Although it’s normal to anticipate pain and have certain fears about giving birth, some women are much more affected than others by the intensity of their fears about carrying and giving birth to a baby.

Tocophobia is the fear that some women feel at the mere thought of carrying a baby in their womb and/or giving birth to one. This state of being is distinguished by its intensity and the consequences it can have on the woman herself and possibly on the baby. In the past, we used to talk about anxiety in pregnant women, which increased as the pregnancy progressed.

Although little known, according to Scandinavian studies, it can affect between 2% and 5% of women, especially after 20 weeks of pregnancy and just before childbirth. Living with these excessive and persistent worries is no mean feat, since this fear is at the root of many torments in everyday life. Those who suffer from them have difficulty managing and controlling their reactions, which often become invasive and responsible for their withdrawal and isolation. Seeing a pregnant woman, hearing about a baby on the way, may already be too much for them.

Without giving a precise picture with the figures available for the moment, some researchers in the field of tocophobia suggest that around 20 to 25% of women pregnant with their first child have experienced a mild to moderate fear of childbirth, while 6% describe their perceived fear as severe, extreme. The number of women living with tocophobia appears to be on the rise.

In general, motherhood is highly valued in society. The pregnant woman attracts attention and benevolence for this body that is carrying another. However, while for many women pregnancy and childbirth represent the most fulfilling and enriching experience of their lives, for others it’s a real nightmare. The very thought of feeling a living being stirring in the womb, and imagining that the baby will one day have to crawl out of there through the vaginal canal, is enough to create indescribable panic and dread.

The history of tocophobia

Even if the term tocophobia doesn’t ring a bell, the manifestations of this state of being are nothing new. As far back as the 1800s, it was documented in Germany that many women of that era suffered from these extreme fears, obviously linked to the experience of that period when maternal and infant mortality was very high. Today, with the care of pregnant women and babies, these fears are considered more irrational.

It wasn’t until the 1980s that the Scandinavians wanted to know more about this phenomenon, and carried out more in-depth research into what they called tocophobia. It was only in 1997 that the World Health Organization (WHO) recognized tocophobia as an illness. This medical diagnosis falls into the category of anxiety or phobic disorders linked to motherhood. It is indeed a phobia, but a very specific one.

Types of tocophobia

There are two types of tocophobia: primary and secondary.

Primary tocophobia

Primary tocophobia refers to a deep-seated fear of motherhood and childbirth, without ever having experienced it. Women who have never been pregnant (nulliparous) fear the situation just by imagining it. Often, when we question their feelings, we find that this fear often dates back many years, often even to their teenage years. Having been sexually abused or having seen traumatic childbirth films, having heard people speak negatively about their pregnancy or childbirth can be at the root of this uncontrollable fear. Without even having gone through the experience, these women will doubt and have less confidence in their ability to carry and deliver a baby.

There are still many myths surrounding pregnancy and childbirth. For a woman (or couple) unfamiliar with the subject, it’s hard to know what’s true and what’s not. The various online sources of information are not always reliable and credible, and can add to the fear! The fear of dying in childbirth, the fear of experiencing insurmountable pain, the fear that the baby will suffer major trauma that will have serious repercussions on the rest of his or her life, etc. are examples often reported by these women (couples).

Secondary tocophobia

Secondary tocophobia is more common in women who have already experienced childbirth (multiparous). This fear is most often directly linked to their previous experience, which was more traumatic than expected.

Major complications during pregnancy or childbirth, a baby with an abnormality of any kind, or a stillborn baby are typical examples of these women’s fearful reactions and their fear of reliving such experiences. It’s like experiencing post-traumatic shock.

Without going into precise figures, which vary from one study to another, it seems that this type of tocophobia is more frequent than primary tocophobia.

Predisposing factors for tocophobia

In addition to the physical and social factors already mentioned, such as sexual abuse, traumatic and complicated childbirths and reported horror stories, there’s also a person’s personality that is important.

We all know that becoming a parent is a major source of stress in one’s life. Imagine if you’re already a woman who’s having trouble managing several stresses at once on a daily basis.

Personality traits come directly into play when it comes to the predisposition of certain women to develop tocophobia. Women already living with generalized anxiety disorder or depression are more likely to be affected by this kind of reaction. Potential motherhood adds to their vulnerability, to their usual stresses.

For personalities or women who must always be in full control, who must act at all times on themselves and their environment, or who have more obsessive-compulsive behaviors, they can lose many of their means when they realize that pregnancy and childbirth are not experiences that can be predicted and calculated as they would like. They tend to dread all the possible inconveniences surrounding the birth of a child. This type of person unintentionally thinks about it and anticipates the worst, while seeing the possible impacts on their person as disproportionate, such as: weight gain, stretch marks, unthinkable pain, tears, weakening of the pelvic floor, losing the baby, that they themselves die during birth, and so on.

Faced with their desire to become mothers, they will have to learn to let go, to let go. For some, this will require a great deal, often too much, but others will succeed with the right support and guidance.

What are the signs of tocophobia?

What are the signs of tocophobia? When a woman lives with tocophobia, there are several symptoms that are very similar to signs of anxiety and panic attacks. Here are a few examples:

• severe insomnia (unpleasant thoughts and dreams)
• prenatal depression
• mood swings (sudden changes possible)
• abdominal cramps
• digestive problems (nausea, vomiting)
• tremors
• dizziness
• sweating
• increased heart rate (palpitations) and respiratory rate
• anxiety, tightness
• crying spells
• obsession with contraception

When fear interferes with functional activities.

