Tokophobia is a fear of pregnancy and childbirth that affects approximately 6 to 10 percent of pregnant women.1 Women with tokophobia may feel significant anxiety about pregnancy, labor, and delivery. There are several different options available for treating tokophobia, including therapy, medication, and support groups. Women with this condition typically experience an improvement in their symptoms after seeking help.
Symptoms of Tokophobia
Specific phobias like tokophobia involve fear and anxiety that is excessive and more than what would be expected in a given situation.2 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:2
- 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
- Her anxiety is not better explained by another mental health diagnosis, like obsessive-compulsive disorder (OCD) or posttraumatic stress disorder (PTSD)
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:2
- 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 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.
Causes of 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.3 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.3
Women may experience tokophobia for different reasons.3 For most women, 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.
Having experienced a traumatic childbirth in the past is a common cause of secondary tokophobia.3 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.
Past history of sexual abuse or rape can also contribute to primary or secondary tokophobia.3 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).
Treatment of Tokophobia
Treatment for phobias may involve therapy, medication, social support, and lifestyle changes, or a combination of these options. There are several different types of therapy that are effective for treating this condition. Like other types of phobias, 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.
Therapy can also teach you coping skills to use when you are feeling anxious. This can help you deal more effectively when your anxiety is triggered. Third, therapy can help you learn healthier ways to think about and respond to your phobia, so you are less likely to avoid that which makes you anxious. These skills can help you live a life that is no longer controlled by your anxiety.
Specific phobias are typically treated with exposure therapy, which involves a therapist gradually introducing the feared object or experience to the client while helping the client relax and manage the anxiety.4 The goal of exposure therapy is to help the client get to the point of coping with the anxiety that arises when around the feared object without avoiding the feared object.
However, 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, like cognitive behavioral therapy (CBT), psychodynamic therapy, and alternative therapies like eye movement desensitization and reprocessing (EMDR) may be used.5,6
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an effective therapy for treating tokophobia.5 CBT focuses on a person’s thoughts and how thoughts may be contributing to negative emotions, like anxiety. CBT helps a person identify negative thought patterns and learn ways to change these thoughts so that they are less rigid and irrational. By thinking in a more rational and flexible way, a person is better able to control their anxiety. CBT also involves teaching skills to deal with anxiety and stress, like deep breathing and mindfulness techniques.
Psychodynamic Therapy
Psychodynamic therapy is another type of therapy that can be used to treat tokophobia.5 This type of therapy focuses on how unconscious thoughts and feelings affect a person’s emotional state. During therapy, individuals are encouraged to freely express what they are thinking and feeling. The therapist then makes interpretations to help the person better understand their unconscious.
Women with tokophobia often experience a fear of losing control, which can be explored and better understood during psychodynamic therapy. This can help increase self-awareness and understanding, which can in turn lead to greater control over a person’s anxiety.
Eye Movement Desensitization and Reprocessing
Another approach to therapy that can be used to treat secondary tokophobia is eye movement desensitization and reprocessing (EMDR).6 This type of therapy involves a person recalling a traumatic event, like childbirth, while the therapist encourages rapid eye movements by making specific hand motions in front of the individual’s face. This technique is believed to help the person release negative emotions associated with the traumatic event. A therapist must be specifically trained in EMDR to provide this type of therapy.
Intended Treatment Outcome & Timeline
Specific phobias like tokophobia have a good prognosis, meaning that people with this condition that seek treatment often experience an improvement in their symptoms. In some cases this may happen after one therapy session, but often it can take several sessions to notice changes.4 Typically, the longer that you are in treatment, the more likely you will be to overcome your phobia and maintain your progress over time. The length of time it will take to overcome your phobia will depend upon how severe it is. A mental health professional will be able to provide you with more information about the intended treatment timeline after conducting a thorough evaluation of your symptoms.
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.6 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 sharing information and 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 caesarean section births for psychosocial reasons by almost 50 percent.7
Medication
Medications may also be used to treat specific phobias like 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.8
Antidepressants are effective in treating both depression and anxiety.8 Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressants. These medications increase the levels of serotonin in the brain, which can help reduce anxiety. SSRIs must be taken on a daily basis in order to experience their full effects. Common SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa).
Anti-anxiety medications include benzodiazepines, which help alleviate severe anxiety and panic attack symptoms.8 These medications can be taken on an as-needed basis, rather than every day. Benzodiazepines are typically prescribed for short periods of time because long-term use can lead to addiction in some cases. Common benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan).
If a woman is already pregnant, there are special considerations to take before prescribing medications for anxiety.9 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 extender that specializes in working with perinatal mental health.
Lifestyle Changes
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.10 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 mindfulness-based app. Practicing mindfulness meditation over time can help you feel more calm, relaxed, and in control of your anxiety.
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.11
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, phobias, and/or 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 conduct an online search. 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.
Living with Tokophobia: Coping & Managing Symptoms
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.
Practical tips for dealing with Tokophobia include:
- 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.
- 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.
- Develop a birth plan with your doctor or midwife: 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.
- 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.
Tokophobia Statistics
Tokophobia, a type of specific phobia, affects a significant number of pregnant women. The prevalence of tokophobia may be higher than other specific phobias because this type of phobia is not frequently accounted for in studies of specific phobias.
- According to the National Comorbidity Survey Replication (NCS-R), approximately 9.1% of adults over age 18 had a specific phobia within the past year and around 12.5% had a specific phobia at some point in their lifetimes.12
- The NCS-R also found that women were more likely than men to have had a specific phobia within the past year (12.2% vs. 5.8%).12
- Tokophobia is believed to affect up to 20% of women in Western countries.1 This includes mild and severe forms of tokophobia.
- Severe tokophobia affects around 6 to 10% of pregnant women.1
Additional Resources
For more information on tokophobia and specific phobias, how to tell if you are suffering from it, and what to do to get help, see the following organizations:
- Tommy’s Together, for every baby
- National Institute on Mental Health
- Anxiety and Depression Association of America
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
