Fear

Tokophobia: Fear of Pregnancy and Childbirth

Many struggle with tokophobia, but in subtly different ways.

Posted Nov 23, 2020

The concept of pregnancy and childbirth can prompt a range of emotional reactions. It’s normal to have conflicted and varied responses. For some though, the idea prompts terror and disgust that goes beyond what might be thought of as normal apprehension or anxiety. This intense fear of pregnancy and/or childbirth is tokophobia

Tokophobia can involve debilitating distress, a variety of panic and disgust-based physical responses, phobic avoidance, and various compulsions. These often have notable impacts on a person’s relationships and life choices, potentially depriving a person of meaningful relationships or desired children. When pregnancy is undertaken, it is with intense trepidation.

Unfortunately, while there is some formal research on tokophobia and its treatment, there does not seem to be an abundance of it. The term itself was only coined in the 2000s. In the studies available since then, the definition of tokophobia varies—making it challenging to draw accurate conclusions. And because the fear of pregnancy and fear of childbirth are often lumped together in the definition (as are primary and secondary tokophobia—see below), it is tricky to find information on more nuanced presentations. 

Types of Tokophobia

The distinction is typically made between primary and secondary tokophobia. Primary tokophobia refers to the fear of pregnancy/childbirth without first-hand experience of it (often developing in childhood/adolescence). Secondary tokophobia is a fear that arises following a traumatic pregnancy, loss, or birthing experience. 

There seem to be further qualifiers, applicable to both primary and secondary tokophobia, that I would identify as the following (please note that this is not based on empirical research, but on my reading and clinical observations):

  • Reluctant: A person with this type of tokophobia has decided that they do indeed want to have a baby. They may be certain of their desire to have a biological child through pregnancy but be completely paralyzed by fear and unable to take any steps at all toward the goal. Or they might take steps to get pregnant, but along the way be plagued with panic attacks, extreme fear of pain, uncontrollable worry, or other anxious symptoms. 
  • Avoidant: A person with this type of tokophobia decidedly does not want to get pregnant at this time in their life. The tokophobia presents more as obsessive-compulsive disorder (OCD), with obsessive worry about getting pregnant. Much like with contamination OCD, a person with this type of tokophobia may sense that they have somehow come into contact with semen in public spaces or have extreme anxious reactions before, during, and after any sexual contact. They may be stuck in a monthly cycle of intense worry leading up to the relief of getting their period. They may engage in avoidance—by not pursuing romantic relationships or by abstaining from sex altogether. They may also engage in compulsive checking (e.g., taking frequent pregnancy tests), safety behaviors (e.g., using multiple forms of birth control), reassurance seeking (e.g., asking partners, friends, and family for reassurance that they are not or could not be pregnant), information-gathering (e.g., researching if it’s possible to get pregnant in obscure ways) and other rituals to quell what they perceive as the likelihood of becoming pregnant. 
  • Ambivalent: In the third category are people that for various reasons are on the fence about whether they want children at all (or additional children) and are especially fearful about having their own through pregnancy. They may experience obsessive doubt and intolerable uncertainty about the decision. 

While research and formal guidelines for the treatment of tokophobia are scant, it seems clear that a holistic, multifaceted approach, to create the most densely layered web of support, is ideal—especially for those attempting to get pregnant and give birth. It could be helpful to identify which type of tokophobia a person is experiencing to inform the most appropriate approaches to treatment. 

Ultimately, there are no right or wrong or prescribed choices. Not gestating and birthing a biological child is a perfectly valid choice that should be embraced if that’s genuinely what you want. If, however, your aim is to get pregnant and tokophobia is the main hurdle standing in your way, know that there are approaches to manage the fear and feel supported. If you are not looking to get pregnant but you avoid relationships and sexual contact for fear of getting pregnant, know that there are ways to work through the fear and have meaningful connections with others. If you are perpetually in a state of distress at the thought of getting pregnant, there is relief. 

In short, if you find yourself profoundly fearful of pregnancy and childbirth, know that you are not alone. There is nothing wrong with you, you are not broken, and you have options.

More posts on treatment recommendations to come. For now, for further reading, please see the reference section below.

Update: See follow up posts on therapeutic recommendations and additional suggestions for managing tokophobia.  

Facebook image: zulufoto/Shutterstock

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830168/ 

https://core.ac.uk/download/pdf/25510068.pdf

https://www.glowm.com/pdf/section4_chapter21.pdf

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13138

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/tokophobia-an-unreasoning-dread-of-childbirth/492B8EB19D16A2BD455E6BE7539564C9

https://theconversation.com/tokophobia-what-its-like-to-have-a-phobia-of-pregnancy-and-childbirth-91271

https://www.womenandbirth.org/article/S1871-5192(17)30025-2/abstract

https://www.theatlantic.com/health/archive/2016/06/tokophobia/489206/

https://www.theatlantic.com/notes/2016/07/how-to-overcome-your-fear-of-giving-birth/490001/

https://www.nct.org.uk/pregnancy/how-you-might-be-feeling/tokophobia-how-get-over-extreme-fear-giving-birth

https://www.birthtraumaassociation.org.uk/

https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/

https://theswaddle.com/the-pathological-fear-of-getting-pregnant-is-called-tokophobia/