Many pregnant women worry about birth. Some, however, suffer from a much more serious condition called tokophobia: a severe and unreasoning dread of childbirth, which is sometimes accompanied by a disgust of pregnancy.
At its most extreme, tokophobia can lead to:
- an obsessive use of contraception to prevent pregnancy
- termination of pregnancy
- not attending maternity care appointments
- post-traumatic stress disorder and/or other mental health disorders and mother-baby bonding difficulties.
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Tokophobia comes in two forms: primary (in women who have not had a baby before) and secondary (women who have previously had a baby).
Women with tokophobia in a previous pregnancy are more likely to have it in a subsequent pregnancy, resulting in a potential cycle of anxiety and depression.
Our new paper, published in the Journal of Reproductive and Infant Psychology, reflects on a recent meeting of researchers and clinicians about what’s missing from the way we identify and treat tokophobia.
Hard to define, hard to screen for
It’s hard to say how many women are affected by tokophobia; it’s been defined and measured using different questionnaires. One research paper estimated the prevalence of tokophobia at 14% of pregnant women worldwide.
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Screening for tokophobia is not common practice around the world. Screening questionnaires sometimes ask the woman questions about her mood, whether she has fears for herself or her baby, about feeling so afraid of childbirth she’s considered terminating the pregnancy, or feeling fear so overwhelming it interferes with eating, work or sleep.
In other words, tokophobia goes beyond normal childbirth concerns and worries, and becomes an intense and irrational fear of pregnancy and/or labour.
It’s important women with this condition are identified as soon as possible but that often only happens when they seek specialised professional help. This can sometimes (but not always) take the form of a request for a termination of pregnancy or caesarean section.
Treatment for tokophobia remains patchy but should be determined based on factors such as the woman’s level of fear, stage of pregnancy and her individual wishes.