Tokophobia – A pathological fear of pregnancy
MANY women anticipate the joy of motherhood, but getting there, particularly because of the unpredictable nature of pregnancy, is a journey that some women dread. In fact, obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan said that for some, this fear of pregnancy and childbirth is so crippling that many avoid pregnancy altogether.
“Tokophobia is the pathological fear of pregnancy that leads to the woman taking measures to avoid pregnancy. A woman can develop the condition before pregnancy or it may start during pregnancy,” Dr Buchanan said.
She pointed out that this obsessive fear of pregnancy is categorised as primary or secondary.
“In primary Tokophobia, the woman has never been pregnant and takes measures to avoid pregnancy. In secondary Tokophobia, the woman has had birth prior and it was traumatic, or she may not have had a traumatic pregnancy but had trauma due to some external factors such as a death of someone close to her, or violence, and she associates the trauma with pregnancy,” Dr Buchanan explained.
She noted that for many of these women the fear of becoming pregnant is triggered by a psychological fear of pain during labour, fear of trauma during the birthing process to mother or baby, or a fear of death, and so those who get pregnant often request a caesarean section.
“Tokophobia is marked by panic attacks during pregnancy, and nightmares about pregnancy or childbirth. A previous traumatic birth can trigger post-traumatic stress disorder in which the patient has repeated nightmares after the pregnancy, about the pregnancy, and recurrent recollections of the traumatic experience after delivery associated with recurrent feelings of apprehension and fear.”
A woman who has Tokophobia often has an underlying history of anxiety disorders, panic disorders and depression. Dr Buchanan said that she might also experience difficulty concentrating on regular day-to-day activities, might become detached from her spouse or friends, and perform poorly at work. She said that the woman may also take extensive steps to prevent pregnancy; for example, she may request a tubal ligation or even a hysterectomy (removal of her womb) or avoid sex altogether or consider having a surrogate.
“Another symptom triggered by Tokophobia is depression. Many women would want to have children or are even being pressured by their spouses or families to have children, but the fear of childbirth prevents them from getting pregnant or causes them to take contraception without the knowledge of their spouses. For women who have never had childbirth, Tokophobia may have been triggered by exposure as a young woman or as a child witnessing a woman during childbirth, especially if she wasn’t counselled properly and given adequate support during what she witnessed,” Dr Buchanan advised.
Women who have been sexually abused are also more likely to have Tokophobia.
As it relates to secondary Tokophobia, Dr Buchanan said that this includes trauma during childbirth, such as shoulder dystocia. This is where the baby’s head is delivered but the shoulder gets stuck, leading to extensive manoeuvres to deliver the baby, and this may cause trauma to the baby including broken bones and nerve injuries. Also, there may be extensive tears or bleeding occurring during childbirth that may have been traumatic. However, other forms of trauma can trigger Tokophobia such as social trauma.
“Those women with Tokophobia who do enter into labour are more likely to have prolonged labours and need a vacuum or forceps to aid delivery. Unfortunately, these tools are associated with an increased risk of foetal trauma or trauma to the mother,” Dr Buchanan said.
The good news is that Tokophobia is treatable. The first step is to treat the underlying anxiety and depression, before and during pregnancy.
“Counselling and support groups before and during pregnancy may help her to overcome her fear. Giving her a tour of the maternity ward and the labour and delivery suite prior to birth and letting her meet her delivery team including midwives and doctors in a relaxed atmosphere may help her to feel more at ease prior to delivery, and overcome her fear,” Dr Buchanan advised.
She said that support after giving birth is also equally important. She also suggested maintaining a balanced diet and remaining physically active as a way to elevate the woman’s mood.
