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, but research suggests that more severe fear of childbirth may affect up to 14% of women.

There are two recognised types of tokophobia:

• Primary tokophobia refers to women who have had no previous experience of birth, but who nevertheless have a longstanding strong fear of childbirth. In these cases, the feelings of dread associated with childbirth may link to early negative experiences, anxiety or trauma unrelated to childbirth and can start in adolescence
• Secondary tokophobia is the most common form of tokophobia and occurs in women who have already had a difficult or traumatic previous birth. It is now widely recognised as a form of birth-related 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 and practical steps can help.

Talk to someone you trust  

Speak to your partner and family/friends if you feel comfortable doing so.

Speak to your Midwife or Obstetrician

• They can listen to your concerns and discuss your options
• They can refer you to Birth Choices Clinic to discuss your concerns
• They can arrange for support from perinatal mental health specialists because you may benefit from psychological therapy such as cognitive behaviour therapy (CBT) Your midwife, obstetrician or GP can refer you or you can self-refer to your local counselling service

Read relevant sources of information

Don’t rely on information from blogs or internet forums and gradually expose yourself to reliable information.

Write a detailed birth plan

You can do this in partnership with your birth partner and midwife, or within the Birth Choice Clinic.

Arrange to visit the labour ward or birth centre

This will help you become familiar with the environment and reduce anxiety.

Request an appointment with an anaesthetist

They may be able to help you to discuss pain relief options.

Take care of yourself

You can do this with a balanced diet, exercise, relaxation.

You can 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. You will be referred to the Birth Choices Clinic where you will receive appropriate information and support 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. You can access the Birth Afterthoughts Service to discuss the events surrounding your birth or alternatively you could speak with your perinatal mental health professional or psychological therapist for further support

Birth Afterthoughts Self-Referral:  [email protected]

Lincoln Labour Ward           01522 573889

Lincoln AAC                         01522 573138

Pilgrim Labour Ward            01205 445424

Pilgrim AAU                          01205 445144