Tokophobia is an intense and overwhelming apprehension of childbirth, and this fear can lead individuals to adopt extreme measures to prevent pregnancy. Those with tokophobia who do become pregnant might find themselves consumed by anxiety throughout each stage of pregnancy rather than relishing the experience. Fortunately, with therapeutic interventions and additional support, it is possible to successfully manage or overcome this condition.1
Tokophobia denotes an intense and debilitating dread of childbirth, a condition that can manifest even in women who desire to have children. While it's not unusual to harbour some trepidation or unease regarding the birthing process, a more profound manifestation of this fear, known as tokophobia, could impact as many as 14% of women.2
Primary tokophobia pertains to women who have yet to undergo childbirth and harbour a profound apprehension about the process. In such instances, the distressing emotions associated with childbirth may be traced back to childhood experiences or from others sharing traumatic birthing stories.2
Secondary tokophobia is categorized as a variant of post-traumatic stress disorder (PTSD). It stands as the prevalent form of tokophobia and emerges in women who have previously endured a traumatic childbirth experience.2,3
The vast majority of women expect and desire conventional childbirth, but many grapple with anxieties regarding unsafe, traumatic or damaging birthing experiences.2
Tokophobia can sometimes stem from other phobias, which can include:1
- Algophobia: The fear of pain
- Haphephobia: The fear of physical touch
- Iatrophobia: The fear of doctors or medical procedures
- Nosocomephobia: The fear of hospitals
- Obesophobia: The fear of gaining weight
- Pedophobia: The fear of children
- Thanatophobia: The fear of death
- Trypanophobia: The fear of needles
These underlying fears can contribute to or exacerbate tokophobia in certain cases.
Causes of tokophobia
There are numerous factors that can contribute to the development of tokophobia, including:
Past Trauma: A history of abuse or sexual assault can lead to feelings of shame and distress regarding pregnancy1
External Pressure: Feeling coerced into pursuing a traditional vaginal birth can contribute to tokophobia1
Negative Experiences: Learning about others' challenging birthing experiences can instill fear1
Vulnerability: Apprehensions about healthcare providers' proximity to intimate areasduring childbirth can intensify tokophobia1
Misconceptions: Lack of awareness regarding the low likelihood of childbirth complications can amplify fear associated with pregnancy and birth1
Lifestyle Changes: Anticipating alterations in one's daily routine and loss of control over schedules and autonomy can also contribute to tokophobia1
Symptoms of tokophobia can be cognitive and behavioral, often leading to depression and other adverse psychological and health effects.1,3,4 These symptoms manifest in various ways:
Cognitive and behavioral manifestations:
Avoidance of Intimacy: Tokophobia may lead to avoiding sexual intercourse to prevent pregnancy.1,4
Emotional Detachment: Some individuals may struggle to form an emotional connection with their unborn child.1
Lack of Excitement: A notable absence of enthusiasm or joy about the pregnancy could be present.1
Concealing Pregnancy: Individuals might attempt to hide their pregnancy from others.1
Relationship Disconnection: Tokophobia can result in feelings of detachment from partners or loved ones.1
Some Individuals with tokophobia may choose to undergo an abortion if they find themselves pregnant due to their fears over childbirth, and others who choose to carry to term may consider putting the baby up for adoption due to their struggles regarding pregnancy and childbirth.1 Those with a severe fear of childbirth might opt for a voluntary Cesarean section (C-section) even if a safe vaginal delivery is feasible.1
Tokophobia is frequently identified during medical appointments that are initially scheduled for other purposes.1
For individuals not currently pregnant:
During routine examinations, healthcare providers often inquire about contraception methods and future family planning. These discussions often present an opportunity to openly address any apprehensions or worries regarding childbirth that may be indicative of tokophobia.
For pregnant individuals:
Regular prenatal check-ups encompass discussions about various aspects of your well-being, including mental health. Responding candidly to these inquiries assists healthcare providers in recognizing signs of tokophobia and ensuring timely intervention and support. The Wijma Delivery Expectancy Questionnaire Part A is often used by medical professionals to diagnose tokophobia.2
Treatment and management
Treating tokophobia involves several approaches to alleviate fears and enhance well-being.
Common treatments include:
Cognitive Behavioral Therapy (CBT): CBT is a widely utilized method that can identify and address the specific elements of childbirth contributing to tokophobia. Through this therapy, healthy coping strategies can be learned under the guidance of a mental health professional.1,3
Other potential treatments and coping methods include:
Antidepressants: In cases where tokophobia is accompanied by depression, antidepressants can be beneficial.1 These medications help regulate brain chemicals responsible for mood regulation.
Hypnotherapy: Hypnotherapy employs focused relaxation to tap into a heightened state of awareness. While in this state, a mental health provider assists the patient in exploring subconscious thoughts that may be perpetuating fear.1
Stress Reduction Techniques: Practices such as yoga, meditation, and relaxation exercises help clear the mind and promote a sense of calm.1,3 This newfound tranquillity can bolster confidence in facing childbirth.
These treatments, individually or in combination, are tailored to address the unique concerns and needs of individuals grappling with tokophobia. Consulting with healthcare professionals will help determine the most suitable approach for each situation.
