Tokophobia (Fear of Pregnancy): Symptoms, Treatments, & How to Cope

Tokophobia Definition

Tokophobia is a fear of pregnancy and/or childbirth that affects adolescent and adult women.² Most women experience some anxiety and fear around giving birth, but for women with tokophobia, anxiety and fear is severe and can affect how they approach family building. Some women choose surrogacy, adoption, or a cesarean delivery because of their fears. Others may go forward with pregnancy and childbirth but endure significant anxiety.

There are two types of tokophobia: primary and secondary.² Primary tokophobia is when a woman who has never given birth experiences severe pregnancy and childbirth anxiety. Secondary tokophobia is a fear that develops after a previously traumatic pregnancy or traumatic birth, such as one that involved complications or loss.

Is Fear of Being Pregnant Normal?

It’s difficult to pinpoint exactly how many women experience tokophobia. Up to 78% of women report experiencing some fear of pregnancy and childbirth, but about 13% experience anxiety that is severe enough to cause them to put off or avoid getting pregnant.² Tokophobia is more common in women who have never given birth, compared to those who have.

Tokophobia Vs. General Fear of Pregnancy & Giving Birth

General fears of pregnancy and giving birth are common. In fact, the majority of women experience them at some point.² Tokophobia, on the other hand, is when a woman’s anxiety is severe enough that it affects how she approaches building her family. This causes significant distress as she tries to figure out how to make her dreams of having children happen while managing her fears.

Women who have a fear or discomfort of pregnancy or childbirth and who do not want children, or are not distressed by their fears, do not have tokophobia. Some women find the idea of pregnancy anxiety-provoking but do not feel that the fear holds them back. On the contrary, women with tokophobia feel distressed by how their anxiety affects their desire to have children. For women with tokophobia, there are multiple layers of distress.

Primary & Secondary Tokophobia

There are two types of tokophobia, primary and secondary:

• Primary tokophobia is childbirth anxiety that occurs in women who have never given birth before.⁶ These women often feel anxious about childbirth before pregnancy, which may lead to avoiding pregnancy altogether. Other women may become pregnant despite this phobia, only to experience a significant increase in their anxiety once they are pregnant and faced with having to give birth.
• Secondary tokophobia develops after a woman has already given birth at least once before.⁶

Who Is Likely to Get Tokophobia?

Any woman can be affected by tokophobia.² Women who have never given birth may develop primary tokophobia during adolescence or adulthood. Women who have previously given birth may develop secondary tokophobia. This can affect women who had a previous traumatic birth experience or loss, such as an emergency cesarean section, use of forceps or vacuum during delivery, or stillbirth. However, women who had a routine delivery can also develop tokophobia.

Do I Have Tokophobia?

Determining if you have tokophobia is a complicated process. Luckily, it is not up to you to diagnose the condition. Instead, you should entrust your symptoms and experience to a mental health professional, so they can make an accurate diagnosis. Though tokophobia is a genuine condition, the phobia only occurs sporadically in the general population.

Tokophobia Symptoms

Tokophobia involves fear and anxiety that is excessive and more than what would be expected in a given situation.⁵ Women with this condition may become anxious and fearful leading up to giving birth. Even thinking about or imagining childbirth can lead to significant panic. These feelings are usually accompanied by other physical and emotional signs of anxiety.

Symptoms of tokophobia include:⁵

• Excessive anxiety or fear when a woman imagines or thinks about childbirth
• Experiencing immediate anxiety when a woman is faced with having to give birth
• The woman understands that her fear is excessive or unreasonable
• She either avoids a vaginal birth by requesting a cesarean delivery or goes through with it while experiencing significant anxiety
• Her anxiety affects several areas of her life, including her work or school, relationships, social activities, and daily routine
• The anxiety is persistent and lasts for at least six months
• The anxiety is not better explained by another mental health diagnosis, like obsessive-compulsive disorder (OCD) or posttraumatic stress disorder (PTSD)

Tokophobia & Panic Attacks

Panic attacks may also occur in women who experience tokophobia. They are rapid and intense feelings of fear and anxiety that occur along with multiple physical sensations. In the case of tokophobia, panic attacks can be triggered by thoughts, images, or reminders of childbirth.

Symptoms of a panic attack include:⁵

• Increased heart rate or palpitations
• Sweating
• Shaking
• Shortness of breath
• Choking sensation
• Chest pain
• Nausea or stomach pain
• Feeling dizzy, lightheaded, or faint
• Derealization (feelings of unreality) or depersonalization (feeling detached from one’s self)
• Fear that a person is losing control or going crazy
• Fear that a person is dying
• Chills or hot flashes
• Numbness or tingling in the body

Some people who experience panic attacks describe feeling as though they are having a heart attack, unable to breathe, or that they are dying. This can often lead to seeking emergency medical attention. Though panic attacks can be uncomfortable, they are not dangerous. Medical professionals can rule out whether your symptoms are a sign of a panic attack or something more serious.

