Tokophobia: What To Do And How To Get Support If You're Pregnant And Scared Of Giving Birth

Women affected may attribute fear to a previous negative experience.

Tokophobia, the extreme fear of childbirth that can be triggered by thinking or even talking about pregnancy, is becoming increasingly common.

That’s according to Gillian Houghton, consultant midwife at Liverpool Women’s NHS Foundation Trust, who believes modern women are feeling less excitement about childbirth and more fear, because it’s like nothing else we experience in our increasingly organised lives.

“Labour can start at any time and in any place, it cannot be planned with certainty and it can unfold in variable ways,” Houghton explained to HuffPost UK.

“What other event is so unique and less predictable?”

What causes tokophobia?

Clare Murphy, director of external affairs at the British Pregnancy Advisory Service (BPAS) explained that tokophobia can be primary, which means it predates a woman’s first pregnancy or secondary, where it is a direct consequence of a previously traumatic delivery, which causes women to fear - and sometimes avoid - going through giving birth again.

Murphy believes there is an issue around using the term “phobia” to describe the condition, as she feels it implies an “irrationality”.

“For many women - particularly those who have undergone a difficult delivery, perhaps with severe blood loss - this feels like an entirely rational response to the situation they have endured,” she said.

“Childbirth may be the safest it has ever been, and maternal mortality is extremely low in countries with advanced healthcare systems, but that does not mean every woman’s experience of birth is a walk in the park, or that they are daft to feel anxious – sometimes profoundly so.”

Other causes of tokophobia can include, according to Houghton: “a previous negative experience of receiving healthcare, previous traumatic personal experiences, hearing negative birth stories and exposure to negative images or portrayals of birth through the media.”

What are some of the signs and symptoms of tokophobia when a woman is pregnant?

Women who are tokophobic and pregnant can experience distressing physical symptoms in the form of panic attacks.

“Their heart races, they become breathless, feel dizzy, faint or feel sick,” explained Houghton.

They may also experience worrying psychological symptoms such as believing they or their baby will die, feeling detached from reality and feeling isolated and alone.

“Women with tokophobia can feel out of control and overwhelmed during pregnancy and in an attempt to reduce symptoms, may try to avoid talking or thinking about the birth, think or talk about the birth all the time, or plan to quicken the birth experience by requesting a caesarean.”

How can we differentiate between someone who is naturally worried about giving birth and someone who has tokophobia?

Feeling anxious about childbirth is a normal response, according to Houghton, and it can even be useful in motivating pregnant women to prepare themselves for the birth.

But a woman who is tokophobic will have a lot more “severe” thoughts and worries that affect their lives every day.

Common elements of extreme fear women disclose include the possibility of sustaining birth injuries, dying themselves or their baby dying, experiencing unbearable pain, not feeling supported by family, friends or medical professionals, not having the physical or emotional capacity to give birth and losing emotional or physical control,” she explained.

“Women with tokophobia will experience worrying psychological symptoms such as believing they or their baby will die.”

- Gillian Houghton, consultant midwife at Liverpool Women’s NHS Foundation Trust

How do midwives work with women who are fearful of giving birth?

Midwives will provide support to women with tokophobia in a variety of different ways.

“Many women feel better just discussing their anxieties with someone who understands, so I do a lot of listening,” explained Houghton.

“Some women need more information, this might be in relation to their birth choices, and include information on choosing a caesarean birth.

“I provide a lot of information on symptoms, how the brain works and strategies and techniques to control or lessen fear and panic responses.”

Houghton said consultant midwives will generally work with women to support birth without resorting to surgery.

“This is not purely because caesarean birth is associated with significant risks to women, their babies and the health of society generally,” she said.

“But because avoiding the thing that is feared (giving birth) can actually encourage health-related fears to escalate and multiply.”

How can pregnant women who are tokophobic prepare themselves for giving birth?

Women who are tokophobic may feel like they don’t have control over how they feel, but there are steps they can take to help them prepare for the unexpected:

Relaxation Techniques

Houghton advised trying relaxation techniques - such as mindfulness and hypno-birthing - to help reduce anxieties so you can begin to imagine, visualise and ultimately plan for your baby’s birth.

Write A Birth Plan

“Control is a very important factor,” said Houghton. “Writing a birth plan can help a woman feel in control and involved. She can express her worries and preferences and influence what will happen around the time of her baby’s birth.

“I regularly work with women who are fearful of the birth, by developing birth plans that meet specific needs, for example agreeing we will avoid ‘routine’ interventions such as vaginal examinations, having a birth partner stay after the birth or making her desire for epidural at a very early stage of labour clear.”

Houghton added: “It’s very important to balance the risks associated with caesarean birth with the possibility of negative emotional/psychological outcomes associated with a planned vaginal birth.

“Arranging a caesarean birth is sometimes the most appropriate option.”

Get Support

“I always encourage women with a fear of birth to access as much support and help as they can get,” said Houghton. “For example, talking to their midwife or GP. There are also excellent support services such as the Birth Trauma Association.

I also try to help women identify personal resources that might help them feel more confident generally, such as the help of a friend, support of their partner or developing a close relationship with one midwife.”

Murphy agreed, adding that there is greater recognition now of the issues women can face, so women are encouraged to open up so they can access early support.

“Women need to feel they are in control and that they have choices,” she added.

Treatment And Therapy

Women can be referred for treatments such as CBT (Cognitive Behavioural Therapy), EDMR (Eye Movement Desensitisation and Reprocessing), which involves making side-to-side eye movements while recalling a traumatic incident, and the REWIND technique, where people are encouraged to bring their anxieties to the surface, and then are calmed down again.

For more information and support:

- If you suffer from tokophobia and are pregnant, speak to your midwife or GP about this as soon as possible.

- If a previous traumatic birth has caused you to develop tokophobia, you can contact the Birth Trauma Association, which supports women by offering emotional and practical support to them and their families.

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