What Is Tokophobia?

Tokophobia is 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, tokophobia is what's known as a specific phobia, meaning it is severe enough to interfere with 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 in people who have never given birth before but have tokophobia.
2. Secondary tokophobia: Occurs when fear stems from a prior experience of giving birth.

In addition, some people may experience post-traumatic stress disorder (PTSD) after a difficult childbirth. This can be related to tokophobia but is not quite the same.

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 those of depressive disorders and generalized anxiety disorders, and they can interfere with several aspects of life, from sleep to diet to overall mood.

Common symptoms of tokophobia include:

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

Diagnosis 

Like other psychological conditions, tokophobia is diagnosed by a qualified mental health professional, such as a psychologist, psychiatrist, or licensed clinical social worker. In some cases, a primary care provider or even your OB/GYN may be able to make the diagnosis based on your reported symptoms.

It can be important to distinguish among tokophobia, PTSD, and postpartum depression. All of these may have overlapping symptoms, but could require different approaches to treatment.

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 person’s life. 

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

Medical Fears

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

In people with secondary tokophobia (those who have given birth before), fears may be similar to PTSD if your birth experience was especially painful, challenging, or complicated. This can also happen if you had a miscarriage, stillbirth, or abortion.

However, secondary tokophobia can arise after “normal” or healthy prior births as well.

History of Anxiety and Depression

A history of mental health conditions, including anxiety and depression, can increase the likelihood that someone will develop 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 people during pregnancy or providing prenatal 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.

You will 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. A doctor can help determine which medicines are safe for during pregnancy.

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 pregnant people do not have a diagnosable phobia of childbirth, many 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.