What Causes Fear of Pregnancy & Childbirth?

Women may experience tokophobia for many different reasons.⁶ For most women with tokophobia, fear of pregnancy and childbirth develops during the teenage years or early adulthood. In the case of primary tokophobia, women who already experience anxiety or fears around pain, the unknown, and medical procedures may be at higher risk of developing tokophobia. Women who have heard other people describe negative childbirth experiences or “horror stories” may also be more likely to develop their own negative feelings about childbirth.

Secondary Tokophobia From a Previous Traumatic Birth

Having experienced a traumatic childbirth in the past is a common cause of secondary tokophobia.⁶ A woman who experiences a past childbirth as traumatic can develop fears about future births and anticipate that future births will also be traumatic. What makes a childbirth experience traumatic varies from woman to woman. Two women experiencing the same type of birth may have different opinions on whether it was traumatic.

Experiences during childbirth like the use of forceps, requiring an emergency cesarean section, or having a stillbirth can all contribute to experiencing a birth as traumatic. Negative experiences with medical professionals or a woman’s own support system during birth can also lead to trauma.

History of Abuse

Past history of sexual abuse or rape can also contribute to primary or secondary tokophobia.⁶ Women who have experienced sexual abuse may feel uncomfortable when it comes to being exposed or touched in the vaginal area. The concept of childbirth can trigger these past memories. Women with a history of sexual abuse may have intrusive thoughts or flashbacks to the abuse when they imagine giving birth. This can also be a sign of posttraumatic stress disorder (PTSD).

Tokophobia vs. PTSD From Birth Trauma

Women who have experienced a traumatic birth are at risk of developing both PTSD and tokophobia.³ While the two conditions share similar features, they are distinct disorders.

• PTSD develops after exposure to a traumatic, life threatening event. It involves four types of symptoms, including re-experiencing of the trauma, avoidance, hyperactivity and arousal, and cognition or mood changes.⁴ A woman must experience symptoms from each of these categories for at least one month in duration after the event occurred in order to have PTSD.
• Tokophobia, on the other hand, is a fear of pregnancy or childbirth that can either lead to avoidance or enduring the fear with severe anxiety.

Women who have had a traumatic birth may have both PTSD and tokophobia, just one, or neither disorder. When it comes to trauma, each person is affected differently. Some people who experience trauma go on to develop PTSD or other anxiety disorders while others are able to cope and move forward.

Complications of Tokophobia

With other phobias, you only experience symptoms when exposed to the triggers. With tokophobia, though, you may find it hard to escape the realization of your pregnancy, so symptoms linger for extended periods.

This long-term exposure to the trigger can result in:

• Anxiety: Rather than only creating intense, short-lived panic, tokophobia may create longer lasting anxious symptoms.
• Depression: Anxiety, panic, and depression are intricately intertwined. As anxiety increases, you will have a better chance to experience depressive symptoms, like low mood, irritability, and poor self-esteem.
• Avoiding sexual intercourse: If pregnancy is your trigger, it makes sense that you would begin avoiding intercourse or all sexual activity, even if the avoidance is extreme and irrational.
• Sleeplessness: Both anxiety and depression have the ability to produce sleeplessness and poorer quality of sleep

How Is a Phobia of Pregnancy Diagnosed?

• For people who are pregnant: A medical or mental health professional will evaluate your symptoms and experiences since pregnancy. If symptoms do not change over time and impact your life then you could have the condition.
• For people who aren’t pregnant: Like with any phobia, professionals will look at the intensity of your reaction and the methods you use to avoid exposure. For example, if you avoid all physical contact to keep yourself from getting pregnant, it’s a sign of a problem.

Treatment of Tokophobia

Treatment for phobias may involve therapy, medication, social support, lifestyle changes, or a combination of these options. There are several different types of therapy that are effective for treating this condition. Tokophobia is a treatable condition and women are likely to experience a decrease in their symptoms after seeking help.

Women who recover from tokophobia may feel less anxious about childbirth overall and are less likely to request a cesarean delivery.

Therapy for Tokophobia

Therapy is a common treatment for phobias like tokophobia. Therapy can help you work through your anxiety about pregnancy in several different ways. First, therapy can help you better understand your phobia by exploring how it might have developed and how it is impacting your current life. This is called building insight.

Exposure therapy is typically used for phobias, but tokophobia is different from other types of phobias in that you cannot expose a person to pregnancy or childbirth during a therapy session. Therefore, exposure therapy is not typically used to treat this type of phobia.

