“There’s so much I didn’t know about childbirth and, the more I learn, the more anxious I get about all of the things that could go wrong,” a client recently told me. She was researching strategies and skills to help her through labor and delivery as her due date approached. Her anxieties about childbirth aren’t unusual, especially if it is a woman’s first pregnancy or she has had a traumatic birth experience. However, for some women, the fear of childbirth goes beyond this typical stress and anxiety, causing the debilitating, pathological fear of pregnancy and childbirth known as tokophobia.
What is tokophobia, and how does it differ from typical anxieties about pregnancy and childbirth?
Having some level of anxiety about pregnancy and childbirth is perfectly normal. In fact, about 80% of women report feeling worried or fearful about their pregnancy or upcoming labor and delivery experience. In other words, the woman who feels completely at peace with the whole experience is rare, indeed! After all, your body goes through some significant (and amazing) changes during pregnancy, and childbirth can be a tough and painful, yet empowering experience. It is understandable that many women experience some apprehension over the intensity and unknown aspects of this intense, life-changing event.
But if pregnancy fear becomes all-encompassing or debilitating, it can become what is known as tokophobia. A clinical diagnosis of tokophobia is described as a “pathological fear of pregnancy and can lead to avoidance of childbirth,” Although relatively uncommon, tokophobia affects an estimated 5-15% of women.
This phobia differs from the less intense pregnancy fears many women experience because it can lead to a strong desire to avoid pregnancy altogether. Tokophobia can cause strong physical and emotional distress, such as having a physical reaction to a pregnancy and to childbirth-related stimuli (e.g., seeing a pregnant woman or watching a video on childbirth).
It is estimated that 9-11% of women who experience tokophobia have delayed pregnancy or considered terminating a pregnancy because of their fears. In some cases, tokophobia can lead to an obsessive focus on using hormonal birth control or avoiding sexual activity altogether, in an effort to avoid any possibility of becoming pregnant. Other women with tokophobia have reported opting for a Caesarean section to help mitigate their fears of delivery. In all of these cases, tokophobia contributes to women having an intense fear of pregnancy and childbirth that affects their ability to function on a daily basis.
Primary vs. secondary tokophobia
Tokophobia has two classifications: primary or secondary. Primary tokophobia refers to a woman who hasn’t experienced pregnancy or childbirth but has a strong fear of both. Secondary tokophobia refers to a woman who has developed this fear after a traumatic birthing experience. Tokophobia is often stronger and more prevalent in women who have not given birth before.
Where do these fears come from?
There are several hypotheses for the origins of tokophobia, including:
- Hormonal changes during pregnancy that can make it more challenging to manage one’s anxiety
- Hearing traumatic birth stories from family or friends
- Fear of loss of control during the pregnancy and birth process
- Fear of inability to handle/manage pain during the pregnancy and birth process
- Age (especially being younger)
- Socioeconomic status (not having access to needed resources)
- Psychological factors such as low self-esteem, past trauma, or a pre-existing mental health condition
What can be done about tokophobia?
Fortunately, there are research-backed ways to treat this debilitating phobia and equip women to have the family and birth experience they desire. Find family and friends who are very supportive of childbirth. Research has found that strong and positive support from family and friends plays an important role in reducing psychological distress surrounding pregnancy and childbirth. In fact, a positive support network is so significant that one study found that having such support resulted in a 50% reduction of Caesarean sections.
In addition to surrounding yourself with family and friends who are positive and supportive of childbirth, you can consider talking with a doula. Doulas are childbirth support people who can accompany you in the hospital or wherever you plan to give birth, to help you advocate for your needs and make the experience more comfortable. Doulas believe childbirth is beautiful and aspire to help women feel in tune with their bodies during the powerful experience. While they have a philosophy supportive of natural childbirth, they can also be supportive and helpful even if you choose to go a different path.
Cognitive behavioral therapy and other forms of psychotherapy may be helpful, as well as medication for managing anxiety, depression, and other mental health issues that could be present in some cases. In addition, learning a fertility awareness method (FAM) and working with a FAM instructor and/or a therapist can help empower you to learn about your cycle, your fertility, and your body, all of which can help equip you to handle whatever you experience in pregnancy and childbirth.
If you’ve dreamed of having children but are experiencing intense fears that are preventing you from achieving pregnancy, don’t be afraid to reach out to your OB-GYN, midwife or doula, FAM instructor, or a therapist to help you implement some of these treatment strategies. While it may require some hard work and commitment on your end, it is possible for you to overcome tokophobia with the right kind of help.
Additional Reading:
Pregnancy Fears and What to Do About Them
Who’s Afraid of Fertility Awareness? How to Tackle Your Fears about Using a FAM
The Powerful Link Between Fertility Awareness and Mental Health
Having worked 25 years in the field of after-abortion recovery and healing, I would simply add that one particular past trauma which can lead to fear of pregnancy is the experience of having suffered induced or spontaneous abortion. In my experience (and that of many colleagues involved in similar trauma recovery work around that U.S. and abroad), it’s not at all uncommon that women (and couples) become terrified of conceiving again. This past trauma can precisely rear its head when a woman or couple is faced with “planning” parenthood. Working through abortion trauma can be extremely liberating and can help these women and couples open up to the prospect of pregnancy and motherhood/fatherhood in a more hope-filled way.