Tokophobia

Tokophobia is a significant fear of childbirth. It is a common reason why some women request an elective cesarean section. Factors often include a fear of pain, death, unexpected problems, injury to the baby, sexual problems and a lack of self-belief of the capacity to birth a child. Treatment may occur via counselling.

It is a type of specific phobia. In 2000, an article published in the British Journal of Psychiatry described the fear of childbirth as a psychological disorder that has received little attention and may be overlooked.

Signs and symptoms
Phobia of childbirth, as with any phobia, can manifest through a number of symptoms including nightmares, difficulty in concentrating on work or family activities, panic attacks and psychosomatic complaints. Often the fear of childbirth motivates a request for an elective caesarean section. Fear of labor pain is strongly associated with the fear of pain in general; a previous complicated childbirth, or inadequate pain relief, may cause the phobia to develop. A fear of pregnancy itself can result in an avoidance of pregnancy or even, as birth control methods are never 100% effective, an avoidance of sexual intercourse or asking for sterilization, e.g. via hysterectomy.

Tokophobia is a distressing psychological disorder which may be overlooked by medical professionals; as well as specific phobia and anxiety disorders, tokophobia may be associated with depression and post-traumatic stress disorder. Recognition of tokophobia and close liaison with obstetricians or other medical specialists can help to reduce its severity and ensure efficient treatment.

The causes of tokophobia are complex and unique for every woman. Ways of treating tokophobia need to be investigated further but a number of psychological interventions including psychoeducation [18], cognitive behavioural therapy, enhanced midwifery care [19], psychodynamic therapy and eye movement desensitisation and reprocessing therapy [20], have been found to reduce FOC in pregnant women. More tailored support needs to be developed since not all women have the same type of symptoms and fears.

Cause
Reasons for tokophobia can be complex, and are associated with a lack of social support, and with stress, depression and anxiety.

Primary tokophobia
Primary tokophobia is the fear and deep-seated dread of childbirth in women who have never experienced birth. It may pre-date pregnancy and can start in adolescence or begin in pregnancy. This may relate back to their own mother's experience or be triggered by exposure to childbirth without adequate explanation at a young age. It may also be experienced by women who have been sexually abused or raped; childbirth could trigger flashbacks in women who are traumatised.

Secondary tokophobia
For parous women, a previous negative birth experience is often the underlying cause of fear of childbirth (tokophobia). Sometimes the negative birth experience is strongly correlated to having experienced imminent danger to the health of the child, such as having an emergency caesarean section [10-11].

Risks
Unaddressed tokophobia may lead to termination of pregnancy, a prolonged labour, epidural use and complications during childbirth. Tokophobia is also associated with postpartum depression and post-traumatic stress disorder (PTSD).

Terminology
The term tokophobia was introduced in the medical literature in 2000. The word is from the Greek tokos, meaning childbirth and phobos, meaning fear.

It is also known as "maleusiophobia" (though this is certainly a variant of "maieusiophobia", from the Greek "maieusis", literally meaning "delivery of a woman in childbirth" but referring generally to midwifery), "parturiphobia" (from Latin parturire, meaning "to be pregnant"), and "lockiophobia".