Tocophobia: the Fear of Giving Birth

It’s normal to be a little scared of the unknown, and giving birth is no exception. In this day and age, when everyone shares every detail of giving birth, it is not uncommon to hear horror stories and wonder if you can handle the labor and childbirth process.

However, there is a psychiatric disorder for when this fear goes too far. It’s called tocophobia, and women who have this have such a deadly fear of giving birth that they may avoid pregnancy altogether (despite wanting children) or demand that they deliver by C-section (since this can be planned and controlled and seem less frightening). These women have more than the usual trepidation associated with pregnancy and often require psychiatric care.

Primary tocophobia occurs when a woman has this fear without having had a baby before; secondary tocophobia is fear of childbirth that develops after giving birth. Women in this second group may have had a difficult or traumatic delivery. Sadly, many of these women had a strong fear that they or their babies were going to die during childbirth and are afraid to give birth again.

A history of sexual abuse can lead to tocophobia, since the act of laboring and delivering vaginally can bring up unwanted memories of past abuses. Tocophobia may also be a symptom of prenatal depression. Appropriate counseling and possibly medications can help women in these scenarios. Other women fear the lack of control during their delivery—they worry about the pain, whether or not they will have access to good medical treatment, and have a lack of trust in those caring for them.

For some women with this disorder, the fear is so immense that they will opt to terminate their pregnancy rather than give birth—even though they desire children. Others may request to deliver by C-section. For women who are denied this and forced into a vaginal delivery, the risk of developing posttraumatic stress disorder (PTSD) and postpartum depression is extremely high. While elective C-sections should not be undertaken lightly, this is a small subset of women where this may be helpful, both for mother and baby.

When an OB/GYN suspects more than just the usual anxiety about giving birth, a referral to a psychologist or psychiatrist experienced in identifying and treating tocophobia is in order. Working together, the combination of therapy, prenatal care where the patient feels she is in trusted hands, and sometimes medication (including anti-anxiety medications and antidepressants) can help a woman through her pregnancy. A delivery plan that everyone is comfortable with is essential as well.

While this is a rare disorder, tocophobia is quite traumatic, and hearing stories of childbirth gone well can help a woman with this fear feel more confident in her own ability to give birth.

While it may be tempting to write this off as yet another over-diagnosis for a “fake” disorder, keep in mind that mental health disorders are severely underdiagnosed, especially in pregnant women who are expected to be overjoyed throughout their pregnancy.

Sources:

• K Hofberg and IF Brockington
• Tocophobia: an unreasoning dread of childbirth
• The British Journal of Psychiatry (2000) 176: 83-85.
  MS Bhatia and A Jhanjee
• Tocophobia: a dread of pregnancy
• Industrial Psychiatry Journal 2012 Jul-Dec; 21(2): 158-159.

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