HNY Policy and Pathway Repository - Humber

The Fear of Birth/Tokophobia pathway will enable equitable support and treatment, as required, to women with Tokophobia / Severe FoC, as they engage with maternity services, during a pregnancy and in the postpartum period. This will potentially reduce poor psychological outcomes for the women, and improve outcomes for her baby and wider family, whilst ensuring that all services have robust and clear pathways and processes. The pathway will support health care providers in identifying need and securing the appropriate education, support or treatment for the woman. The pathway will also provide clarity for obstetricians and medical staff approached by women who are requesting an elective caesarean section due to fear of birth.

Perinatal Mental Health Care Pathway can be consulted in conjunction with this pathway.

Exclude Red Flag Symptoms

If the patient is requesting a caesarean section – at late stage of pregnancy:

• All women should be referred for support from the midwife and mental health team (if required) as soon as concerns about severe fear of birth are raised, which will enable time to offer the appropriate interventions and support to the woman. Dependent upon the severity of symptoms if referred late for a psychological intervention there may not be time prior to the childbirth to complete a psychological assessment and treatment.
• If women are referred after 35 weeks of pregnancy to the Specialist Perinatal Mental Health team there may not be time for them to be seen prior to the delivery.
• In the event of a late referral the responsible consultant should ensure that the women has a plan for the birth in her maternity records which has been agreed by the woman and the doctor
• The consultant should be able to determine with the help of specialist midwives that the woman is displaying symptoms of Tokophobia and will make late stage of pregnancy decisions about elective caesarean without a psychological assessment

Do Not Refer

• If a woman does not want additional psychological support regarding fear of birth.
• If a woman is already receiving psychological support/treatment determine with the woman and provider whether this support and treatment is adequate prior to making alternative referrals.

• Early interventions and advice is recommended.
• Follow a stepped care model
• Primary care services may direct women for additional support and information to their midwife or heath visitor.
• Additional support from Children's Centres
• Referral to Primary care psychological services such as Let's Talk. Cognitive Behavioural Interventions are particularly useful for anxiety/fear of birth.
• Referral to the Perinatal Mental Health Liaison Team via the Mental Health Response Service if symptoms are moderate to severe or if primary care level interventions have been unsuccessful.

• Pregnant women
• Fear of birth
• Liaise directly with midwifery team.
• If a caesarean section is being requested please liaise with obstetric team
• If mental health assessment/intervention is required referral to Primary care mental health provider via Let’s Talk or specific provider dependant on patients wishes. If involvement from the specialist perinatal mental health liaison team is needed refer via Mental Health Response Service

• Referral to Midwife – Email at direct.access@hey.nhs.uk
• Text on 07825 280822
• Call on 01482 605304 (weekdays only from 9.00am – 4.30pm)
• Referral to Lets Talk  (Hull) Call 01482 247 111
• Referral to Emotional Wellbeing Service (East Riding) 01482 344958
• Referral to Perinatal Mental Health Liaison Service  via Mental Health Response Service, tel. 01482 301701 or email hnf-tr.rapidresponseservice@nhs.net You can discuss a patient with the Perinatal  mental health Liaison Team by calling 01482 617735 between Monday and Friday 9-5

• Stage of pregnancy Expected delivery date.
• Specific concerns that the woman has about the birth. For example: pain management, risk of bladder/bowel problems, reoccurrence of previous complication.
• Previous pregnancies and any difficulties with childbirth
• Physical health issues eg, diabetes, epilepsy.
• Current medication
• Current mental health
• Previous mental health issues
• Risk issues such as suicidal thinking, self harm, aggression, thoughts of estrangement from the baby.

Fear of Childbirth/Tokophobia Pathway Guidance