What Is Tokophobia?

Understanding the Fear of Childbirth

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What Is Tokophobia?

Tokophobia

The extreme fear of giving birth. This isn’t run-of-the-mill anxiety or reluctance over the thought of delivering a baby, which is generally normal. Like a paralyzing fear of heights or spiders, fear of childbirth diagnosed as tokophobia is severe enough to interfere with your quality of life.

In some cases, tokophobia may also result in a fear of pregnancy as well, or cause sufferers to avoid becoming pregnant (even if they would like to have children).

A 2012 case report of tokophobia published in the Industrial Psychiatry Journal estimates that as many as 13% of non-pregnant women report having a strong enough fear of childbirth to avoid becoming pregnant.

Types

There are two different types of tokophobia: primary and secondary.

  1. Primary tokophobia: Occurs if you have never given birth before but have tokophobia
  2. Secondary tokophobia: When you have given birth before and your fear stems from your prior experience

Symptoms

Although an intense, psychological fear of childbirth is the biggest characteristic of tokophobia, it isn’t the only one.

Many of the symptoms overlap with depressive disorders and generalized anxiety disorders, and they can interfere with several aspects of your life, from sleep to diet to overall mood.

Common symptoms of tokophobia include:

  • Panic attacks or increase in anxiety symptoms such as fatigue, irrational worry, or headaches
  • Mood swings
  • Symptoms of depression, such as fatigue, body pain, decreased appetite or libido, or loss of interest in favorite activities
  • Insomnia or nightmares
  • Avoidance of intercourse
  • Going to great lengths to avoid getting pregnant (such as doubling or tripling birth control methods)
  • Fixation on what could “go wrong” during childbirth, such as maternal or child death or appearance of birth defects
  • Delaying or avoiding pregnancy even though you want to have children
  • Requesting a cesarean delivery (c-section) without medical reasons

Diagnosis 

Like any other psychological condition, including phobias, tokophobia is diagnosed by a qualified mental health professional, like a psychologist, psychiatrist, or licensed clinical social worker.

In some cases, your primary care provider or even your OB/GYN may be able to make the diagnosis based on your reported symptoms.

Causes

There isn’t always a clear or obvious reason for why someone has developed tokophobia. It can be the result of an accumulation of thoughts, fears, experiences, and preconceived notions about childbirth that develop over the course of a woman’s life. 

However, there are some factors that have been associated with an increased risk of tokophobia.

Medical Fears

Women with primary tokophobia may have larger fears about the medical field in general, including fears of doctors, fears of hospitals, fears about pain or losing control, and fears about undergoing medical procedures. 

They may also have been victims of medical malpractice or mistreatment by healthcare professionals, and lack trust in the competence of medical professionals.

They may also have a higher-than-average knowledge of the potential for childbirth risks and complications.

Traumatic Personal History

Fears around childbirth may stem from traumatic sexual experiences in the past, whether they occurred during childhood or adulthood.

Traumatic Birth Experiences

If you have secondary tokophobia, i.e. you’ve given birth before, your fears may be similar to post-traumatic stress disorder (PTSD) if your birth experience was especially painful, challenging, or complicated.

This can also happen if you had a miscarriage, stillbirth, or abortion.

That said, women can develop secondary tokophobia after “normal” or healthy prior births as well.

History of Anxiety and Depression

A history of mental health conditions, including anxiety and depression, can make it more likely to have tokophobia.

There is some evidence suggesting that having prenatal depression, specifically, can increase the chances of tokophobia, though it’s not overly common.

Treatment 

Although phobias are an intense form of anxiety, they are also treatable. The two main avenues for treating tokophobia are therapy and medication.

Therapy

Cognitive behavioral therapy (CBT), psychotherapy, and exposure therapy have been shown to be effective in the treatment of phobias and other anxiety-related disorders.

It’s important to find a therapist with training in their preferred treatment method as well as experience with treating women or providing maternal mental health care. 

Medication

Medications for anxiety disorders range from selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) to benzodiazepines and beta blockers.

There is no one right way to prescribe medication for someone with an anxiety disorder; treatment plans are very individualized.

However, you will most likely need to visit a psychiatrist or your primary care provider to receive a prescription for antidepressant medication, since social workers and psychologists typically cannot write prescriptions for patients.

Coping 

One of the best ways to cope with a fear of tokophobia is to talk about your fears with a compassionate and understanding healthcare professional. 

While most women do not have a diagnosable phobia of childbirth, most women do have anxieties and concerns about the birthing process; an OBGYN or midwife should have some experience in talking to patients about the realities—both positive and negative—of giving birth safely, as well as what your pain relief options are during delivery (which can be helpful if fear of pain is behind your tokophobia).

If your fear of childbirth is related to something else, such as past sexual trauma, distrust of the medical profession, or a prior traumatic birth, a mental health professional may be able to help you resolve those outstanding issues and reduce or eliminate your phobia.

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  1. Bhatia MS, Jhanjee A. Tokophobia: A dread of pregnancyInd Psychiatry J. 2012;21(2):158-159.

  2. Hofberg K, Ward MR. Fear of pregnancy and childbirth. Postgraduate Medical Journal. 2003;79:505-510.