TOKOPHOBIA (A SEVERE FEAR OF CHILDBIRTH AND BEING PREGNANT)

Tokophobia is an extreme fear of being pregnant and giving birth. While many women experience some anxieties about coping with pregnancy and the birth, tokophobia is when the fear becomes so severe that it dominates the woman’s life: this fear can affect their ability to cope with daily life and can lead to the woman not wanting to go through childbirth, no matter how much they want to have the baby.

Which women are more likely to experience tokophobia?

Up to 14% of women suffer from Tokophobia, which can be debilitating for those who do not receive the right support. Tokophobia is more common in women who have never given birth than in those who have, and they are more likely to have a severe form of the condition. This is called ‘primary tokophobia’. Tokophobia can also occur in women who have previously given birth. This is known as ‘secondary tokophobia’, and while it can occur after any birth, it is more common after a traumatic childbirth, miscarriage or stillbirth. Tokophobia is also more common in women who have previously had severe gynaecological problems or mental health problems such as anxiety disorder or depression, and in those who have experienced sexual abuse or rape.

Women whose female relatives are afraid of pregnancy and who have told them frightening stories about childbirth can also be affected by tokophobia. On the other hand, women with strong support networks from family, friends or colleagues are less likely to develop tokophobia and are more able to overcome it when it does occur.

Symptoms of tokophobia

Tokophobia in pregnancy can lead some women to seek a termination despite desperately wanting the baby. This can then lead to further mental health issues as they live with the impact of their decision. Other women may insist on a caesarean section, and even change Obstetrician to find one more willing to recommend the procedure. In pregnant women with tokophobia who enter labour, the severe anxiety can increase the risk of complications during the birth.

In women who are not pregnant, tokophobia may lead them to adopt a child rather than going through pregnancy. Alternatively, they may avoid becoming pregnant through obsessive use of contraception or, in severe cases, through permanent surgical sterilisation.

What should I do if I have tokophobia while I am pregnant?

If you have any fears or anxiety about your pregnancy and childbirth, tell your midwife or doctor as soon possible. They should refer you to a healthcare professional who is trained to provide mental health support for pregnant women. Psychological treatments such as psychotherapy and cognitive behavioural therapy can be useful in supporting women with tokophobia to manage and overcome their fears. m

If you are still fearful, you can talk to your midwife or doctor about having a caesarean section. They will discuss the risks and benefits of caesarean and vaginal births, and will support you to make your own decision.

There is increasing awareness of this condition amongst health professionals, and pathways of care and support are being developed to help identify women with these psychological needs. A leading example is the Perinatal Mental Health Liaison team of the Humber Teaching NHS Foundation Trust who, in collaboration with local clinicians, patients and the University of Hull, have developed evidence-based guidelines for Tokophobia/fear of birth. Not only that, but the team have recently secured additional funding to carry out further research to help practitioners (e.g., GPs and midwives) recognise and treat the fear of childbirth.  

Claire Marshall, Specialist Nurse and Clinical Lead for the team, says:

“Providing assessment of the woman’s fears, undertaking antenatal education, visiting the birthing environment and psychological interventions such as CBT (cognitive behavioural therapy) can be helpful interventions for a woman experiencing this condition. It is also helpful for the woman to have care provided from a health professional that she is familiar with and who can provide continuity of care throughout the pregnancy and into the postnatal period”.