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What is tokophobia?

Tokophobia is the term used to describe a severe fear (or phobia) of childbirth. This extreme fear can cause debilitating levels of anxiety, which can feel incredibly scary and overwhelming and can interfere with day-to-day functioning. Tokophobia can occur before someone experiencing a pregnancy or childbirth (known as primary tokophobia) or can occur following a difficult pregnancy or childbirth (known as secondary tokophobia). Secondary tokophobia may be particularly likely following a traumatic birth experience.

Tokophobia can affect people at different stages in their lives, although it is more common around the reproductive years – the time when someone is considering having children or experiencing pregnancy and childbirth. Tokophobia can affect men and partners as well as women and birthing people. 

Although many people will experience childbirth as a positive event, there are many elements of labour and childbirth that can feel stressful, ‘unknown’ or unpredictable, and might be associated with high levels of pain or feeling helpless. Everyone will experience labour and childbirth in very different and individual ways.

It is common to have heard stories about other people’s labour and birth experiences prior to having children. These stories may have had an influence on how someone feels about having a baby, or how they think that they will be able to manage this experience.

Tokophobia is often related to high levels of fear about experiencing pain, being helpless, or fearing that their life is at risk. People experiencing tokophobia usually worry that they will not be able to cope with the experience.

If tokophobia occurs before conceiving a baby it may prevent people from having children – something which may be very important to them and their hopes for the future. This might lead to excessive measures to prevent pregnancy.

If tokophobia occurs during a pregnancy, it can stop this being an enjoyable time. Instead, there may be a sense of dread with each week that passes, as the labour and birth become closer.

Remember anyone, of any gender, can experience a severe fear of childbirth, which may be termed ‘tokophobia’. This can happen to anyone, regardless of whether they have experienced pregnancy or childbirth. 

How can tokophobia have an impact? 

Tokophobia may elicit intense emotions and distressing thoughts, leading to physical changes or bodily sensations, and significant disruptions in daily living. Some symptoms you might experience are:

  • Constant feelings of fear, anxiety, and apprehension about the future.
  • Persistent and uncontrollable thoughts or mental images. These might be about labour and birth (including memories of a previous experience) or the health of the baby.
  • Concerns about the potential consequences of being unable to cope with labour and delivery, such as physical or emotional harm to oneself or the baby, and fears about a future without children.
  • Fears about physical examinations and medical interventions.
  • Feeling sad, disappointed in yourself or your situation, a sense of hopeless about the future and inability to enjoy regular activities. Tokophobia may increase the risk of depression.
  • Overwhelming feelings of guilt, failure and shame about your feelings and the impact tokophobia may be having on you and other people.
  • Irritability, restlessness, or angry outbursts towards yourself, your friends and family, or health professionals involved in your care.
  • A sense of isolation from others. It may feel hard to communicate your feelings, and you may find that you withdraw from social interactions.
  • Worries about not bonding or feeling a connection to your baby.
  • Feeling ashamed for not enjoying pregnancy as others might expect.

Tokophobia can cause physical symptoms, including:

  • Headaches and difficulty concentrating.
  • An upset stomach, feeling sick, and diarrhoea.
  • Feeling panicky, dizzy or light-headed, shaky, and having panic attacks.
  • Shortness of breath and raised heartrate.
  • Trouble sleeping, including nightmares.
  • Feeling tired and fatigued.

Tokophobia can interfere in many aspects of people’s lives. This can include:

  • Losing interest in previously-enjoyed activities.
  • Struggling with relationships. Your partner or family may not understand what you are experiencing.
  • You may develop coping strategies which feel helpful in reducing your distress but can cause longer-term difficulties or place you at risk, such as misusing alcohol.

It is common to avoid things that remind you about pregnancy, labour or birth, to reduce the distressing emotions which occur with tokophobia. You may notice that you:

  • Take extreme steps to avoid becoming pregnant; this may include an avoidance of intimacy and sexual relationships.
  • Avoid people you used to be close to, for fear they won’t understand or will judge you.
  • Try to avoid check ups, scans, planning or preparing for birth during the antenatal period
  • See if you can avoid aspects of labour and/ or childbirth that you are worried about

Avoidance may help in the short-term but does not help to overcome tokophobia, and can actually prolong symptoms.

Why is this happening to me? 

Historically it has been beneficial to develop a fear response to situations which might be dangerous. Being able to recognise a possible threat and respond quickly helps us to stay safe. This has been termed as the ‘fight or flight’ response. When we are in a situation which we perceive is dangerous or threatening, we might: 

  • Enter ‘flight’ mode, when we prepare to leave the scene or get away from the perceived danger as soon as possible.
  • Enter ‘fight’ mode, when we prepare to fight back against whatever is causing the potential danger.

