What is a fear of childbirth?

Fear of childbirth is also known as tokophobia. It is a severe (or phobic) fear of giving birth, with high levels of anxiety about birth, even if your desire is to have a child. Some women also feel very anxious and uncomfortable about pregnancy. Many women experience some uncertainty or anxiety about giving birth. More severe fear of childbirth may affect up to 14% of women. Primary tokophobia refers to women who have had no previous experience of birth but who nevertheless have a strong fear of childbirth. In these cases, the feelings of dread associated with childbirth may link to early experiences and can start in adolescence. Secondary tokophobia is the most common form of tokophobia and occurs in women who have already had a baby. This is where the woman has had a previous traumatic experience of childbirth. It is considered to be a form of post-traumatic stress disorder (PTSD).

Why might I have a fear of childbirth?

• A previous birth that you experienced as traumatic
• A previous traumatic medical experience
• Experience of sexual assault or rape
• A history of childhood abuse
• A history of mood disorders, anxiety disorders (including PTSD)
• A strong need to be in control
• Hearing, reading or witnessing negative experiences of childbirth

How might tokophobia make me feel?

• Distress and heightened anxiety when a pregnancy is confirmed
• Feelings of being out of control and trapped, agitation, irritability, stress, restlessness and nervousness
• Feelings of isolation, loneliness, being misunderstood and unsupported
• Negative thoughts about being abnormal and different to the people around you, especially those who are pregnant
• Thoughts about having an abortion, even though you want to have children
• Self-doubt about your ability to go through labour and birth
• Intrusive thoughts and memories (sometimes images) of a previous traumatic birth
• Fear of harm or death as a result of birth (in relation to both mother and baby)
• Increasing distress and anxiety throughout the pregnancy and especially in the last trimester
• Symptoms of anxiety, which can include: altered sleep pattern, nightmares, rapid heartbeat, tension, abdominal pains and panic symptoms, difficulty relaxing
• Avoidance of talking about/thinking about birth
• Avoidance of antenatal education

How can I help myself?

The earlier you can get help the better:

• Speak to your partner and family/friends if you feel comfortable doing so
• Speak to your Consultant Obstetrician and/or midwife and enquire what options and services are available for women with tokophobia
• You will be offered an appointment in the Birth Choices Clinic to discuss your concerns. You may benefit from psychological therapy such as cognitive behaviour therapy (CBT) either in an IAPT service or in a perinatal mental health service. Your midwife, obstetrician or GP can refer you or you can self-refer to your local IAPT
• Read relevant sources of information – don’t rely on information from blogs or internet forums.
• Write a detailed birth plan in partnership with your birth partner and midwife
• Arrange to visit the labour ward or birth centre so that you can become familiar with the environment
• If you are concerned about coping with pain, request an appointment with an anaesthetist to discuss pain relief options
• Take care of yourself with a balanced diet, exercise, relaxation
• Consider yoga and mindfulness

Can I request a caesarean section?

• If you feel strongly that a caesarean section would be the best birth option for you, let your midwife or obstetrician know this as soon as possible. Appropriate support will be offered to address your anxieties, including some of the options discussed above
• Maternity services will work together with you towards a plan for the birth that takes account of both your physical and mental health
• Often, the decision about mode of birth will be made in the third trimester (recommended at around 32 weeks)
• Ultimately, if you feel that a caesarean section is the best choice for you, it will be offered to you

What about after the birth?

Discuss your experience of the birth with a health professional. This could be someone you saw antenatally such as a specialist mental health midwife, consultant midwife, a perinatal mental health professional or your psychological therapist. Alternatively, it might be your midwife, health visitor or GP. If you need further support, you may be able to access a birth reflections appointment, support from a perinatal mental health team or psychological therapy.