The fear of giving birth is not always on the common list of phobias — but maybe it should. It’s more pervasive than most people think, and it’s poorly understood.

Fear of heights. Fear of flying. Fear of spiders. Fear of germs. We know about irrational fears through popular media, armchair psychologists, journal studies, case reports. A lesser-known phobia, though, has not been given as much spotlight as others, and health professionals say it is time to pay attention. The stranger is tokophobia — so what is it?

The name of the phobia refers to a pathological fear of pregnancy and avoidance of childbirth; it can also be spelled with toc-, toco-, tok-, and toko- as combining forms, and all refer to labor or childbirth.

At first glance, it wouldn’t really seem like a big deal or a common problem. But this should not be confused with the usual concerns pregnant women may have after reading tips on what to do and not to do during pregnancy — this fear is much more intense and abrasive . Tal Slome wrote in kidspot that “It can be so debilitating that sufferers may avoid pregnancy, or, in extreme cases, choose to terminate a pregnancy or refrain from sex altogether.” She said that symptoms can include nightmares, sleeplessness, overwhelming fear of stillbirths, maternal death, birth defects.

Here is one observation published in a blog of BMJ, one of the most reputable medical journals, and a subsidiary of the British Medical Association, further detailing the issue.

“Tokophobia is an extreme fear of pregnancy and childbirth; it causes severe psychological distress and can have far reaching consequences. Despite this, tokophobia is under-researched and many healthcare professionals have never heard of it.” The author of the BMJ blog entry, Sarah-Jane Archibald, is a UK-based clinical psychologist.

Depending on where you look, tokophobia is described as fear of pregnancy and childbirth, but it is also frequently described as, primarily, a fear of childbirth. An article from authors at the University of Hull and Southern Cross University last December in The Conversation, for example, defined tokophobia as “a severe and unreasoning dread of childbirth, which is sometimes accompanied by a disgust of pregnancy.”

Discussion after discussion bears a similar lament among health professionals: As Melissa Weinberg, a therapist wrote in Psychotherapy.net in February, this phenomenon is widely experienced, yet “not thoroughly researched. There are some, but not enough, comprehensive studies.” The literature mentions the problem, but there are indeed more questions than answers at this point.

Triggers vary

Tokophobia can come in two forms: primary (in women who have not had a baby before) and secondary (women who have previously had a baby).

In a study published in the in Industrial Psychiatry Journal, Manjeet Singh Bhatia and Anurag Jhanjee referred to it as “a pathological fear related to childbirth.” They explain:

“Primary is morbid fear of childbirth in a woman, who has no previous experience of pregnancy. Secondary is morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy.”

The two authors observed that triggers for this fear can come from a number of situations. They discussed hypotheses for why a woman might fear childbirth and there’s a wide variety of reasons. Examples of what include disturbance in mechanisms regulating anxiety; the women talked with women who had already undergone traumatic births; they are afraid they will receive poor medical care (ineffective pain control, low confidence in team providing care); and factors such as traumatic memories of childhood or psychiatric disorders.

So how likely is it that you would ever know someone with tokophobia? From Australia, earlier this year, Shona Hendley wrote in Body and Soul that “tokophobia can affect anywhere between 2.5-14% of women; although some studies have identified this figure as high as 22%.”

Addressing the issue

Tokophobia has two main challenges: understanding its causes and its profiles is the first. The second is, given its complexity, figuring out effective interventions which ideally are evidence-based. Since there is such a wide variety in the way it manifests, neither will be easy.

The authors from University of Hull and Southern Cross who wrote in The Conversation said that there was “much work left to do if we are to understand and identify when standard worries deviate from expected levels to problematic levels.” Elsewhere, Weinberg noted that there was little in the way of specific treatment guidelines.

Meanwhile, the authors from University of Hull and Southern Cross University last December in The Conversation reminded readers of their new paper published in the Journal of Reproductive and Infant Psychology, which reflected on a decisive meting of researchers and clinicians to nail down what’s missing un the way tokophobia is identified and treated. That meeting’s conclusion: “Significant gaps remain within the FoC/tokophobia knowledge base.” FoC stands for fear of childbirth. The authors in The Conversation did talk about treatment options, which if simplified might be summed up as listen carefully to the woman and give her support. They said among approaches that may help was “additional midwifery support to discuss the birth, with continuity of care, which is where the same midwife and/or midwifery care team sees the woman throughout pregnancy and labor.”