Being scared of giving birth when you’re pregnant is not uncommon but what if it’s a severe fear. Here’s what you need to know.
Ask any group of pregnant women their thoughts on labour and you’ll know that a fear around childbirth is, understandably, pretty common.
As many as three quarters of pregnant women will have some degree of fear around pregnancy and childbirth (Melender, 2002). Fears can be wide ranging but include concern about the pain of childbirth, worry for their baby's health and anxiety about interacting with healthcare professionals. For some women, their fear of childbirth will be significant enough to cause tokophobia (Melender, 2002).
What is tokophobia?
Tokophobia, a type of anxiety, is where a person has an extreme fear (phobia) of childbirth that can lead to them avoiding pregnancy altogether. The fear of childbirth becomes overwhelming, and terrifying, and can become physically and emotionally disabling (Hofberg and Brockington, 2000). The worldwide rate of tokophobia in pregnant women is over 1 in 10 (O’Connell et al, 2017). Early research in this area in fathers suggests a tokophobia rate of over 1 in 10 men too (Masoumi and Elyasi, 2021).
Symptoms of tokophobia
Symptoms of tokophobia can include:
- sleep disturbances, including nightmares
- panic attacks
- extreme fear of birth defects, stillbirth or maternal death
- feelings of dread at the thought of pregnancy and birth
- insistence on a caesarean section for the birth.
Who is likely to get tokophobia?
Fears are likely to be more common and intense in parents who have never been pregnant or given birth (primary tokophobia) (Bhatia and Jhanjee, 2012). Women and their partners who have had a previous difficult or traumatic experience of childbirth or pregnancy can also have (secondary) tokophobia.
In some cases, tokophobia is caused by prenatal depression (Scollato and Lampasona, 2013).
Information is limited about the reasons for a fear of childbirth and tokophobia but we know some people have tokophobia due to the following:
- Hearing stories from others close to them who have been through traumatic births (Fisher et al, 2006).
- Fears related to medical care, like ineffective pain control, loss of control, injury or death, or a lack of confidence in the team providing care (Fisher et al, 2006).
- Psychosocial factors like being a young parent or at a social disadvantage (Fisher et al, 2006).
- Psychological factors like low self-esteem, revival of traumatic memories of childhood or psychiatric disorders like depression or anxiety (Fisher et al, 2006).
- Being a lesbian, bisexual or transgendered person (Malmquist et al, 2019).
- History of sexual abuse (Lukasse et al, 2010).
- Previous traumatic events in pregnancy or childbirth (Jomeen et al, 2021).
- In men, a fear of childbirth may be due to a lack of knowledge, or a feeling of being outside of the process (Masoumi and Elyasi, 2021). Research in other partners is not yet available.
Effects of tokophobia
The physical effect of tokophobia is that people try to delay or avoid pregnancy by using contraception. If they do get pregnant, women might be more likely to choose an abortion (Bhatia and Jhanjee, 2012). They may also opt for a caesarean section when it comes to giving birth (Gutteridge, 2013).
Tokophobia can have big emotional effects on a parent, such as increased stress, loss of self-control and fear around caring for the baby. Those with tokophobia are also more likely to have anxiety and depression. There are also concerns about consequences for child health related to tokophobia, such as decreased mother–infant bonding, lower birth weight and increased rate of admissions to neonatal care (Elyas et al, 2019).
Those with tokophobia are more likely to have more complicated birth experiences, such as longer, more painful labours, and have a higher chance of having a negative or traumatic birth experience (Ayers, 2014).
Treatment for tokophobia
Having good support from friends, family and healthcare professionals may be important for helping to limit the impact of tokophobia (Laursen et al, 2008). Effective support and psychological treatment can also be effective in reducing the need for elective caesarean by up to 50% (Sjogren and Thomassen, 1997).
Forms of psychological treatment include cognitive behaviour therapy, psychotherapy and taking medication to help tackle your feelings (Striebich et al, 2018). Your GP can help you decide what might be the best course of treatment in your circumstances. You might also like to discuss with your midwife and/or obstetrician the benefits and risks of vaginal birth and elective caesarean on your emotional wellbeing (NICE, 2021).
There is some evidence that birth education and self-hypnosis may be beneficial for those with a fear of childbirth and tokophobia (Aguilera-Martín et al, 2021). Yet it is important for you to choose the right provider or source of education and hypnosis techniques. Your midwife or GP may be able to advise on a suitable source of support.
Peer support may be useful for some people.
If you feel you have secondary tokophobia due to a previous traumatic birth, you may wish to explore treatment for the trauma.
If you wish to explore private therapies, it is important that the person offering you care and treatment is appropriately qualified and insured. For help finding a qualified therapist with professional accreditation, follow this link. It may be beneficial to speak to your GP first about the type of private therapy you are considering.
