Tokophobia – what are its causes and symptoms?

The thought of pregnancy and impending birth often causes fear. It is natural and completely normal for women to feel fear of the unknown, whether pain or possible complications that may arise during childbirth. For the vast majority of women, the fear of childbirth is moderate and not a problem, but for some it is very strong or extremely strong, then it is called tokophobia. This is a condition that cannot be taken lightly, but action must be taken. What exactly is tokophobia and how to deal with it?

Tokophobia (Greek toko – childbirth, phobia – fear, anxiety) is a state of pathological fear of pregnancy and childbirth. It has been classified as an anxiety disorder not clearly defined clinically due to poorly defined diagnostic criteria. Tokophobia affects a woman’s well-being, affects her health, sometimes hinders normal functioning, so it should not be underestimated, and if it appears, it is worth seeking help from a specialist.

There is a division of tokophobia into primary, secondary and being a symptom of depression.

It may appear long before the first pregnancy. It often causes postponing or even giving up pregnancy altogether. Tokophobia in many cases contributes to obtaining a guarantee from the doctor regarding the termination of pregnancy by caesarean section.

It is a consequence of the traumatic course of childbirth (traumatic childbirth), miscarriage, stillbirth, but it can also occur after a normal, physiological childbirth. It is associated with the occurrence of depression, and more specifically, postpartum psychogenic post-traumatic syndrome, decreased libido and emotional ties disorders.

It can occur in the first or subsequent pregnancies, and it is caused by a depressive syndrome. This type of tokophobia is characterized by the occurrence of obsessive thoughts that bring to mind black scenarios about childbirth.

It is estimated that up to 80% of pregnant women may experience mild fear of childbirth, while strong anxiety and fear, i.e. tokophobia, occur in 6 to 10% of pregnant women. An extremely high level of fear of childbirth is observed in about 2% of expectant mothers.

So you can see that the scale of the problem is really big. Interestingly, the incidence of tokophobia is not related to the order of pregnancy.

Numerous studies show that the highest level of fear of childbirth concerns women in the third trimester of pregnancy and occurs both in primiparous and multiparous women. Factors that may influence its occurrence include:

• socio-economic situation of the pregnant woman,
• number of childbirths,
• personality type.

In his study, Sjögren showed that labor anxiety in pregnant women was associated primarily with the loss of control over the course of childbirth, fear of their own or child’s death, and lack of trust in medical personnel. Although pain was also the cause of anxiety, it was not the dominant determinant.

In turn, according to another researcher – Saisto, the factors determining the occurrence of birth anxiety include:

• previous course of childbirth,
• fear of pain,
• low self-esteem of a pregnant woman,
• no support,
• partner dissatisfaction.

It turns out, therefore, that the cause of tokophobia can also be a failed relationship with a partner. The lack of positive, mutual relationships not only cause anxiety related to pregnancy and childbirth, but sometimes even cause depression.

Feeling strong fear and anxiety related to childbirth triggers a stress reaction and activates the hypothalamic-pituitary-adrenal axis (HPA axis). Then the whole body goes into a state of great excitement and various undesirable symptoms appear, such as:

• tachycardia (rapid heart rate),
• pressure spikes,
• diarrhea,
• excessive vomiting,
• dehydration.

With very severe symptoms, a natural miscarriage may even occur.

Psychotherapeutic methods are considered to be the basis for the treatment of pathological anxiety and fear of childbirth, which is why a psychologist should be the right specialist to turn to for help in such a situation. A team consisting of a psychologist, a doctor and a midwife is formed, which is focused on making a diagnosis and implementing appropriate treatment and prevention.

One of the methods of minimizing the fear of childbirth is participation in childbirth classes. Another effective way is the presence of a trusted midwife who will take care of the pregnant woman and provide her with the necessary support during pregnancy and childbirth.

Bibliography:

1. Billert H., Tokofobia – problem multidyscyplinarny, Ginekol Pol. 2007, 78, 807-811.
2. Kaźmierczak M., Sołdyńska M., Gierszewska M., Ocena lęku przed porodem u kobiet ciężarnych, Piel Zdr Publ. 2017;26(1):69–75.
3. Stanek-Misiąg E., Kiedy lęk przed ciążą i porodem trzeba leczyć, Medycyna praktyczna dla pacjentów, 2020.