Instead, other types of therapy may be used, including:^7,8

• CBT for anxiety
• Psychodynamic therapy
• EMDR for anxiety

Support Groups & One-on-One Support

Support from other people, either by attending a support group or connecting with another person one-on-one can help you deal with your tokophobia.⁸ Support groups allow you to connect with other women who share similar feelings about childbirth and pregnancy. Group members can share their experiences and give and receive advice. Support groups may be run by a mental health professional or another woman who has recovered from tokophobia.

For women without access to a tokophobia support group, speaking with family, friends, or other women about your thoughts and feelings and getting their advice can help you feel supported. Support groups and one-on-one support can be helpful when combined with therapy or, in cases of mild tokophobia, on its own. One study of women with tokophobia found that receiving support decreased the rate of cesarean section births for psychosocial reasons by almost 50%.⁹

Medication

Medications may also be used to treat tokophobia. They can be prescribed by a primary care physician, Obstetrician, psychiatrist, or psychiatric nurse practitioner or physician assistant. Antidepressants and anti-anxiety medications are the most frequently prescribed medications for anxiety.¹⁰

If a woman is already pregnant, there are special considerations to take before prescribing medications for anxiety.¹¹ Certain medications may be harmful to the fetus and can lead to birth complications or birth defects. The pros and cons of a pregnant woman taking medication must be considered carefully. Pregnant women considering medication should consult with a psychiatrist or psychiatric physician that specializes in working with perinatal mental health.

Hypnobirthing

Hypnobirthing is another way that women can help cope with their fear of pregnancy. During hypnobirthing classes, women learn how to use self-hypnosis by engaging the breath to relax and remain calm during labor and delivery. When the body and mind are relaxed, women may experience less pain and anxiety. One study found that women with a fear of childbirth who participated in a hypnobirthing class felt more positive and prepared for labor.¹²

How to Get Help for Tokophobia

There are several different ways to find help for tokophobia. This condition is usually treated by a mental health professional in an outpatient setting. If you are seeking medication, you will want to find a psychiatrist or psychiatric physician extender that specializes in anxiety and perinatal mental health.

If you are seeking therapy, you will want to find a psychologist, social worker, or counselor that also specializes in this area. You can start by calling your health insurance company or conducting a search of in-network providers on their website. The benefit of finding a provider through your insurance company is that all or a portion of treatment may be covered. You can also ask your primary care physician, OBGYN, or midwife for a referral or you can search an online therapist directory for someone who matches your specific needs.

Taking the first steps to get help can be challenging, but working through your tokophobia can help you have a more positive pregnancy and childbirth experience.

Can Tokophobia Be Cured?

Mental health treatment has a great track record of successfully treating phobias. Although your condition may not disappear completely, you could find a significant alleviation of symptoms.

5 Tips for Coping With Tokophobia & Fear of Childbirth

Living with tokophobia can mean experiencing overwhelming anxiety daily, especially as your pregnancy progresses. By arming yourself with coping skills, education, and a birth plan, you can help yourself feel more in control of your labor and delivery experience, which can help alleviate a significant portion of your anxiety.

Here are five practical tips for dealing with Tokophobia:

1. Start a Mindfulness Practice

In addition to treatment, you can also make lifestyle changes to help deal with your fear of pregnancy. Mindfulness meditation is one such practice that can be beneficial for women with tokophobia.¹³ Mindfulness is the act of maintaining awareness of the present moment. There are several different ways to practice mindfulness, such as listening to a guided meditation, practicing yoga, or conducting a body scan.

Beginners can start by finding a meditation class, watching an online video, or subscribing to a meditation app. Practicing mindfulness meditation over time can help you feel more calm, relaxed, and in control of your anxiety.

2. Utilize Coping Skills to Manage Your Anxiety

Coping skills are activities that help you distract yourself from your anxiety by focusing on other positive emotions. Consider coping skills that have worked for you in the past or new ones that you are willing to try, such as yoga, mindfulness, exercise, or art.

3. Take a Childbirth Education Class

Whether you choose Lamaze, hypnobirthing, or another method, taking a class on labor and delivery can help you feel more prepared and relieve fear of the unknown.

4. Develop a Birth Plan

A birth plan is an outline of how you would like your birth experience to go, including who you would like with you and what you would like to do for pain management. Sometimes a birth plan will have to be changed in the moment, but having a guide can help you feel less worried about the process and ensure that your doctor and midwife are aware of your preferences.

5. Remember That It Is Never too Early to Get Help

You can seek treatment for tokophobia even before you are pregnant or early on in your pregnancy. Getting help earlier gives you more time to address your anxiety and work through your phobia.