In both of these situations, our body prepares for action so that we are able to ‘fight’ or ‘take flight’. All of the body’s responses are happening for good reasons – to help us to stay safe. However, they can feel very uncomfortable and scary. 

Remember there are effective ways to overcome tokophobia. You are not alone, and help is available. 

The anxiety responses outlined above have developed to keep us safe from physical harm or danger. However, our brains often overestimate the dangers, and the actual risks are usually not as great as our mind makes us believe.

We may also feel that we do not have the ability to cope with these situations. However, we are often much more resilient than we realise. 

The Psychological side of anxiety

We are likely to notice a lot of changes happening very quickly in our bodies:

  • Heart rate and breathing: Our heart starts beating fast. This allows blood to be pumped quickly around the body, so that we can move fast. As a result, we may notice that our breathing changes; it can become more shallow and rapid.
  • Stomachs and bladder: Our stomachs may feel unusual; we may feel sick/ nauseous (often referred to as ‘butterflies’), and we may feel the need to go to the toilet more often or fairly urgently. This happens because the body diverts blood away from our stomachs to other parts of our bodies which need to move quicky, such as our arms and legs. Emptying our bladders and stomachs also helps us to move more quickly.
  • Limbs and muscles: As blood circulates quickly through our bodies to prepare us for movement, we may experience physical sensations. These include tingling or numbness, muscle tension or aches, and trembling in our fingers, arms, or legs. These bodily responses enable us to be ready to respond and act accordingly.
  • Head: The hormone adrenaline is pumped quickly around the body. This can cause changes to the blood vessels and muscles in the neck and head, leading to tension headaches, or dizziness as adrenaline rushes to your head.
  • Fatigue: Following a period of anxiety it can be common to feel extremely tired and ‘wiped out’. 

Getting help and support - What can you do about Tokophobia?

Stay connected to people you care about and ask for their help. This could be a partner, family member or a friend. Social support is crucial in helping overcome mental health difficulties, including tokophobia. Trusting others with your experiences can feel very difficult, but finding a way to connect with others can help your recovery.

It can be helpful to talk to others who have similar experiences. You could try:

Develop strategies to look after yourself mentally and physically. Below are a few suggestions:

  • Focus on your wellbeing, through things such as gentle exercise, eating well, seeing friends or family
  • Make sure you rest when possible.
  • Rebuilding or reclaiming your life
    • What did you used to enjoy?
    • What made you feel good?
    • What have you stopped doing because of tokophobia
    • How can you start to do these things again? 

  • Talk to your midwife about how you feel.
  • Start to think about how you want to give birth. Considering different options at different stages of the labour and birth can help you to feel more in control. Share these ideas and wishes with your birth partner and midwife.
  • See if there are local antenatal classes which you can attend to provide you with information about labour, and provide the opportunity to meet others in similar situations.
  • Speak to people who have had positive birth experiences.
  • You may want to try:

  • Use techniques that help you stay connected to the present moment. Focus on your senses: what you can see, hear, touch, smell. Notice what is real in the moment and not what might happen in the future. This can help to know that you are safe right now.
  • Learning relaxation and breathing techniques to help soothe your body’s threat response.
  • Stand back and observe intrusive thoughts or memories rather than push them away: label them and picture them as external to you. Focus on something that reduces the fear in that moment.

Tokophobia can be overcome, but you may need some professional help to support your recovery. Do not be ashamed in asking for help:

  • Cognitive Behaviour Therapy (CBT) is an evidence-based therapy which is recommended for people with anxiety. This may be offered as a supported self-help intervention, or meeting with a mental health care professional for group or individual sessions.
  • Speak to your GP, Health Visitor or other health care professional to find out what is available, and see if they can signpost or refer you to services.
  • You can self-refer to an NHS Talking Therapies service by finding one local to your GP: www.nhs.uk/service-search/mental-health/find- apsychological-therapies-service.
  • Surrey and Borders Partnership NHS Foundation Trust have services designed to support moderate to severe perinatal mental health difficulties:–Maternal Mental Health Service: AFLoaT: Addressing Fear, Loss and Trauma relating to your maternity experience.
  • Community perinatal mental health teams based at sites across the county.

Further support

It can be helpful to understand more about how tokophobia affects your brain and body.

Sometimes people may find things so difficult that they experience thoughts about ending their life. If you are experiencing these, please either:

  • Attend your local A&E department
  • Dial 999
  • Call the Surrey Crisis Line: 0800 915 4644

Remember to be kind to yourself. It is not your fault that you feel this way. You can recover, but this may take time. Be compassionate to yourself.