Tokophobia: Fear of Childbirth and Pregnancy

In This Article

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 in order 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.

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:

  • Feelings of dread at the thought of pregnancy and birth
  • Anxiety and depression
  • Extreme fear of birth defects, stillbirth, or maternal death
  • 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.

Men can also experience tokophobia. Researchers have found that men with tokophobia often have a severe fear regarding the health and safety of their partner and child.

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

Causes

Tokophobia can develop due to a number of causes. Some factors that may contribute to its development can include a fear of the unknown, loss of control and privacy, past sexual abuse, fear of pain, a fear for the life of the infant, and/or a lack of trust in medical practitioners.

Uncertainty over the labor and birth process can also come into play, as can the fear of birth-related complications such as preeclampsia and death. In addition, if a woman has poor social support, this can contribute to or worsen her fear of childbirth.

There are two different types of tokophobia:

  • Primary tokophobia occurs in women who have never experienced birth. It may begin during adolescence, although it can also occur after a woman has become pregnant. It may also be seen in girls and women who have been sexually assaulted or raped. Medical exams during pregnancy and childbirth may also trigger flashbacks of the original trauma.
  • Secondary tokophobia occurs in women who have previously experienced pregnancy and birth. It is often the result of traumatic labor and birth. However, it can also occur in women who had normal, non-traumatic births, as well as women who have experienced miscarriage, stillbirth, pregnancy termination, or failed fertility treatments.

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.

How Common Is Tokophobia?

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.

Such fear is actually quite common, with as much as 80 percent of pregnant women feeling some degree of anxiety and worry over things such as pain, health, and safety during birth. 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 is unclear just how common tokophobia may be. Some research suggests that rates range somewhere between 2 and 15 percent, although there is evidence suggesting that as many as 20 to 25 percent 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 percent 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.

Normal levels of this fear tend to be relatively low, while severe levels can affect a woman's day-to-day functioning.

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 percent 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.

Treatments

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. A mental health professional can help address some of the underlying reasons why the disorder may have developed in the first place, including pre-existing depression or anxiety conditions.

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.

Studies have found that offering support to pregnant women with a severe fear of pregnancy and birth can be an effective strategy for minimizing symptoms.

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 percent 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.

Treatment for tokophobia takes a multidisciplinary approach, incorporating both psychological and obstetric support.

Having a birth plan in place that acknowledges a woman's concerns can be helpful. Knowing that she will receive pain management upon request and is capable of choosing her method of delivery can be particularly important.

Steps to Take

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 with your doctor or midwife. Some anxiety is normal, and they may be able to provide reassurance and further assistance.

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 can help you feel more empowered and in control.

Talk to people you trust. Knowing that there are people who understand your fears and are there to offer support can help reduce anxiety.

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.

A Word From Verywell

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.

Was this page helpful?

Article Sources

  • Bhatia, MS & Jhanjee, A. Tokophobia: A Dread of Pregnancy. Ind Psychiatry J. 2012; 21(2): 158-159. doi: 10.4103/0972-6748.119649.

  • Hildingsson, I, Nilsson, C, Karlstrom, A, & Lundgren, I. A Longitudinal Survey of Childbirth-Related Fear and Associated Factors. J Obstet Gynecol Neonatal Nurs. 2011; 40(5): 532-543. DOI: 10.1111/j.1552-6909.2011.01274.x.

  • Poggi, L, Goutaudier, N, Sejourne, N, & Chabrol, H. When Fear of Childbirth Is Pathological: The Fear Continuum. Matern Child Health J. 2018; 22(5): 772-778. DOI: 10.1007/s10995-018-2447-8.

  • Rondung, E, et al. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health. 2018; 10(5): e10420. DOI: 10.2196/10420.

  • Striebich, S, Mattern, E, & Averie, GM. Support for Pregnancy Women Identified with Fear of Childbirth (FOC)/Tokophobia: A Systematic Review of Approaches and Interventions. Midwifery. 2018; 61: 97-115. DOI: 10.1016/j.midw.2018.02.013.