Jarman & Osbourn (1999), from which tables of individual themes were created. For the participants, violation of expectations led to enduring distress, which manifests as symptoms of post-traumatic stress. ‘Loss of control’ and ‘loss of self’ are powerful themes that support existing literature. The theme ‘need of acknowledgment’ adds to the existing literature. As difficulties adapting to changes in lifestyle were expressed, a seven-phase transition model was suggested as a way of explaining and understanding difficulties faced by women with regard to changes in identity and lifestyle. It was concluded that the presentation of ‘secondary tokophobia’ does not fit with the term ‘phobia’. A reclassification of tokophobia was suggested for women who experience fear and avoidance of childbirth following a traumatic birth.

Aim: The overall aim of this study is to describe experiences of, and the association between, fear of childbirth and birth experiences of women with fear ofchildbirth. Methods: In studies I, II, and IV, a reflective lifeworld approach based on phenomenological philosophy was used to describe women’s experiences of fear of childbirth (I), previous birth experiences (II), and fear of childbirth and of birth experience in a long-term perspective (IV). In study III, differences between women who reported fear of childbirth and those who did not were calculated using risk ratios with a 95 % confidence interval and multivariate logistic regression analysis. Data were collected from interviews with eight (I) and nine (II) pregnant women with intense fear of childbirth, and with six women who had sought care for intense fear of childbirth 7 to 11 years prior to the interview (IV), and via questionnaire from a sample of 763 women during pregnancy and again one year following birth (III). Findings: Fear of childbirth was described as “to lose oneself as a woman into loneliness” (I). Previous birth experience was described as “a sense of not being present in the delivery room and an incomplete childbirth experience” (II). Fear of childbirth was associated with a previous negative birth experience and a previous emergency caesarean section (III). From a long-term perspective, fear of childbirth and birth experience was described as “an effort to make all the pieces come together” (IV). Conclusions: This thesis generates evidence on the importance of previous birth experience for women with fear of childbirth, from both qualitative and quantitative perspectives. These perspectives illustrate the complexity where women´s experiences in the delivery room are central. To avoid creating fear of childbirth, it is important that maternity care services focus on women’s birth experiences and critically evaluate care in relation to childbirth.

Cirka 3 % av kvinnor som fött barn uppfyller DSM-5 diagnostiska kriterier för PTSD, och minst en tredjedel uppger att de upplevt förlossningen som traumatisk. Prolonged exposure (PE) är en evidensbaserad traumafokuserad kognitiv beteendeterapi och en effektiv behandling för att reducera PTSD-symptom över en varierad traumatiserad population. Terapeutperspektivet gällande behandling av patienter med förlossningstrauma (PTSD-FC) är sällsynt i forskningen. Övergripande syfte var att belysa KBT-terapeuters perspektiv av att arbeta med behandlingsmetoden PE vid PTSD-FC med frågeställningar som; Vad kan vara utmärkande med att behandla patienter med PTSD-FC? Vilka kliniska erfarenheter har terapeuterna av att tillämpa PE-manualen med aktuell patientgrupp? Studien har en kvalitativ ansats. Semistrukturerade intervjuer har genomförts med åtta terapeuter. Bearbetning av data utgick från reflexiv tematisk analys. I resultatet genererades tre teman med subteman utifrån terapeuternas erfarenheter. ”Ett förlossningstrauma har vissa utmärkande drag”, ”Betydelsen av traumat”  samt ”PE-manualens möjligheter”. Terapeuterna ansåg att PE är en flexibel, hjälpsam och effektiv traumabehandling som fungerar väl med patientgruppen. Patienterna var vanligtvis motiverade och fullföljer terapin i hög grad. Tillgången till adekvat vård var god inom terapeuternas egna verksamheter medan en problematisk bild kom fram avseende andra vårdgivare. Utmaningar och möjligheter diskuteras angående det terapeutiska arbetet med patientgruppen. Kliniska implikationer som tas upp är till exempel behovet av ökade terapeutiska resurser inom kvinnosjukvården för adekvat bedömning och behandling vid PTSD-FC, där fördelen är samverkan mellan olika professioner. / Approximately 3% of women who have given birth, meet the DSM-5 diagnostic criteria for PTSD, and at least a third say they experienced childbirth as traumatic. Prolonged exposure (PE) is an evidence-based trauma-focused cognitive behavioral therapy and an effective treatment for reducing PTSD symptoms across a diverse traumatized population. The therapists’ perspective regarding the treatment of patients’ with postpartum trauma (PTSD-FC) is rare in research. The overall aim was to highlight CBT therapists' perspectives of working with the treatment method PE at PTSD-FC with questions such as; What may be distinctive about treating patients’ with PTSD-FC? What clinical experience do therapists’ have of applying the PE manual with the current patient group? The study has a qualitative approach. Semi-structured interviews have been conducted with eight therapists’. Processing of the data was based on reflexive thematic analysis. In the results, based on the therapists' experiences, three themes with subthemes were generated. “A postpartum trauma has some distinguishing features”, “The meaning of the trauma” and “The possibilities of the PE manual”. The therapists’ considered PE to be a flexible, helpful, and effective trauma treatment that works well with the patient group. The patients’ were usually motivated and completed the therapy to a high degree. Access to adequate care was good within the therapists' own settings, while a problematic picture emerged regarding other caregivers. Challenges and opportunities are discussed regarding the therapeutic work with the patient group. Clinical implications addressed are for example the need for increased therapeutic resources in women's healthcare for adequate assessment and treatment for PTSD-FC, where the advantage is collaboration between different professions. / <p>Linköpings universitet | Institutionen för beteendevetenskap och lärande Psykoterapeutexamensuppsats/magisteruppsats/uppsats på avancerad nivå, 15 hp | Psykoterapeutprogrammet (KBT) Höstterminen 2022 </p>

