It’s natural to feel some trepidation around pregnancy. Whether you’re expecting or thinking about becoming pregnant, you likely have some level of concern about potential health risks during this period and at the delivery.
But for some, the concern goes beyond low-level fear and into a more extreme condition. This issue is clinically known as tokophobia.
“Tokophobia is an extreme or pathological fear of pregnancy and childbirth,” said Aimee Danielson, a clinical psychologist and director of the women’s mental health program at MedStar Georgetown University Hospital. “It’s also called a fear of birth or FOB, though I prefer tokophobia because many patients I’ve seen fear pregnancy more so than the childbirth experience. It’s common to think of it as fear of birthing, but for some it includes a pronounced fear of pregnancy itself.”
Below, experts break down the symptoms, causes and ways to cope:
What’s the difference between tokophobia and general worry about childbirth?
Although it’s common to feel some level of worry around the pregnancy or birthing experience, tokophobia goes beyond these typical anxieties.
“The fears a person may experience can persist longer than six months and can cause people to feel overwhelmed, resulting in sometimes extreme efforts to avoid pregnancy or childbirth,” said Dr. Javine McLaughlin, an OB-GYN and senior director of clinical solutions at Carrot Fertility. “Tokophobia can severely impair a person’s ability to function in their work or social lives.”
The term tokophobia first appeared in medical literature in 2000, but experts were aware of the condition long before the 21st century.
“There are records of it, albeit under other names, in medical journals as early as 1897,” noted Jill Lamar, a licensed professional counsellor with Thriveworks in Philadelphia. Indeed, there are many older references to “maieusiophobia” or “parturiphobia.”
Tokophobia is typically classified as either primary or secondary tokophobia. The former pertains to individuals with a fear of pregnancy and childbirth who have no previous childbearing experience, while the latter refers to those who developed this fear after having undergone at least one pregnancy.
What causes tokophobia?
As with other phobias, there is a wide range of causes and risk factors for tokophobia, though it’s often related to past trauma.
“Secondary tokophobia typically develops after a traumatic childbirth or obstetric outcome,” Danielson said. “It can occur after a stillbirth, pregnancy loss or termination of pregnancy.”
With primary tokophobia, witnessing or hearing about someone else’s traumatic birth experience might be a contributing factor. Actor Helen Mirren has stated that a graphic birth film she watched in school as a young teen deeply traumatised her to the point of not wanting to have babies of her own.
“A child or teen witnessing another person’s complicated childbirth ― or even a medically uncomplicated birth ― could be a risk factor,” Danielson said. “And sometimes that extreme fear or dread of pregnancy doesn’t actually manifest until a person is newly married or newly partnered, and parenthood is coming up or is otherwise on the table in front of them.”
She added that a history of sexual trauma or abuse may also be a risk factor, especially if it has led to fear around the vaginal exams that are part of prenatal care. People with tokophobia might have other phobias like fear of needles, blood-injection-injury phobia, fear of pain, or just a debilitating fear of the unknown.
“Women from marginalised groups, who data reveals are at greater risk of fatality from pregnancy and childbirth, or those who have experienced difficulty in previous pregnancies or with providing child care for existing children also tend to experience tokophobia at higher rates,” Lamar said.
She noted that many people developed a deep fear of pregnancy after the onset of the COVID-19 pandemic as expectant parents faced the prospect of going to the hospital amid widespread infection, and giving birth alone without a partner or other emotional support.
You might be more likely to experience tokophobia if you have a personal or family history of generalised anxiety, depression or panic disorders as well.
How does it manifest?
“Since fears related to childbirth are not unusual, a tokophobic’s fears may be dismissed and perceived as normal,” said psychologist Michele Leno. “Unlike healthy fears, tokophobia causes significant emotional distress for the affected person. The person may want a child, but the fear of childbirth is too overwhelming.”
She noted that tokophobia, like other phobias, can cause high anxiety and avoidant behaviour.
“A lot of people with tokophobia can’t tolerate watching a TV show where someone is having a baby because it’s too distressing,” Danielson said. “They can’t hear friends talk about their childbirth experiences.”
People with the condition tend to overly fixate on the unpredictable, worrisome and potentially dangerous aspects of pregnancy and birth.
“The concept of your body changing shape, the need to consume more food than usual, weight gain, morning sickness, fatigue, and other issues related to pregnancy often viewed as unpleasant, become not just distasteful to you, but rise to an unbearable level,” Lamar said. “The thought of allowing doctors regular access to your body to check on and ultimately deliver a child, as well as what you may perceive as the horrors of childbirth, may paralyse you to such an extent that avoiding sex with your partner brings you relief.”
Many tokophobics use multiple forms of contraception and take excessive measures to avoid getting pregnant.
“Symptoms can include constant worry or thoughts about pregnancy and delivery,” McLaughlin echoed. “Physical symptoms such as stomach issues, or changes in eating or sleeping habits can occur. Relationships can also be affected by avoidance of sexual contact or the inability to have an intimate relationship.”
Tokophobia might also manifest in nightmares, panic attacks, hyperventilation, crying, anxiety attacks and other physical and psychological symptoms that reach an extreme level that interfere with healthy functioning.
“For those who do become pregnant, each week of pregnancy may be dreaded rather than enjoyed,” said Nadia Teymoorian, a psychologist with Moment of Clarity.
They can develop severe depression, hopelessness and a sense of worthlessness, especially if their concerns are ignored or minimised.
“Many women with tokophobia are unaware of their phobia until they get close to full term,” Teymoorian said. “They may request an elective C-section but find their doctor doesn’t understand or is not sensitive to their fear. This can lead to more anxiety. Women whose phobia is related to pregnancy may be seen as overreacting or being melodramatic about their fear.”
How can you cope with tokophobia?
When it comes to addressing your tokophobia, knowledge is power.
“Taking childbirth classes and improving understanding of the pregnancy and childbirth process can help decrease the unknown components that are often associated with the pregnancy and childbirth process,” McLaughlin said. “Having a support person throughout pregnancy and delivery such as a doula can also help advocate and create a soothing atmosphere for delivery.“
Talking to loved ones who have experienced smooth pregnancies and deliveries can offer reassurance and clear up misconceptions. Lamar advised being upfront about your anxieties and asking them to avoid the horror stories some people like to focus on in these conversations.
“Medical professionals, especially OB-GYNs can provide additional information and data to put to rest some of your fears,” she added.
Options like surrogacy and adoption may also provide alternative paths to parenthood, though many people with tokophobia are happy to remain child-free. If carrying a child is a goal, however, mental health counselling can make a huge difference.
“Since phobias are so deeply rooted, one may find little success in efforts to manage them alone,” Leno said. “A therapist or coach can help you identify thoughts that perpetuate your fears. Trying to hide or avoid talking about may cause more distress.”
Cognitive behavioural therapy helps people with tokophobia learn to cope with past trauma.
“Women who have tokophobia are often prescribed antidepressant or anti-anxiety medication,” Teymoorian said, noting that treatment approaches vary depending on the nature of their experience. “The first step is talking to a trusted care provider so that you can be supported with the right help and treatment for you.”
There are also in-person and online support groups that provide a safe space to express fears, anxieties and even ambivalence about pregnancy. Many people with tokophobia feel a sense of shame, but the right support systems can help them process these feelings in a healthy way.
“The decision to have a child should be one you can embrace with confidence,” Lamar said. “Yes, as with many things in life, there are uncertainties. But if we let the uncertainties of life keep us from enjoying the beauty of the world and the people around us, we all lose.”