Tokophobia: fear of childbirth

Among the different fears related to pregnancy, there are some related to the moment of childbirth. They can, for example, concern the fear of complications for themselves or for the unborn child, the concern of not being “adequate” or capable enough to give birth, the fear that the moment of delivery may arrive earlier than expected.

These are thoughts common to many women, more or less, often easily resolved. However, some women have an intense fear of childbirth, a real phobia called tocophobia, from the Greek tokos (childbirth) and phobos (panic, fear). Its synonyms are tokophobia, parturiphobia, maieusiphobia, locquiophobia.

A specific phobia

Tokophobia is a specific phobia, i.e. a marked and persistent fear caused by the presence or anticipation of a specific object or situation (in this case childbirth).
A phobia, to be such, has certain characteristics:

  • is disproportionate to the real danger of the object or situation;
  • it cannot be controlled by rational explanations and reasoning;
  • involves a systematic avoidance of what stimulates it;
  • the mere thought of being in front of the stimulus generates anxiety;
  • the person feels they cannot handle it, it is uncontrollable;
  • remains, without attenuation, for a long period of time;
  • causes discomfort, suffering in the quality of life of those who experience it;

In practice, a woman with tokophobia, at the mere thought of giving birth, may experience symptoms of the following type:

  • rapid heartbeat, shortness of breath;
  • recurring nightmares;
  • persistent thoughts of death during childbirth;
  • sweats, shaking;
  • sudden bursts of crying;
  • feelings of pure terror, anguish;
  • anxiety and panic attacks.

In the presence of physical symptoms – for example rapid heart rate – a medical evaluation is recommended first in order to be able to exclude causes of organic origin, especially if the symptoms are persistent and long-lasting.

The causes: primary and secondary tokophobia

As with any phobia, there is no single cause that is the same for all sufferers. Rather, there are unique factors and experiences that combine with each other:

  • biological factors related to the neurohormonal mechanisms that regulate anxiety;
  • psychosocial factors: young age, situations of social disadvantage, unfavorable socio-economic context;
  • exposure to narratives of negative experiences; e.g. tales of women who have had dramatic parts;
  • fear of medical care, also but not necessarily due to previous adverse hospital events;
  • psychological factors: low self-esteem, predisposition to anxiety and depression, traumatic experiences in childhood, sensitivity to pain.

There are two subtypes of tokophobia, depending on whether or not the woman has already had childbirth experience. This distinction was drawn for the first time in a  study  published in 2000 in the British Journal of Psychiatry, which also gave the first definition in scientific literature of tokophobia itself.

We talk about primary tokophobia for those women who have no pregnancies behind them. Their phobia began in adolescence or early adulthood. They tend to lead a normal sex life but are very scrupulous in contraception. They can be persuaded to carry on with a pregnancy provided they are guaranteed a caesarean delivery.

In women with previous experiences of pregnancy we speak of secondary tokophobia. They may have experienced a particularly traumatic or painful birth. It need not have been complicated in itself: what makes a trauma such is the meaning that the event has for the person who experienced it. This means that even a regular birth without medical complications can take on a traumatic value for the woman and therefore be the cause of secondary tokophobia. Circumstances related to uncompleted pregnancies also fall into this category.

Talking about it is difficult

A woman can experience tokophobia while strongly desiring to become a mother: what terrifies her is the idea of ​​natural childbirth, for the reasons listed above. To reconcile her desire for her with the avoidance of what terrifies her, she could opt for an adoption or convince herself to carry on with a pregnancy by placing a cesarean delivery as a fundamental condition. In any case, she will have to explain to the operators who follow her the reasons for her choice, why she wants to escape something culturally considered “obvious and obvious” for a woman. Moreover, already in the Bible the woman is told that she will have to give birth with pain.

If someone with an elevator phobia can walk up the stairs and continue to be socially accepted, the tocophobic woman risks being stigmatized, not understood, rejected. She is the first to experience the paradox of a desire for motherhood that collides with the fear of natural childbirth: how much of this paradox can be accepted and understood by those around her? Will she be listened to or will her thoughts be labeled as passing fears? Will she find medical personnel willing to reassure her or will she be treated as a “wimp” or a “hysteric”?

Fear of stigma makes it difficult for many women to not only ask for help, but also to share their fears with loved ones.

Academy Award-winning actress Hellen Mirren said in a 2007 television interview that she was traumatized in her teens by watching a documentary about childbirth she saw at school. This is why she never wanted to have children, saying she was “terrified” and “disgusted” just at the idea.

The importance of asking for help

Untreated tokophobia can lead to other disorders such as potpartum depression. In the aforementioned study it was seen that in extreme cases some women are so ill as to sacrifice their desire for motherhood in order to avoid childbirth, deciding to terminate the pregnancy or resorting to sterilization practices. Obviously, these are not decisions taken lightly, far from it.

Since this phobia can be the consequence of past traumas, treating it becomes important not only for the consequences but also for treating the causes that triggered it. It can derive not only from trauma to dramatic hospital experiences, but also from abuse suffered in childhood or unresolved mourning.

The goal of psychotherapy is not to “fix” the tokophobic patient. To say this would be to feed the stigma that a woman is only complete if she is a mother.

During therapy we work together with the woman to help her express her discomfort, understand where it comes from and enhance the resources at her disposal. Even if childbirth will continue to frighten her, she will be able to deal serenely with the medical staff and implement new ways to get better.

EMDR (Eye Movement Desensitization and Reprocessing) therapy may be helpful for unresolved trauma  . It is a structured protocol aimed at treating traumatic life experiences. The memory of the experience is not removed or forgotten; the goal is to treat it so that it loses the negative charge that generates suffering in the individual.

On a broader level, greater collaboration between professionals is desirable in order to raise awareness of tokophobia and reduce stigma, making women more free to talk about it and ask for help.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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