While tokophobia itself cannot be entirely prevented, there are steps that can be taken to mitigate its impact and reduce its influence. Here are some strategies:
Open Communication with Healthcare Provider: If you have concerns or anxieties about childbirth, it's important to discuss them openly with your healthcare provider. Early communication can help in receiving appropriate guidance and support.
Address Anxieties Early: Don't hesitate to bring up fears and worries, even before becoming pregnant. Addressing concerns in advance can help better manage them when the time comes.
Selective Exposure to Information: While staying informed is important, it's also wise to limit exposure to negative childbirth experiences shared by others. Remember that each person's journey is unique, and their experiences may not necessarily reflect your own.
Mindfulness and Relaxation Techniques: Practicing mindfulness, meditation, yoga, and relaxation exercises can help manage anxiety and stress, fostering a more positive outlook on childbirth.
Educational Classes: Consider attending childbirth education classes, which can provide accurate information about the birthing process and help dispel myths and misconceptions.1,3
Support Network: It is important to have a supportive network of friends, family, and professionals who can provide encouragement, understanding, and guidance throughout a pregnancy journey.
Therapeutic Interventions: If you start experiencing significant fear or anxiety related to childbirth, seeking therapy early, such as cognitive behavioural therapy (CBT), can help you develop effective coping strategies.1
Focus on Positive Outcomes: While acknowledging potential challenges, try to focus on the positive aspects of childbirth and the potential joy of starting or expanding a family.
Remember, it's normal to have concerns about childbirth, but with proactive steps and a supportive approach, you can work towards managing tokophobia's impact and achieving a more positive pregnancy experience.
Overcoming challenges and seeking support
Establishing a strong support network can significantly aid in managing tokophobia. Identify individuals among your circle of friends and loved ones who radiate positivity and offer unwavering encouragement. These individuals may or may not have experienced pregnancy themselves, but their reassuring words can be a valuable source of comfort.1
To expand your knowledge and alleviate fears related to childbirth, consider the following avenues:
Participate in Prenatal Classes: Enroll in prenatal classes that provide comprehensive guidance on the childbirth process. Typically held during the later stages of pregnancy, these classes offer insights and preparation to enhance your understanding.1
Explore Early Pregnancy Classes: Early pregnancy classes cater to individuals in the initial phases of pregnancy or those aspiring to conceive. These classes equip you with fundamental knowledge to confidently navigate this stage.1
Embark on Hospital or Birthing Center Tours: Many healthcare facilities organize guided tours of their birthing centers, allowing you to familiarize yourself with the environment, inquire about procedures, and ease any concerns.
Engage with Support Groups: Join online pregnancy forums or virtual communities, which serve as platforms for sharing experiences and seeking advice. Additionally, inquire about local in-person support groups that may be hosted by your hospital.
By actively engaging in these educational and supportive endeavors, you can expand your understanding of childbirth and gather the resources needed to confront tokophobia with increased resilience.
Tokophobia is a profound and intense fear of childbirth that can affect women's emotional well-being and lead to extreme measures to avoid pregnancy. It can be categorized into primary tokophobia, which is the fear of childbirth in women who have never given birth, and secondary tokophobia, which emerges in women who have experienced traumatic childbirth in the past. This fear can stem from various underlying fears such as fear of pain, medical procedures, and more.
Factors contributing to tokophobia include past trauma, external pressure, negative experiences, body image concerns, misconceptions, and lifestyle changes. Symptoms encompass avoidance of intimacy, emotional detachment from the unborn child, lack of excitement about pregnancy, concealing pregnancy, and relationship disconnection. These symptoms can lead to preferences for Cesarean section, consideration of abortion, or contemplating adoption.
Diagnosis often occurs during medical appointments, both for individuals not currently pregnant and those who are pregnant. Treatment involves Cognitive Behavioral Therapy (CBT), antidepressants, hypnotherapy, stress reduction techniques, and more. Prevention strategies include open communication with healthcare providers, addressing anxieties early, selective exposure to information, mindfulness and relaxation techniques, educational classes, support networks, and therapeutic interventions.
Building a support network, participating in prenatal classes, exploring hospital tours, and engaging with support groups are ways to alleviate fears and enhance understanding of childbirth, ultimately helping individuals confront tokophobia with resilience.
- Cleveland Clinic [Internet]. [cited 2023 Aug 11]. Tokophobia (Fear of childbirth): causes, symptoms & treatment. Available from: https://my.clevelandclinic.org/health/diseases/22711-tokophobia-fear-of-childbirth
- O’Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O’Neill SM. Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstet Gynecol Scand [Internet]. 2017 Aug [cited 2023 Aug 11];96(8):907–20. Available from: https://onlinelibrary.wiley.com/doi/10.1111/aogs.13138
- Fox, Sarah. GUIDELINE FOR TOKOPHOBIA. NHS Wales, Apr. 2023, https://wisdom.nhs.wales/a-z-guidelines/t/tokophobia-guideline-pdf1/.
- Bhatia, Manjeet Singh, and Anurag Jhanjee. ‘Tokophobia: A Dread of Pregnancy’. Industrial Psychiatry Journal, vol. 21, no. 2, 2012, pp. 158–59. PubMed Central, https://doi.org/10.4103/0972-6748.119649.