How common is tocophobia?

It has been estimated that tokophobia may affect more than 20% women in Western countries. Analyses conducted by researchers at the Medical University of Szczecin showed that tokophobia accounted for 25% of extra-obstetric indications for caesarean section between 2014 and 2018, which was not reported in previous years.

What are the types of tocophobia?

Common fears reported by women suffering from tocophobia can be related to fear of the unknown, labour pains and the safe arrival of the baby into the world. However, the causes of tokophobia can be complex, including difficult childhood experiences, previous traumatic experiences in hospital, a history of sexual abuse and a lack of trust in hospital staff.

Tokophobia can be primary or secondary. The former affects women who have never given birth and is most often neurotic in origin. This fear can also be caused by stories from other women who have given birth or the death of a loved one during childbirth. Many women say they are afraid of losing control of their bodies during childbirth and the unknown amount of pain. They are terrified that their body will change, that they will no longer recognise themselves in it or that they will no longer be attractive to their partner. Fear of childbirth may be related to a previous history of mental disorders i.e. anxiety, depression or eating disorders.

Secondary toxophobia is related to traumatic experiences during previous births/births or may occur in the course of a depressive disorder that occurred earlier. Possible causes also include a traumatic previous pregnancy, such as a miscarriage. Importantly, it has been noted that assisted reproductive techniques are not associated with an increase in the incidence of tokophobia. In the worst case scenario, tokophobia can be so profound that some women, even those who wish to have children, choose not to get pregnant.

What is the difference between simple fear and tokophobia?

Many common phobias include a fear of heights, public places or being in enclosed spaces. People with phobias avoid what they fear and, if they cannot, experience panic, rapid heartbeat, shortness of breath, trembling and a strong desire to escape. Tokophobia is included in a group of so-called specific phobias, which are defined by diagnostic criteria in medical classifications (ICD-10 or DSM 5). Specific (so-called isolated) forms of phobia may concern specific features of the environment (e.g. wind - ankraophobia), objects, animals or specific situations. Hence, tokophobia is in the same group of disorders as, for example, arachnophobia (fear of spiders), haemophobia (fear of blood) or lepidopterophobia (phobia of butterflies).

In the case of specific phobia, the anxiety is usually stronger and occurs immediately in a situation that may trigger the phobia. There may also be a marked avoidance of any subject related to the fear-inducing topic. Fear also leads to feelings of discomfort and stress and can affect other areas of life. In the case of fear of childbirth, even the sight of another pregnant woman can trigger crying, hyperventilation, sweating and nausea.

Factors associated with fear of childbirth

Among the most common factors associated with tocophobia are:

fear of pain,
low pain threshold,
concern for the child's health.

In addition, causes related to loss of control over the situation, body changes and fear of the unknown are important, including:

fear of loss of privacy and dignity,
fear of complications of pregnancy/birth or significant harm to the child,
lack of support from relatives,
fear of not getting adequate pain relief or not getting adequate medical care.

Many researchers note that women who experience fear of natural childbirth also experience pain more strongly during labour, which can further reinforce later anxiety in subsequent pregnancies. In women with tokophobia, the anxiety and fears are so strong and intense (often associated with phobic symptoms such as panic attacks, insomnia and sleep nightmares) that they require specialised care.

Fear of childbirth can also result from depression or other psychiatric conditions, such as obsessive-compulsive disorder (OCD) or paroxysmal anxiety syndrome. When a woman has comorbid depression, whether she has had a previous pregnancy or not, she may have intrusive thoughts that she will die if she tries to give birth. In this situation, fear of childbirth is associated with depression and depressive personality. Theophobia may also co-exist with other phobias: fear of injections, fear of seeing blood or social anxiety.

Help and therapy for tokophobia

How to deal with fear of childbirth? As with all anxiety disorders, psychotherapy plays a huge role in treatment. If you notice anxiety that intensifies as your pregnancy approaches termination, it is a good idea to go for a psychological consultation. Meeting with a specialist can help you look at whether the accompanying fear is a natural occurrence or requires therapeutic intervention. If the anxiety is simply related to a new situation, a few meetings with a psychologist are usually sufficient help.

If a phobia exists, therapy is often longer. Therefore, it is important not to wait until the last minute to seek counselling, but to come in as early as possible. Theophobia, like other phobias, can be treated with cognitive behavioural therapy using exposure and anxiety reduction techniques or anti-anxiety and antidepressant medication.