Treatment for any mental health problem should always start with a clear assessment of your mental health to ensure the techniques the therapist will use will be helpful. With any type of therapy, it is important that you feel comfortable and safe with the therapist and with the therapeutic techniques they use. If you are not comfortable for any reason, you should consider moving therapists, which is possible even within the NHS.
Experiencing mental health symptoms can be overwhelming but help is available. So speak to a trusted healthcare professional, such as a midwife, health visitor or GP. If you feel at risk of harming yourself or others, call 999, attend an emergency department or call the Samaritans on 116 123.
This page was last reviewed in January 2022.
Our support line offers practical and emotional support with feeding your baby: 0300 330 0700.
We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
Aguilera‐Martín Á, Gálvez‐Lara M, Blanco‐Ruiz M, García‐Torres F. (2021) Psychological, educational, and alternative interventions for reducing fear of childbirth in pregnant women: a systematic review. J Clin Psychol. 77(3):525-555. Available at: https://doi.org/10.1002/jclp.23071
Ayers S. (2014) Fear of childbirth, postnatal post-traumatic stress disorder and midwifery care. Midwifery. 30(2):145-148. Available at: https://doi.org/10.1016/j.midw.2013.12.001
Bhatia MS, Jhanjee A. (2012) Tokophobia: A dread of pregnancy. Ind Psychiatry J. 21(2):158-159. Available at: https://doi.org/https://doi.org/10.4103/0972-6748.11964910.4103/0972-67…
Cherry K. (2020) Tokophobia: fear of childbirth and pregnancy. Available at: https://www.verywellmind.com/tokophobia-overview-4684507 [Accessed 6 January 2022]
Fisher C, Hauck Y, Fenwick J. (2006) How social context impacts on women’s fears of childbirth: a Western Australian example. Soc Sci Med. 63(1):64-75. Available at: https://doi.org/10.1016/j.socscimed.2005.11.065
Gutteridge K. (2013) Who’s afraid of the big bad birth? MIDIRS Midwifery Digest. 23(4). Available at: https://www.academia.edu/27982265/Whos_afraid_of_the_big_bad_birth.pdf [Accessed 6th January 2022]
Hofberg K, Brockington I. (2000) Tokophobia: an unreasoning dread of childbirth: a series of 26 cases. Brit J Psychiatry. 176(1):83-85. Available at: https://doi.org/10.1192/bjp.176.1.83
Jomeen J, Martin CR, Jones C, Marshall C, Ayers S, Burt K, Thomson G. (2021) Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research. J Reprod Infant Psychol. 39(1):2-15. Available at: https://doi.org/10.1080/02646838.2020.1843908
Laursen M, Hedegaard M, Johansen C. (2008) Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG. 115(3):354-360. Available at: https://doi.org/10.1111/j.1471-0528.2007.01583.x
Lukasse M, Vangen S, Oian P, Schei B. (2010). Fear of childbirth, women’s preference for cesarean section and childhood abuse: longitudinal study. Acta Obstetricia et Gynecologica Scandinavica, 90(1):33-40. Available at: https://doi.org/10.1111/j.1600-0412.2010.01024.x
Malmquist A, Jonsson L, Wikström J, Nieminen K. (2019) Minority stress adds an additional layer to fear of childbirth in lesbian and bisexual women, and transgender people. Midwifery. 79:102551. Available at: https://doi.org/10.1016/j.midw.2019.102551
Masoumi M, Elyasi F. (2021) Tokophobia in fathers: a narrative review. Iran J Psychiatry Behav Sci. 15(1):e104511. Available at: https://doi.oerg/10.5812/ijpbs.104511
Melender HL. (2002) Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women. Birth. 29(2):101-111. Available at: https://doi.org/10.1046/j.1523-536x.2002.00170.x
NICE. (2021) Caesarean birth NICE guideline. Available at: https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66… [Accessed 6th January 2021]
O'Connell MA, Leahy‐Warren P, Khashan AS, Kenny LC, O'Neill SM. (2017) Worldwide prevalence of tocophobia in pregnant women: systematic review and meta‐analysis. Acta Obstet Gynecol Scand. 96(8):907-920. Available at: https://doi.org/10.1111/aogs.13138
Scollato A, Lampasona R. (2013) Tokophobia: when fear of childbirth prevails. Mediterranean J Clin Psychol. 1:1-18. Available from: https://doi.org/10.6092/2282-1619/2013.1.893
Striebich S, Mattern E, Ayerle GM. (2018) Support for pregnant women identified with fear of childbirth (FOC)/tokophobia–a systematic review of approaches and interventions. Midwifery. 61:97-115. Available at: https://doi.org/10.1016/j.midw.2018.02.013