Whether you’ve been thinking about having a baby or currently have a bun in the oven, it’s common to feel worried and apprehensive about delivery day. For some people, though, fear of childbirth can become debilitating. Let’s take a look at how to tell whether you’re experiencing typical pre-baby anxiety or a more serious fear known as tokophobia.

What Is tokophobia?

Tokophobia is the pathological fear of giving birth. While some degree of fear or anxiety is completely normal and expected, tokophobia is like other phobias or extreme fears in that it is severe enough to interfere with one’s quality of life. Sometimes the fear is powerful enough that it may also include fear of pregnancy and cause a person to avoid pregnancy altogether (even though they may actually want children).

There are two main types of tokophobia: primary and secondary. Primary tokophobia afflicts people who have never experienced childbirth. Onset can occur as early as adolescence or even during pregnancy. Secondary tokophobia happens to people who have had a prior birthing experience, often in response to a miscarriage, stillbirth, or traumatic labor.  

What are the symptoms of tokophobia?

While an extreme, pathological fear of childbirth is the primary attribute of tokophobia, there are other symptoms. Many of those symptoms coincide with other depressive and anxiety disorders and can disrupt the functions of daily life, from eating to sleeping to one’s general mood.

Typical symptoms of tokophobia may include the following:

• Nightmares or inability to sleep
• Abstinence from sex
• Postponing pregnancy (even if you want children)
• Obsessing about potentially negative outcomes, such as death or birth defects
• Difficulty regulating emotions
• Taking excessive measures to avoid pregnancy (like doubling and tripling birth control efforts)
• Asking for cesarean delivery with no medical basis
• Increased anxiety symptoms (headaches, fatigue, obsessively worrying)
• Increased depression symptoms (aches, pains, loss of appetite or sex drive, loss of interest in activities)

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How is tokophobia diagnosed? 

As with any psychological condition, tokophobia is diagnosed by a qualified mental health professional, like a psychologist, psychiatrist, or licensed clinical social worker. In certain instances, your primary care doctor or gynecologist may diagnose you based on your symptoms. It should be noted that tokophobia shares many characteristics and symptoms with other conditions, such as postpartum depression (PPD) and post-traumatic stress disorder (PTSD). Therefore, it’s important to identify it correctly as treatment could require a different approach.

What causes tokophobia?

There’s not always a straightforward or evident reason for why someone is experiencing tokophobia. It may simply be a build-up of various fears and experiences over the course of a person’s life. There are, however, several characteristics linked to an increased risk of tokophobia.

Medical concerns

Sufferers of tokophobia may have an overall fear of hospitals, pain, doctors, and medical procedures in general. They may also have had negative experiences in a medical setting or suffered from medical mistreatment or malpractice.

Personal trauma

Phobic anxiety surrounding the labor and delivery process may be triggered by past sexual trauma.

History of depression and anxiety

A history of prior mental health issues, such as anxiety and depression, may raise the likelihood that a person will form tokophobia. Some studies indicate that experiencing prenatal depression, in particular, may increase the odds of developing tokophobia.

Traumatic birth experiences

People with secondary tokophobia may have a fear that stems from previous birth trauma. Birth trauma is the result of extreme distress during labor and delivery. What qualifies as “extreme” is subjective and varies between women, but in most instances, trauma is triggered by the fear that your or your child will die. Secondary tokophobia can also arise in people who previously experienced stillbirth, abortion, or miscarriage. It can happen after a healthy prior birth experience as well.

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What is the treatment for tokophobia? 

Like other phobias, tokophobia is a treatable form of extreme anxiety. Treatment primarily consists of medication and therapy. 

Medication

Pharmaceutical options for anxiety disorders are highly individualized. In general, drug treatment may vary from selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) to benzodiazepines and beta blockers. A physician or psychiatrist will have to write a prescription for these medications and can select an option that’s safe during pregnancy. 

Therapy

Psychotherapy, cognitive behavioral therapy (CBT), and exposure therapy have proven to be both useful and practical for treating a variety of anxiety disorders, including phobias. CBT can be an especially effective choice due to its short-term duration and focus on specific symptoms. Consult with a therapist who has experience treating pregnant patients or has a background in providing prenatal mental healthcare.

The Takeaway 

One of the most effective ways to deal with tokophobia is to discuss your fears with a knowledgeable, empathetic healthcare professional. Anxiety about the childbirth process is completely normal, and your doctor can give you insight into what to expect (and what could go wrong) during the process. They can also discuss available pain relief measures during childbirth. If a previous birth or personal trauma is triggering your fears, a mental health professional can help you begin working through those issues.

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