Tokophobia: Fear of Childbirth and Pregnancy

Tokophobia is the fear of pregnancy and childbirth. Women who have this phobia have a pathological fear of giving birth, and will often avoid becoming pregnant or giving birth altogether.

This fear may lead women to avoid becoming pregnant, even though they want to have children or to opt for a Caesarean section to avoid vaginal birth. Tokophobia may occur in women who have never given birth to a child, but it may also affect women who have had prior traumatic birth experiences.

Overview

Pregnancy and childbirth are major events in many women’s lives. While it can be a time of great joy, it can also be a source of stress and anxiety. Women often worry about the normal pain of childbirth and about the possibility of something going wrong. These are all normal concerns that almost all pregnant women experience to some degree.

The normal anxieties that accompany bringing a child into the world are often dealt with using medical help, education, social support, and self-help strategies. Sometimes, however, this fear can become pathological and so severe that women will avoid becoming pregnant or giving birth altogether.

Symptoms

Tokophobia is a type of specific phobia, which is an anxiety disorder in which people feel an irrational and unreasonable amount of fear about a specific object or situation.

Symptoms of tokophobia can include sleep disturbances, panic attacks, nightmares, and avoidance behaviors.

Other symptoms might include:

• Anxiety and depression
• Extreme fear of birth defects, stillbirth, or maternal death
• Feelings of dread at the thought of pregnancy and birth
• Insistence on a Caesarean section for their birth

Women may sometimes avoid any sexual activity out of fear of becoming pregnant. Those who do become pregnant may be more likely to request an elective c-section, feel greater trauma surrounding the birth, and may even have difficulty bonding with her baby.

This fear tends to center on concerns over labor and delivery, medical treatments, decision-making, finances, and parental capabilities.

Causes

Researchers have suggested a number of explanations to account for the development of tokophobia. Some of these including hearing about traumatizing accounts of childbirth experiences from other women, fear of inadequate pain management, and pre-existing psychiatric conditions such as anxiety and depression.

There are two different types of tokophobia:

Some factors that may contribute to the development of tokophobia can include:

• Fear for the life of the infant and/or a lack of trust in medical practitioners
• Fear of birth-related complications, such as preeclampsia and death
• Fear of pain
• Fear of the unknown, loss of control and privacy
• Having a history of anxiety, depression, or childhood sexual abuse 
• Hearing traumatic birth stories from friends or on social media
• Hormonal changes that make it harder to manage anxiety
• Psychosocial factors like getting pregnant at a young age, being impoverished, or lack of social support
• Uncertainty over the labor and birth process

Prevalence

It is completely normal to have fears and concerns about pregnancy and childbirth. Having a certain degree of fear can actually be beneficial in some ways since it prompts women to seek maternal care and advice in order to cope with these concerns.

While such worries are the norm, the majority of women are able to cope with these concerns by learning more about the labor and delivery process, talking to other women, and consulting with their pregnancy care providers.

In some instances, however, this fear can become so severe and debilitating that it may be diagnosed as tokophobia. It's unclear just how common tokophobia may be. Some research suggests that rates range somewhere between 2% and 15%, although there is evidence suggesting that as many as 20% to 25% of women may experience severe and debilitating symptoms of childbirth-related fears.

Further Research

In another study looking at prevalence rates, researchers estimated that only about 0.032% of women experience tokophobia. They note that there are important distinctions between fear of childbirth and tokophobia, although the two are often conflated. Fear of childbirth involves a continuum of fearful feelings and thoughts related to giving birth.

Differences in the estimates of prevalence rates for tokophobia may differ based upon how the condition was defined by researchers. Women with relatively moderate levels of fear might be lumped in with women experiencing severe anxiety, and some women may have been misdiagnosed.

Tokophobia vs. PTSD

An estimated 3% of women develop posttraumatic stress disorder (PTSD) following childbirth. This rate goes up among women in high-risk groups. Symptoms of PTSD following birth can include flashbacks, hypervigilance, and nightmares about the event.

Women are sometimes diagnosed with secondary tokophobia following traumatic childbirth when they actually have symptoms of PTSD. It is also not uncommon for postnatal PTSD or tokophobia to be misdiagnosed as postpartum depression. Distinguishing between these diagnoses is important in order to ensure appropriate and effective treatment.

Treatment

It is important that women with tokophobia receive treatment in order to ensure that both the mother and child are healthy. This can include receiving support from the woman's obstetrician in coordination with a psychologist or psychiatrist.

Maternal health care providers can offer reassurance, education, and appropriate health care so that women feel that their fears surrounding the birth process and adequately addressed.

Support

Finding sources of social support is important. For many, simply knowing that there are people who are there to help them can be comforting. Such support can strengthen women's sense of self-efficacy and even reduce the number of elective c-sections.

Effective support can occur one-on-one or through support groups. Such support is often provided by people that women already know, such as family member or friends, but it can also come from obstetricians, midwives, psychologists, or counselors.

Having a positive birth experience has also been shown to reduce the fear of childbirth. One study found that women who felt that they were in control of their bodies and were well-informed about the progress of labor were more likely to show a decrease or elimination of fear symptoms.

Many women seek out the guidance and support of other women who have already had experience with bearing children, often including mothers, sisters, family members, and friends. Research has shown that providing support to women with a severe fear of birth resulted in a 50% reduction in cesarean rates.

Therapy

Cognitive behavior therapy and psychotherapy can also be effective in the treatment of tokophobia. CBT can be a good choice due to its short-term duration and focus on specific symptoms.

One study looked at the effectiveness of internet-based cognitive behavioral therapy treatments in comparison to standard care. While the researchers found that both approaches led to reductions in fear, those in the CBT group showed a greater reduction in symptoms at one-year postpartum.

However, only a small number of women completed the CBT treatment modules, which the researchers suggested indicated low feasibility and acceptance of this treatment approach.

Medications

Medications may also be used either alone or in conjunction with other treatment approaches to treat underlying depression, anxiety, or other psychiatric disorders.

Coping With Tokophobia

If you feel that a significant fear of childbirth and pregnancy might be affecting your life, there are steps that you can take to get the help you need.

Discuss Your Feelings

Some anxiety is normal, and your doctor or midwife may be able to provide reassurance and further assistance. Talking to trusted friends or loved ones can also help. Knowing that there are people who understand your fears and are there to offer support can help reduce anxiety.

Begin Forming a Birth Plan

Talk to your doctor about your wants and needs, including your options for pain management and giving birth. Having a plan and choosing your method of delivery can help you feel more empowered and in control.

Avoid Childbirth “Horror Stories"

Hearing such stories can exacerbate your tokophobia. Instead, seek out good medical information and focus on positive experiences with childbirth. If people try to share stories that you do not want to hear, it is perfectly acceptable to ask them to stop.

Take a Prenatal Support Class

Learning about what happens during childbirth and what you can do to manage labor pain can help you feel more capable as your approach giving birth.

Talk to a Mental Health Professional

If your fear is interfering with your life, ask your doctor to refer you to a psychiatrist, psychologist, counselor, or another mental health provider who can offer further advice and assistance.

Keep in Mind

While tokophobia is rare, it can have a major impact on a woman’s life and functioning. People who have this severe fear of childbirth may avoid becoming pregnant even if they do want to have a child.

Proper support and treatment can address the fears that women may have surrounding pregnancy and childbirth, making it possible to manage symptoms and have a healthy pregnancy and positive birth experience. Be sure to talk to your doctor if you are concerned that you may have symptoms of tokophobia.