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 discuss 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 due to their previous experience, therefore will not be seen in obstetrics, this statistic could underestimate the actual number of women affected by this condition.

Some men may also suffer from tokophobia and have an intense fear of their partner becoming 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 test 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 help-seeking. There is little research available highlighting the reality of these men, and since a majority of women suffer from 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 beginning in adolescence or early adulthood.
• Secondary: Appears after experiencing a traumatic or perceived distressing pregnancy or childbirth.

Those living 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 after they become pregnant. When pregnancy occurs, they may avoid obstetric follow-ups or be in denial about their condition, which can put their health and that of their baby at risk. The overwhelming feeling of terror can lead some to request an elective cesarean section, and others may request an 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 patterns of violence experienced in childhood, experiencing obstetric violence, lack of control, unpredictability, having to undergo invasive physical examinations, being left alone during childbirth, pain, experiencing an involuntary termination of pregnancy, the child having health/developmental problems, or death. One or more of these elements may be present in the person living with tokophobia. Other fears and phobias not listed above may also be active. Because phobias present on 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. Therefore, it is 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 and images can be triggers that affect several areas of their lives, including work, studies, relationships, social activities and daily routines. Avoidance of any information or situations related to pregnancy and childbirth, sleep difficulties, nightmares, panic attacks, feelings of shame, guilt and conflicting emotions associated with pregnancy or parenthood. Difficulties related to the intimate and sexual sphere, feeling unreal or detached from oneself, chills or hot flashes, numbness or tingling in the body, having an obsession with contraception or compulsively taking pregnancy tests to reassure oneself, feeling uncomfortable disclosing thoughts/needs and emotions to their partner, having the fear of not being involved in decision-making related to the pregnancy, being afraid of being abandoned or judged by their loved ones or being afraid of not developing the parenting skills to raise the child. Some women may also feel frustrated with men because they do not have to experience the pregnancy and give birth.

What are the predisposing factors for tokophobia?

Several factors can lead to the onset of tokophobia, but those that stand out from research are: A 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). Experiencing 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 partner dissatisfaction, 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 the condition feel they are not taken seriously by the medical community due to a lack of awareness and disparities in the provision of healthcare. However, this phobia is legitimate, valid, and should be considered by the treating team to ensure personalized care that takes into account the needs of the pregnant woman. Please note that if you experience tokophobia and do not feel respected, you have the right to request follow-up with another healthcare professional at any time.

How to support someone affected by tokophobia?

Behaviors to avoid: Trivializing stress feel or expressing your opinions about the best methods of childbirth without invitation. Making comments like "you're better off without children" or recommending terminating the pregnancy outright; The person who chooses to fight their phobias may perceive this as invalidating their efforts to overcome their fears or feel judged. Assuming that because you survived your pregnancy/childbirth without physical or psychological damage, the concern is unjustified. Making any comments related to body image. Even if they are well-intentioned, they can revive multiple fears. Touching the pregnant woman's belly without asking; This can make her feel as if her body is public property, and for some people with tokophobia, the failure to respect bodily boundaries is a major issue. Talking about unpleasant childbirth experiences or the risk of traumatizing the partner when the baby is born. Bringing up these elements amplifies worries and can reinforce the impacts of existing fears. If you have experienced a traumatic pregnancy or childbirth yourself, it may be beneficial to seek psychosocial support from a mental health professional who will have the tools to support you emotionally through your experience.

Recommended behaviors: Simply listen. If you have children, ask if they have any questions and be patient. Ask if they would like to talk to you about how they are feeling; if they are pregnant and in a lot of pain, they may find it difficult to start a conversation even if they want to talk about it. Respect their personal boundaries and pace, especially in relation to consent for physical contact. Surround the person with positive energy and support. Your openness will make all the difference for the person affected by tokophobia.

What support resources are available?

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 made available.

I offer my sexologist services via teleconsultation to all women in Quebec, as well as internationally, living with primary or secondary tokophobia, whether pregnant or not. I use a cognitive-behavioral approach when providing support and counseling. I understand that tokophobia can be destabilizing and overwhelming. My goal is to offer you a caring space where you can express your fears without judgment, to move forward together towards a better well-being.

I can also assist you in writing a personalized document attesting to your personal experience with tokophobia to give to your healthcare team (gynecologist or midwife), to raise awareness of your situation and ensure that your personal boundaries are respected during pregnancy.

Art therapy has also proven effective in helping women living with tokophobia express their feelings. Enlisting the help of a doula or birth companion educated on the issues related to tokophobia is also an interesting avenue. Similarly, some midwives in Quebec are aware of this condition and can 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 "Tokophobia Support Network" support group to anyone affected and comfortable with English.

Note of distinction: The author would like to acknowledge the valuable collaboration of Dr. Tuong-Vi Nguyen, psychiatrist, MUHC, and Ms. Aline St-Denis for their efforts in researching the information in this article and thank them for its production.