Tokophobia is a fear of pregnancy and childbirth that affects approximately 14% of pregnant women worldwide. It is a specific phobia belonging to the category of anxiety disorders. However, considering that many women do not talk about their phobia due to the social taboo associated with it, that it is difficult for women who are not pregnant to obtain a referral to gynecology or for midwifery follow-up to discuss their condition before considering procreation and that some women who have experienced a traumatic childbirth will choose not to have more children because of their previous experience, and therefore will not be seen again in gynecology, this statistic could underestimate the real number of women affected by this condition.

Some men may also experience tokophobia and have an intense fear that their partner will become pregnant. They may use multiple methods of contraception to reassure themselves, track their partner's menstrual cycle, be particularly anxious when their partner is ovulating, or request that their partner tests as soon as possible if their period is late. It is important to welcome their apprehensions with openness and compassion, considering that they are also suffering and that stigma could impact their seeking help. There is little research available highlighting the reality of these men and since a majority of women experience tokophobia, this article will focus more on their reality.

There are two types of tokophobia;

• Primary: Occurs in a woman who has never given birth, often begins in adolescence or early adulthood.
• Secondary: Appears after experiencing a traumatic, painful pregnancy or childbirth, or one perceived as such.

Those who live with tokophobia experience a pathological fear of pregnancy and/or childbirth that can prevent them from trying to become pregnant, despite their desire to have a child. Sometimes women become aware of their tokophobia only once they are pregnant. When they become pregnant, they may avoid attending obstetrical follow-ups or be in denial about their condition, which can put their health and that of their baby at risk. The feeling of overwhelming terror can lead some to request an elective caesarean section and others may request an elective termination of pregnancy (abortion) even if the motherhood project was planned. Women living with tokophobia may be destabilized by the thought of a baby growing inside them and have difficulty developing an attachment bond with it. Some women with tokophobia fear the impact that pregnancy may have on their mental or physical health or are afraid of losing their personal identity. In fact, most women with tokophobia experience a combination of fears.

Fears identified by women living with tokophobia include:

Fear of blood, needles, hospitals, vomiting, hormonal changes, pregnancy symptoms, weight gain, not being a good mother, losing career opportunities, repeating childhood patterns of violence, experiencing obstetric violence, lack of control, unpredictability, having to undergo invasive physical exams, being left alone during childbirth, pain, experiencing an involuntary termination of pregnancy, the child having health problems or dying. Note that only one of these elements or several of them may be present in the person living with tokophobia. Other fears and phobias not listed above may also be active. Since phobias come in the form of a spectrum, some women will be affected more intensely than others by the impact of their fears. It is difficult to assess when pregnancy-related anxiety and fears develop into tokophobia. It is therefore recommended to welcome any fears expressed with empathy.

What are the symptoms associated with tokophobia

Excessive anxiety or fear about pregnancy and/or childbirth; Spoken or written words, images can be triggers that affect many areas of their lives, including work, school, relationships, social activities and daily routine. Avoidance of any information or situations related to pregnancy and childbirth, difficulty sleeping, nightmares, panic attacks, feelings of shame, guilt and conflicting emotions associated with pregnancy or parenthood. Difficulties related to the intimate and sexual sphere, feeling of unreality or detachment from oneself, chills or hot flashes, numbness or tingling in the body, having an obsession with contraception or compulsively doing pregnancy tests to reassure oneself, feeling uncomfortable disclosing thoughts/needs and emotions to their partner, fearing not being involved in decision-making related to the pregnancy, fearing abandonment or judgment by loved ones, or fearing not developing the parenting skills to raise the child. Some women may also feel frustration with men because they do not have to experience pregnancy and give birth.

What are the predisposing factors for tokophobia?

There are several factors that can lead to the onset of tokophobia, but those that stand out from research are: History of anxiety or depression. Having read, heard or witnessed a negative pregnancy or childbirth experience (documentaries, films or television series may have had this effect). Having experienced sexual violence or abuse in childhood, having had previous traumatic medical experiences, having a strong need for control, low self-esteem, specific sociocultural factors, experiencing dissatisfaction with the partner or a lack of social support.

What are the impacts of tokophobia on the affected person?

Tokophobia can lead to social isolation and significant psychological distress. Some women may experience sexual and relationship difficulties, even leading them to avoid any form of intimacy or physical closeness with their partner, in order to avoid becoming pregnant.

Many women with tokophobia feel like they are not taken seriously by the medical community due to a lack of awareness and a disparity in the provision of health care to them. However, this phobia is legitimate, valid and should be considered by the medical team, in order to ensure personalized care that takes into account the needs of the pregnant woman. Note that if you live with tokophobia and do not feel respected, you have the right at any time to ask to be followed by another health professional.

How to support someone who is affected by tokophobia?

Behaviors to avoid:  Trivializing the stress you feel or expressing your opinions about the best methods of childbirth without invitation. Making comments like “you’re better off without a child” or recommending that you end the pregnancy outright. The person who chooses to fight their phobias may perceive this as invalidating their efforts to overcome their fears or feeling judged. Assuming that because you survived your pregnancy/birth without physical or psychological harm, the concern is unwarranted. Making any comments related to body image. Even if they are well-intentioned, they can rekindle multiple fears. Touching the pregnant woman’s belly without asking. This can make her feel like her body is public property and for some people with tokophobia, the lack of consent regarding bodily limits is a major issue. Talking about unpleasant childbirth experiences or the risk of traumatizing the partner when the baby is born. Recalling these elements amplifies worries and can reinforce the impacts of fears already present. If you yourself have experienced a traumatic pregnancy or childbirth, it may instead be beneficial for you to obtain psychosocial support from a mental health professional who will have the tools to support you emotionally in the face of your experience.

Recommended behaviors:  Simply listen. If you have children, ask if she has any questions and be patient. Ask if she would like to talk to you about how she feels; if she is pregnant and in a lot of pain, she may have difficulty starting a conversation even if she wants to talk about it. Respect her personal boundaries and pace, especially in relation to consent for physical contact. Surround the person with positive energy and support. Your welcome and openness will make all the difference for the person affected by tokophobia.

What support resources are available?

In order to obtain support related to tokophobia, resources are currently limited in Quebec, however with research and awareness, we can hope that more support will be put in place.

I offer my teleconsultation services to all women in Quebec living with primary or secondary tokophobia. I use a cognitive-behavioral approach during follow-ups, as recommended in the treatment of anxiety and phobias, which are two main components of tokophobia. I can also help you write a personalized document attesting to your personal experience with tokophobia to give to your care team (gynecologist or midwife), in order to make them aware of your situation and to ensure that your personal limits are respected in the context of pregnancy. Art therapy has also proven effective in helping to express the feelings of women living with tokophobia. Calling on a doula or birth companion educated on the issues related to tokophobia is also an interesting avenue. In the same vein, some midwives in Quebec are aware of this condition, and could therefore gently support you in your efforts. Finally, there are perinatal mental health psychiatrists who can assess your psychological state and provide pharmacological support if necessary. I highly recommend the Facebook page of the support group " Tokophobia Support Network " to all those affected and who are comfortable with English. 

Note of distinction; I would like to acknowledge the collaboration of Dr. Tuong-Vi Nguyen, psychiatrist, CUSM and Ms. Aline St-Denis for the efforts put into researching the information present in this article and for its production.