Tokophobia: Dread of Pregnancy, Childbirth and Its Outcomes
If you are scared of childbirth, you may have tokophobia (or FOC – fear of childbirth). This is a phenomenon that can happen to a woman who has not yet become (but is interested in becoming) pregnant and may also happen to you after you are already pregnant. Most women who suffer from the phenomenon are before or during their first pregnancy. This condition is defined in professional literature as primary tokophobia. In contrast, for women who have already given birth and develop fear of subsequent births, the phenomenon will be defined as secondary tokophobia.
In a 2017 review article it was reported that approximately 14% of women suffer from tokophobia. Studies report that over the years there has been a constant increase in reports of fear of childbirth. The studies also show that women before their first delivery will suffer more from tokophobia than women for whom it is their second delivery, mainly after the 21st week of their pregnancy.
In the case of tokophobia in women who have already given birth before, it has been found that these are mainly women who had a traumatic birth experience, who had a cesarean section or vacuum delivery, and particularly those who had long childbirth in which complications developed or which necessitated emergency interventions.
Risk factors for developing tokophobia
There are a number of factors that may cause fear of childbirth to develop. The most significant factors are:
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Giving birth in a foreign country -
History of sexual, emotional or physical abuse -
Psychiatric history, depression or anxiety -
Following a long period of infertility
Tokophobia symptoms
Pregnancy is a complex period in which women in general, including those who do not suffer from extreme fear of childbirth, have fears, nightmares and difficulty prior to the pending childbirth. These feeling are very common and are affected primarily by the uncertainty that the pregnancy brings with it and questions that cannot be unequivocally answered such as a certain delivery date, course of birth and so on.
Tokophobia itself manifests in specific symptoms such as:
- Recurring invasive and painful thoughts during the day and night. These thoughts can cause stress, anxiety and restlessness.
- Nightmares, fatigue, frequent crying. A women who suffers from the phenomenon may feel a constant need to talk about fears and need a supportive, containing environment.
- An expectant woman suffering from tokophobia and taking relatively high dosage psychiatric medication may be at higher risk for experiencing induced labor or cesarean section.
- A woman who experiences tokophobia during pregnancy may be at greater risk of suffering during childbirth from intolerable pain (even after epidural anesthesia), her childbirth may be relatively long and the general birth experience will be negative.
- Tokophobia during pregnancy is a significant risk factor for developing PTSD (posttraumatic stress disorder) symptoms a month after childbirth, emotional disorders and difficulty in developing a mother to newborn bond. Some women who have experienced the phenomenon in pregnancy decide not to get pregnant again or postpone additional pregnancies.
The birth: fears of tokophobia
Studies conducted on the subject show that women with tokophobia are scared of one or more of the following cases happening during childbirth:
- Intolerable pain during childbirth.
- Disorders of the pelvic structure that may impede the passage of the newborn.
- Disorders in the start of labor preceding childbirth.
- Long childbirth.
- Anxiety attack during childbirth.
- Lack of strength needed for delivery.
- Inability to breath or push correctly.
- Inability to cooperate with the delivery room team.
- Loss of self-control.
- Lack of support, empathic or dignified treatment from the medical staff.
- Sense of helplessness or lack of control during the delivery.
- Interventions in childbirth such as: cesarean section, vacuum delivery or need for anesthesia.
- Complications such as birth canal tears.
- Damage to the mother or newborn.
- Death of the newborn or mother.
- Fear of the unknown.
Treatment for tokophobia – solutions before and during childbirth
While it is worth treating fear of childbirth before pregnancy, if you didn’t know that you had a strong fear of this kind and are already pregnant, you should know that it is not too late to deal with the problem. It is worth seeking care during pregnancy and before childbirth so that you will be able to enjoy a positive birth experience and reduce the risk of experiencing the fears and risks mentioned here.
When you come to the hospital, at the delivery room choosing stage, and of course during pregnancy follow-up, it is important for you to talk to the attending staff members (gynecologist, midwife, doula, nurse) to share your fears with them. The staff can help you find solutions that will help you try to prepare for childbirth. For example, one recommended treatment for extreme fear of childbirth is cognitive behavioral therapy (CBT), a targeted, limited time treatment that is usually very effective.
In recent years, the medical world has been investing greatly in studying tokophobia. Most hospitals provide an accompaniment and support program for expectant women suffering from it or trauma related to a previous birth, in order to lead to a positive birth experience while maintaining her own health and that of the newborn, irrespective of the manner of delivery.
Therefore, if you suffer from tokophobia, it is desirable and advisable for you to contact the delivery room where you are planning to give birth to find out what options are being offered there for you and to get help. Each medical center has a different name for its help programs but the underlying foundation is the same: understanding the fears and providing a suitable answer during childbirth (such as preparing a birth plan focusing on the things that cause anxiety).
Tokophobia and cesarean section
Tokophobia is one of the main causes of women asking to have an elective cesarean section, instead of ordinary delivery. This happens in developed and undeveloped countries alike, from Europe and Iran to China and in Israel too. A cesarean section is an operation to all intents and purposes involving a possibility of immediate complications and long-term ones too. Therefore, if fear of childbirth is the reason you are interested in an elective cesarean section, it is a good idea to consider the decision to have the operation carefully and take into account all the consequences it may have.
Coping with prenatal post-traumatic stress
There are cases in which hospitals provide an even closer suite of services. If you have experienced sexual abuse in the past or have been diagnosed with posttraumatic stress disorder (PTSD), or are coping with trauma from a previous delivery or another complex mental condition, you should know that most hospitals have a program specifically designed to help you. In this program, you will be able to meet the midwife or other trained professionals who will help you with a specific, personal preparation for childbirth. If you need this assistance, call the delivery room where you are planning to give birth and ask about this program.