Este trabalho discute as vicissitudes da constituição do sujeito do desejo na clínica do bebê pré-termo, constituição agenciada pela articulação das funções materna e paterna que atualizam para um sujeito a estrutura da linguagem, isto é, que articulam o desejo à dimensão da falta. Na clínica do bebê pré-termo o investimento desejante que sustenta a aposta simbólica que preside a inscrição do infans no dizer e no desejo do Outro é posto à prova, pois os pais, primeiros representantes do Outro (simbólico) para o recém-nascido, são confrontados de maneira intempestiva com a dualidade da vida e da morte. A escuta dos pais durante a hospitalização de seus bebês numa unidade de tratamento intensivo neonatal revela que a construção do laço primordial entre pais e filhos sofre o impacto do discurso técnico-científico, pois o lugar e o saber dos pais são inicialmente deslocados pelo saber médico e sancionados como insuficientes para cuidar da criança. Os fragmentos das falas dos pais apresentados neste trabalho são analisados à luz dos ensinamentos da psicanálise. Essa análise mostra que a escuta dos pais humaniza esse nascimento, pois implica-os numa elaboração psíquica que atenua a angústia e o sentimento de desamparo que acompanha esses nascimentos, visto que o bebê pré-termo produz uma inquietante estranheza em seus pais. O apoio psíquico fornecido a eles favorece a retificação do olhar fundador em relação ao bebê, minimizando o impacto das separações precoces que ameaçam a construção dos laços de amor e de desejo entre pais e filhos, a qual sabemos ser uma prerrogativa da saúde psíquica. / This work discusses the vicissitudes of the constitution of the subject of the desire in the clinic of preterm babies, a constitution that is promoted by the articulation of the motherly and fatherly functions that update to a subject the structure of language, that is, that articulates the desire with the dimension of lack. In the preterm baby clinic, the desiring investment that sustains the symbolic anticipation that presides the inscription of the infans in the discourse and in the desire of the Other is challenged, since parents, the first representatives of the (symbolic) Other for the newborn, are confronted in an untimely way with the duality of life and death. The hearing of the parents during the hospitalization of their babies in an neonatal intensive-care unit reveals that the construction of the primordial bond between parents and children suffers the impact of the techno-scientific discourse, since the place and the knowledge of parents are initially displaced by the medical knowledge and sanctioned as being insufficient to take care of the child. The fragments of the testimonials of the parents presented in this work are analyzed at the light of the teachings of psychoanalysis. This analysis shows that the hearing of the parents humanizes this birth, because it involves them in a psychical elaboration that attenuates the anguish and the feeling of helplessness that follows these births, considering that the premature baby produces a disturbing strangeness in its parents. The psychic support offered to them favors the rectification of the founding gaze in relation to the baby, thus minimizing the impact of the precocious separations that threaten the construction of the bonds of love and desire between parents and children that we know as being a prerogative of the psychic health.

