Pregnancy and childbirth are significant milestones in a woman’s life, often filled with excitement and joy. However, it’s also normal to experience stress and worries during this time. Concerns about the baby’s health, the pain of childbirth, and potential complications can be common and reasonable. Most women find support from medical professionals, allied health experts, education, and social support to manage these anxieties effectively.

In some cases, the anxiety surrounding pregnancy and childbirth can become severe and start to impact daily functioning, relationships, and overall well-being. These women may experience persistent and difficult-to-control worry, making relaxation challenging. Some may immerse themselves in exhaustive research about foetal development, labor, and delivery, spending hours each day on these topics.

Researchers introduced the term ‘tokophobia’ in the early 2000s to describe an intense fear and pathological dread of pregnancy and childbirth, despite the strong desire to have a baby. This condition falls under the category of ‘specific phobia,’ an anxiety disorder characterised by excessive and intense fear related to a particular situation or object. Women with tokophobia may take extreme measures to avoid becoming pregnant, even if they deeply desire to have children. This can involve refraining from sexual intercourse or using multiple methods of contraception simultaneously. Some may insist on having caesarean sections without medical necessity, while others may choose to terminate pregnancies without medical reasons.

Two types of tokophobia are identified in the literature, based on different causes:

1. Primary tokophobia: Occurs in first-time mothers and can develop as early as adolescence. It may result from exposure to horror birth stories or experiences of sexual assault or abuse.
2. Secondary tokophobia: Develops after a traumatic delivery in the past, which could include instrumental or operative deliveries, fetal distress, severe pain during delivery, or significant perineal injury. It can also arise from experiences of miscarriage, stillbirth, or termination of pregnancy.

Certain factors may increase the risk of developing tokophobia, although having these risk factors doesn’t necessarily mean an individual will experience the condition. These factors include:

• Previous or current mental health diagnoses like generalized anxiety or depression.
• Limited social support and relationship difficulties.
• Personality traits such as perfectionism, anxiety-prone styles, low self-esteem, or high neuroticism.
• History of sexual assault or abuse.
• Traumatic birth experiences.
• Exposure to negative birthing stories.
• Distrust of medical professionals.

For women experiencing tokophobia symptoms, access to support is vital to ensure positive outcomes for both the mother and baby. A multidisciplinary team, including a GP, midwife, obstetrician, social workers, and psychologists, typically provides education, guidance, and reassurance. Additionally, connecting with other women who share similar experiences can be beneficial.

Psychological treatment for tokophobia often involves education about the factors contributing to anxiety and developing coping skills. Perinatal psychologists may explore crucial psychological factors, such as attachment patterns, pregnancy and birthing expectations, early childhood experiences, relationship issues, and trauma history. This information helps create an individualised treatment plan aligned with the client’s personal values and goals. In some cases, antidepressant medication, in consultation with a psychiatrist, may complement psychotherapy.