Tokophobia: the Fear of Childbirth

Consequences & complications of developing a fear of childbirth, risk factors, and options for treatment

Fear of childbirth is more common than one might think. As many as 6-10% of pregnant women have a severe fear of childbirth. It can be serious enough to lead to panic attacks and acute anxiety. For some women, symptoms may be so substantial that they choose instead to terminate a pregnancy rather than go through delivery.

This fear includes:

  • Concern about both mom and baby’s safety and health
  • Worries about the labor process itself and whether pain will be appropriately managed
  • Fears of death or serious medical complications
  • Distrust of the medical community and fear of abandonment
  • Uncertainty about one’s own abilities and worries about loss of control

What are the consequences and complications of Fear of Childbirth?

One of the most common consequences of this fear is a request for a cesarean section for delivery. In the US and around the world there is an increase in cesarean sections, and not always for medically indicated reasons or pregnancy complications, but by maternal request. Cesarean sections can have numerous complications and a more strenuous recovery period, and therefore there are campaigns to try to reduce this practice when there is not a strong clinical reason. A fear of childbirth can lead to doubts about one’s ability to give birth and a desire to assert control by selecting a cesarean section.

Another complication may be a more prolonged labor and medical complications, such as pre-term births, hypertension, and medical interventions.

Finally, fear of childbirth is associated with higher rates of postpartum depression and postpartum post-traumatic stress disorder.

What are the risk factors for Fear of Childbirth?

Several studies have found associations between a woman’s psychological state, her social situation, and her past experiences with the development of fear of childbirth. More specifically, women who have low self-esteem or pre-existing psychological symptoms, those who lack social supports, women with a previous negative birth experience and those with a history of abuse are all at higher risk.

After a traumatic delivery, the fear of childbirth that develops is sometimes referred to as secondary tokophobia. Tokophobia may also be a symptom of a severe anxiety or depressive disorder.

What are the options for treatment?

An important first step is recognizing the fear of childbirth as out of proportion to the usual anxieties that many women have. One screening tool for providers is the Wijma Delivery Expectancy Questionnaire (and there is a postpartum version, a Delivery Experience Questionnaire).

Several studies have found that antenatal education can decrease the severity of fear of childbirth. For some first-time mothers, what they imagine childbirth could be may not necessarily have grounding in reality. Perhaps perception was shaped by one friend’s traumatic story or misinformation in the media.

Since a history of trauma – whether childhood abuse or a traumatic prior delivery – can be a trigger for tokophobia, treatment of this distress through psychotherapy is essential. It is also important to recognize and address any underlying symptoms of depression or generalized anxiety, which can be treated with psychotherapy, medications if indicated, and a focus on self-care.

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Selected References:
Storksen, H.T. et. al. Fear of childbirth and elective cesarean section: a population-based study. BMC Pregnancy and Childbirth (2015) 15: 221.
Rouhe, H. et. al. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women: randomized trial. BJOG (2013) 120: 75-84.

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You deserve an emotionally healthy & rewarding pregnancy! I started Mind Body Pregnancy to provide you with expert guidance on mental wellness during pregnancy and postpartum. My background as a Harvard-trained clinician with current joint appointments at OB/GYN & Reproductive Psychiatry at UCSF Medical Center enable me to be your partner and guide.