Este trabalho discute as vicissitudes da constituição do sujeito do desejo na clínica do bebê pré-termo, constituição agenciada pela articulação das funções materna e paterna que atualizam para um sujeito a estrutura da linguagem, isto é, que articulam o desejo à dimensão da falta. Na clínica do bebê pré-termo o investimento desejante que sustenta a aposta simbólica que preside a inscrição do infans no dizer e no desejo do Outro é posto à prova, pois os pais, primeiros representantes do Outro (simbólico) para o recém-nascido, são confrontados de maneira intempestiva com a dualidade da vida e da morte. A escuta dos pais durante a hospitalização de seus bebês numa unidade de tratamento intensivo neonatal revela que a construção do laço primordial entre pais e filhos sofre o impacto do discurso técnico-científico, pois o lugar e o saber dos pais são inicialmente deslocados pelo saber médico e sancionados como insuficientes para cuidar da criança. Os fragmentos das falas dos pais apresentados neste trabalho são analisados à luz dos ensinamentos da psicanálise. Essa análise mostra que a escuta dos pais humaniza esse nascimento, pois implica-os numa elaboração psíquica que atenua a angústia e o sentimento de desamparo que acompanha esses nascimentos, visto que o bebê pré-termo produz uma inquietante estranheza em seus pais. O apoio psíquico fornecido a eles favorece a retificação do olhar fundador em relação ao bebê, minimizando o impacto das separações precoces que ameaçam a construção dos laços de amor e de desejo entre pais e filhos, a qual sabemos ser uma prerrogativa da saúde psíquica. / This work discusses the vicissitudes of the constitution of the subject of the desire in the clinic of preterm babies, a constitution that is promoted by the articulation of the motherly and fatherly functions that update to a subject the structure of language, that is, that articulates the desire with the dimension of lack. In the preterm baby clinic, the desiring investment that sustains the symbolic anticipation that presides the inscription of the infans in the discourse and in the desire of the Other is challenged, since parents, the first representatives of the (symbolic) Other for the newborn, are confronted in an untimely way with the duality of life and death. The hearing of the parents during the hospitalization of their babies in an neonatal intensive-care unit reveals that the construction of the primordial bond between parents and children suffers the impact of the techno-scientific discourse, since the place and the knowledge of parents are initially displaced by the medical knowledge and sanctioned as being insufficient to take care of the child. The fragments of the testimonials of the parents presented in this work are analyzed at the light of the teachings of psychoanalysis. This analysis shows that the hearing of the parents humanizes this birth, because it involves them in a psychical elaboration that attenuates the anguish and the feeling of helplessness that follows these births, considering that the premature baby produces a disturbing strangeness in its parents. The psychic support offered to them favors the rectification of the founding gaze in relation to the baby, thus minimizing the impact of the precocious separations that threaten the construction of the bonds of love and desire between parents and children that we know as being a prerogative of the psychic health.

Background Up to 34% of perinatal individuals experience childbirth as traumatic. These individuals are at increased risk for developing depression, anxiety, and posttraumatic stress disorder (PTSD) after the traumatic event. The objective of this study was to elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period after a traumatic delivery. Methods Individuals who delivered within the last three years and perceived their birth experience to be traumatic (n=32) completed an hour-long semi-structured phone interview. The interview included screening for PTSD, depression, and anxiety with validated instruments including the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), the Patient Health Questionnaire depression scale (PHQ-8), and the Generalized Anxiety Disorder scale (GAD-7), respectively. Qualitative data was analyzed using a modified grounded theory characterizing participants’ barriers and recommendations for mental health support after traumatic births. Results Among participants, 34.4% screened positive for PTSD, 18.8% screened positive for major depressive disorder, and 34.4% screened positive for anxiety. Qualitative themes revealed multi-level barriers involving lack of communication, education, and resources which prevented obstetric professionals from recognizing and supporting patients’ mental health needs after a traumatic birth. Recommendations from participants included that 1) obstetric professionals should acknowledge trauma experienced by any individual after childbirth, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support is needed before the ambulatory postpartum visit. Conclusions There are multi-level barriers toward detecting and responding to individuals’ mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively follow-up and assess mental health care in the postpartum period.

People's inability to cope with the demands of modern life, has led to a significant increase in the incidence of anxiety being experienced by people from all walks of life. People are suffering from anxiety without knowing the root cause of it and it was found from the anxiety cases studied that its origin can in many cases be traced to the birth experience where specific negative suggestions were imprinted on the subconscious. In this study the influence of the birth experience as the underlying cause of anxiety and the effect of it on the formation of the self-concept and self-actualisation have been explored. The research shows that a subconscious origin exists in the development of anxiety. In the research for this study, Medical Hypnoanalysis, which is based on a process of diagnosis and therapy, was used as therapeutic method with several clients suffering from anxiety symptoms. In this research the perceptions formed in the subconscious during the birth experience were examined and related to the anxiety experienced during childhood and later life. The case studies, their diagnoses and the follow-up therapeutic sessions relating to the birth experience were investigated and discussed. Educational Psychologists show a specific interest in and a tendency to get involved with, or implement Medical Hypnoanalysis in therapy. It became obvious from this study that Medical Hypnoanalysis supplements the needs of the Educational Psychologist as a tool in therapy. In this study guide lines have been presented to the Educational Psychologist for the treatment of anxiety originating from the birth trauma by regressing the client back to this traumatic experience. Suggestions on how to conduct the birth regression sessions have also been presented and clarified. Through the case studies the identification and removal of the highly charged emotional and negative beliefs that were responsible for the anxiety symptom have been demonstrated. The case studies have furthermore demonstrated the successful utilisation of positive and healing suggestions to achieve the therapeutic goals. The results of this study show that Medical Hypnoanalysis can be used effectively in the treatment of the root causes of anxiety. / Psychology of Education / D. Ed. (Psychology of Education)

