Whether you're currently expecting or thinking about getting pregnant, it's normal to feel anxious and nervous about giving birth. But in rare cases, fear of labor can become overwhelming and even all-consuming. Here’s how to tell if what you’re dealing with is typical or a more severe fear of childbirth called tokophobia.
What is tokophobia?
Tokophobia in its most severe state is an extreme fear of pregnancy and childbirth. Some women with tokophobia might choose to avoid becoming pregnant and giving birth altogether, even if they want a child. Others might choose to get pregnant because their desire to have a biological child is greater than their tokophobia.
Many of the fears surrounding tokophobia have to do with pain and injury. Other women experience general worry about not having control over what happens during labor.
Experts break tokophobia up into two types:
- Primary tokophobia occurs in someone who has never been pregnant before. It can develop at any time, including while a person is pregnant. But sometimes the fear starts early, in adolescence or young adulthood.
- Secondary tokophobia occurs in women who become fearful of childbirth after a previous pregnancy. It usually occurs in response to a traumatic labor or birth experience, or after a miscarriage or stillbirth.
Tokophobia can exist on a spectrum, and its diagnostic benchmarks are murky at best. That makes it difficult to say for sure how many women really have it. But one systematic review of studies found it affects about 14 percent of women worldwide.
What are the symptoms of tokophobia?
Moms-to-be are often expected to be over-the-moon happy and excited about their impending bundles. But the truth is, most pregnant women are also a little nervous or anxious about giving birth — not to mention actually becoming a parent.
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And guess what? Those feelings are completely normal. It’s no secret that childbirth is painful. And even with the best laid birth plan, there’s no guarantee that things will go exactly as you hope.
Having occasional worries about how you’ll handle it all, whether you’ll end up tearing, for example, or what your recovery will be like are par for the course, even in women with healthy, uncomplicated pregnancies. And if your pregnancy is high-risk or you’re managing complications, you likely have even more on your mind.
True tokophobia can only be diagnosed by a mental health professional. But there are red flags that could indicate a woman’s anxiety over birth is more than just garden-variety nerves.
Someone with tokophobia might go to great lengths to avoid becoming pregnant. But plenty of women who are deeply fearful of childbirth do still end up becoming pregnant.
Pregnant people who are dealing with tokophobia might:
- Feel deep fear or anxiety about labor and delivery pain that gets worse as the pregnancy progresses. The fear or anxiety might start to take over other thoughts or feel hard to control, or make it difficult to concentrate on other activities.
- Have repeated nightmares about labor or delivery.
- Think about or ask their doctor about having a C-section, even if there’s no medical reason to do so.
- Think about ending their pregnancy to avoid giving birth.
If you have tokophobia, your fears or anxieties may also make it hard for you to go about your day normally (or sleep well at night).
What causes tokophobia?
There are lots of factors that can come into play. Women with a history of depression, anxiety or another neurobiological disorder may be more prone to developing an extreme fear like tokophobia, since pregnancy hormones can make these disorders harder to deal with. A history of sexual abuse or trauma can trigger tokophobia as well.
Traumatic births can play a role, too. Sometimes women who’ve never been pregnant develop tokophobia after hearing about a family member or friend’s frightening birth experience. Feeling like your own birth was traumatic may also make you deeply fearful of giving birth again.
How is tokophobia treated?
If you believe your labor fears are more severe than what is typical and could be tokophobia, speak to your practitioner. With support from a mental health professional, it’s possible to manage tokophobia and have a more positive pregnancy and birth experience. Cognitive behavioral therapy and psychotherapy can help you better understand your fears and learn how to cope with them.
In some cases, antidepressants or anti-anxiety medications can also be helpful. Your psychiatrist and OB/GYN can help you weigh the pros and cons of taking these drugs during your pregnancy, but often, experts agree that the mental health benefits to women outweigh the potential risks to a developing fetus.
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