For a man living with a lover diagnosed with tocophobia, it’s often difficult to understand the intensity of her reactions. It’s not uncommon for those around him, and even his partner, to be distraught in the face of suffering that seems excessive and sometimes even childish.

A better understanding of tocophobia will enable spouses, families and friends to support women living with this kind of fear.

Possible consequences of tocophobia

You know that the head goes with the rest of the body and unfortunately, if the two aren’t aligned together, it can have repercussions on the rest of the events.

Before pregnancy :

Some women will not be able to overcome their fear and consider pregnancy. According to some reported statistics, 13% of women who have never been pregnant report enough fear to avoid pregnancy. Some will go as far as sterilization for fear of pregnancy despite all their efforts to avoid it.

Many women may choose another way of becoming a mother, through adoption or surrogacy for example, to fulfill their deepest desire to have a child in their lives, without having to carry and give birth to it.

When a pregnancy is announced :

A higher number of abortions are carried out by women who live with tocophobia after the announcement of an unexpected pregnancy, in order to avoid pregnancy at all costs, let alone childbirth.

Others will choose to go ahead with their pregnancy despite the fact that they won’t be able to escape the coming months and the birth.

Before being in labor :

In some cases, a woman with fears that are difficult to control will be more inclined to request a Caesarean section, even if her situation doesn’t necessarily lend itself to it, in order to have more control over the baby’s arrival.

During labor

We note that labor can take longer in women who are afraid, who anticipate the birth and the possible inconveniences. She may have an unconscious block that makes her physically tense, hold back when pushing, and act against nature. This often explains the increased duration of labor and delivery. As a result, the practitioner may need to use more soothing techniques and instrumentation to deliver the baby, such as vacuum extraction or forceps.

After birth :

After childbirth, depending on her experience, the new mother may still feel fears, which may be intensified if her birthing experience was more traumatic than expected. This puts the new mother at greater risk of postnatal depression, and is more likely to hinder the attachment process for her baby.

If the birth was difficult, this could lead to reactions similar to shock or post-traumatic stress, and the mother may refuse to see, hold or care for her baby.

A mother who is emotionally and physically unavailable to her baby can have serious consequences for the latter in the medium and long term.

If the experience has been a positive one, the mother’s fears will diminish over time, but she will always be left with a background of stress about whether or not to go through pregnancy and childbirth again in the future. These fears don’t go away!

What to do about fear of childbirth?

Before pregnancy :

When a woman decides to go ahead and conceive a baby, despite her great fear of pregnancy or childbirth, it’s imperative to begin the process by seeking appropriate psychological help to reduce her anxiety and panic about having a baby. A psychologist, a social worker, someone who can listen to her and accompany her through the personal learning she needs to do in this respect. Specific cognitive-behavioral desensitization therapies can also be helpful, and hypnosis therapy sessions can also be enriching.

Then, in order to minimize the impact of the fear of childbirth on the eventual pregnancy, the woman needs to be surrounded by love and understanding from her natural support network, which will be present and soothing for her through all the stages of becoming a mother, listening, comforting and protecting her.

What’s more, it’s a good idea to practice relaxation methods even before pregnancy, such as meditation, massage, yoga and deep breathing. Learn to relax your muscles and better connect with your inner self to soothe both the physical and the psychological.

During pregnancy:

A woman with uncontrollable fears about pregnancy or childbirth who finds herself pregnant requires special care. If she decides to go ahead with the pregnancy, the doctor or midwife responsible for monitoring her health may ask for the support of a multidisciplinary team that can better respond to the different needs of a person living with tocophobia.

Prenatal courses can certainly help to demystify the truth and falsehood of the information heard, and also help to make the experience more concrete with data that will enable women (and couples) to take part, to some extent, in the decisions to come for themselves and the baby. Knowledge is empowering, enabling exchange and understanding, but childbirth is always a box of surprises. You never know how everything will turn out until it’s all done.

A birth plan (birth wishes) is also something that can be put forward to reassure these women. Their wishes regarding the birthing event can be conveyed to the staff who will be on site.

The presence of a birth companion, met several times during the pregnancy, could be beneficial for the woman living with tocophobia to have a familiar face, a sustained presence of a known woman at her bedside to help her contain herself and also support her lover during this stressful stage.

During labor and delivery:

Women who live with the intense feeling of fear of giving birth need to be supported throughout labor, and even more closely during delivery. A companion? A nurse? A midwife? A doctor?

The people in place need to be aware of the situation and be able to adapt their interventions to better meet the needs for security and reassurance of the woman herself, but also of her partner, who may also experience stress in his role.

After childbirth :

Considering the potential risks in the postnatal period, it is essential that the pregnancy follow-up team follow up with the new family. The team can then intervene or refer the baby if the need arises.

Tocophobia is increasingly recognized as a health issue, and competent resources are attaching more and more importance to it, mobilizing to learn more about it and offer specific support programs for women living with this kind of fear.

Only you know how you feel at the thought of carrying and giving birth to a child. If this is causing you significant stress, it may be time to talk to your doctor or other health professionals for help and support. Don’t wait until you’re pregnant and stress is at its peak.

Marie Fortier
The baby expert