People's inability to cope with the demands of modern life, has led to a significant increase in the incidence of anxiety being experienced by people from all walks of life. People are suffering from anxiety without knowing the root cause of it and it was found from the anxiety cases studied that its origin can in many cases be traced to the birth experience where specific negative suggestions were imprinted on the subconscious. In this study the influence of the birth experience as the underlying cause of anxiety and the effect of it on the formation of the self-concept and self-actualisation have been explored. The research shows that a subconscious origin exists in the development of anxiety. In the research for this study, Medical Hypnoanalysis, which is based on a process of diagnosis and therapy, was used as therapeutic method with several clients suffering from anxiety symptoms. In this research the perceptions formed in the subconscious during the birth experience were examined and related to the anxiety experienced during childhood and later life. The case studies, their diagnoses and the follow-up therapeutic sessions relating to the birth experience were investigated and discussed. Educational Psychologists show a specific interest in and a tendency to get involved with, or implement Medical Hypnoanalysis in therapy. It became obvious from this study that Medical Hypnoanalysis supplements the needs of the Educational Psychologist as a tool in therapy. In this study guide lines have been presented to the Educational Psychologist for the treatment of anxiety originating from the birth trauma by regressing the client back to this traumatic experience. Suggestions on how to conduct the birth regression sessions have also been presented and clarified. Through the case studies the identification and removal of the highly charged emotional and negative beliefs that were responsible for the anxiety symptom have been demonstrated. The case studies have furthermore demonstrated the successful utilisation of positive and healing suggestions to achieve the therapeutic goals. The results of this study show that Medical Hypnoanalysis can be used effectively in the treatment of the root causes of anxiety. / Psychology of Education / D. Ed. (Psychology of Education)

Objective: Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes. Methods: In the prospective-longitudinal Maternal in Relation to Infants’ Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations. Results: A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birthrelated traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems. Conclusion: Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted. Implications: Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

This thesis addresses the role of the birth complex in Friedrich Nietzsche’s philosophy and in Richard Wagner’s operas. I see the birth complex as characterised by a dialectical relation between flesh and light, which is itself polarised by the tension between desire and anxiety. A structural determinant of the human relation to the world, this complex in my argument is of special importance for understanding the roles given to and assumed by women. Wagner gave the birth complex its first comprehensive elaboration through his operas. This, I contend, is the aspect of Wagner’s work that Nietzsche in his writings particularly reacted to through the ambivalent fascination it awakened in him. I argue that, even after Nietzsche’s break from Wagner, the birth complex remains central in his philosophy. The primary reference I build on here is Otto Rank’s theory of birth trauma, as set out in Das Trauma der Geburt (1924). To me, Rank’s theorisation of the trauma of birth is a translation into psychoanalytic language of Nietzsche’s philosophy, which itself arose with a translation into philosophical language of Wagner’s operas. In this thesis I build especially on Rank’s formulation of the tension between desire and anxiety and on his suggestions concerning the causes of the undoing of women. However, Rank did not take into account what I contend is a key aspect of both Nietzsche’s and Wagner’s work: the role of light in its dialectical relation with the flesh. By flesh I mean the interiority of the mother’s body and, by extension, the human body insofar as it is conceived through its relation to the maternal body. In the first main section of my PhD, I propose a theoretical understanding of the birth complex through an analysis of Nietzsche’s philosophy. I start with his writings pro and contra Wagner, showing that what Nietzsche primarily sees in Wagner’s operas is the birth complex. I then go on to argue that Nietzsche’s philosophy of life and of creativity is an exploration of the ways in which birth could be overcome. The second main section of my PhD is dedicated to Wagner, with largely text-based readings of three operas. I first discuss the extent to which death in Der fliegende Holländer and in the Freudian conception of the death drive is a mask for birth. I then tackle Tristan und Isolde and its famous celebration of night and death, in order to investigate whether love can be reduced to the birth complex. The last chapter of this section presents a close analysis of Das Rheingold and especially of its first scene and of Wagner’s indications on lighting. In a third and shorter section, I show that Hugo von Hofmannsthal’s and Richard Strauss’s Elektra pursued and reviewed this fundamental preoccupation of Nietzsche’s and Wagner’s work in proposing a further formulation of the birth complex that incorporates the scene of matricide. Finally, as a coda to the thesis, I explore the extent to which the uses of stage lighting pioneered by Adolphe Appia have been coming to terms with the birth complex.