Causes of Tokophobia

Tokophobia refers to an excessive and unreasonable fear of pregnancy and childbirth.

This may be primary or secondary. Primary tokophobia occurs before a woman ever becomes pregnant. The stimulus may be early sexual trauma, rape, early exposure to the facts of vaginal birth as occurs in sex education classes at school, or even watching videos of childbirth when very young.

In secondary tokophobia, the woman has already undergone at least one pregnancy, which may have been medically normal or abnormal. In other words, secondary tokophobia may follow a normal delivery or a traumatic one, such as a miscarriage or an abortion. It is thought that some women with secondary tokophobia suffer from a heightened sense of anxiety or trait anxiety. This makes them hypervigilant and easily frightened by perceived threats to their safety or life. The threat may be caused by the failure of real childbirth to meet their falsely idealistic expectations about level of pain, the level of compassion they get from their medical care providers, or the feeling of loss of control. The threat arouses great fear, which overshadows even the positive outcome of a normal birth.

Tokophobia and fear

Tokophobia is different from the ordinary fears and anxieties that often strike during pregnancy, and which healthy women face without doubting that they will, in all probability, safely deliver a healthy child, with whom they will bond. In tokophobia, the woman is, quite commonly, already prone to anxiety, and therefore dreads fatal harm if she is compelled to undergo a vaginal delivery. Conversely, many women with primary tokophobia do well during childbirth if they can be assured that they will have a planned elective Cesarean section (C-section) on request.

Tokophobia is one of the most common factors underlying a first-time mother’s desire for a C-section.

Secondary tokophobia may occur in women of any age, but usually stems from a previous traumatic birthing experience. However, it has also been reported to follow births which were medically normal. Other situations which may precede secondary tokophobia include miscarriages or pregnancy terminations, and stillbirths.

Causes

1. Loss of privacy, dignity, and control

Many women have heard a lot about childbirth or read about it in detail. They may fear that the pain of labor will overwhelm them, or cause them to lose control. Others are taken aback by the feeling of loss of privacy, having to be examined vaginally, and having to submit to the exposure of their vaginal passage during delivery.

A history of sexual abuse, rape, or childhood abuse, is extremely important in the genesis of tokophobia in many cases. Such women may feel naked, threatened, or experience the revival of old memories when they are required to adopt the typical dorsal position which exposes their genital regions, and when they undergo the vaginal examinations which are so common during a normal delivery.

2. Fear of harm

Some women have heard stories, witnessed birth, or seen videos of what appeared to be painful or traumatic childbirth, without adequate explanation, at a young age. This may have filled them with the fear of going through a similar experience.

Another fear is that they will be injured, or of chronic illnesses such as urinary incontinence, vaginal laxity, and pelvic organ prolapse.

Some mothers are extremely worried that vaginal birth will be harmful to the child, and so prefer a planned C-section.

Other women have a low threshold for pain, which leads to the fear that they will not be able to tolerate childbirth.

These factors operate chiefly in primary tokophobia.

3. Psychological factors

Psychological factors such as low self-esteem, which leads to low self-efficacy, lead to a higher risk of tokophobia. Low self-esteem is often linked to lack of social supports.

The woman is more likely to have trait anxiety, or an anxious, negative personality which perceives threat everywhere.

The presence of psychiatric disorders such as depression or anxiety also increases the risk of tokophobia.

Fear of losing control is another factor to consider. Some women do not expect the medical team to understand their pain, give them adequate pain control, involve them in decision-making regarding labor and delivery, or take the right decisions. This breeds fear of the process of childbirth itself.

Psychological makeup can impact a woman’s outlook on pregnancy. For example, many women with obsessive-compulsive disorder (OCD) have an intense need for everything around them to be perfect, and this may greatly affect their perception of pregnancy.

Prenatal depression is a prominent cause of tokophobia in some women, and the imbalance of neurochemicals and hormones may be responsible for the unbridled anxiety of tokophobia.

Secondary tokophobia is more likely in women who have had a traumatic vaginal delivery, stillbirth, miscarriage, or termination of pregnancy. Women who feel that the level of labor pain they experienced was out of control, or totally unexpected, may also forcefully resist ever going through such a process again.

4. Demographic profile

Women with tokophobia are more likely to be:

• Very young or old (over 40 years) mothers
• Uneducated or highly educated women
• Socially or economically disadvantaged women
• Single mothers

5. Pregnancy features

Women with tokophobia are more likely to have

Pregnancy complications such as gestational diabetes, fetal anomalies

• A pregnancy brought about by assisted reproduction
• At least one previous Caesarean section
• More common in nulliparous women, especially smokers

References

1. https://www.ncbi.nlm.nih.gov/pubmed/10789333
2. http://www.aafp.org/afp/2005/0815/p697.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742837/