It’s understandable that many people find the thought of childbirth scary. Especially given the uncertainty involved.
But there’s a difference between having a “normal” amount of fear about giving birth and having a phobia, says Professor Julie Jomeen, the Dean of the Faculty of Health at Southern Cross University, a professor in midwifery and expert in tokophobia.
“Tokophobia is a severe fear of pregnancy and childbirth,” explains Professor Jomeen, who has spent 20 years researching the psychological aspects of childbearing.
“There are two types of tokophobia. Primary tokophobia occurs in women who’ve never had a baby before, and secondary tokophobia occurs in women who have given birth, and is probably caused by a traumatic event in the previous pregnancy.”
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The causes of primary tokophobia are still being investigated. “There is some evidence to suggest it’s more prevalent in women who’ve suffered abuse in their childhood. Exposure to negative experiences of childbirth can also play a role,” says Professor Jomeen.
It’s difficult to know how many women are affected by tokophobia, especially considering many of them avoid pregnancy, and as a result, don’t get assessed on the tokophobia severity scale. Some reports suggest 28 per cent of women experience the condition, while other figures are as low as five per cent. Professor Jomeen says the average is around 14 per cent of women. That’s millions of women around the world crippled with a phobia which gets significantly less airtime than claustrophobia, arachnophobia or agoraphobia.
For women with tokophobia who fall pregnant, the impacts can be severe. “The condition affects them every day and influences how they engage with their pregnancy. Many women will avoid decisions and discussions around birth until the very end, and when they share their severe fear of childbirth six-weeks before they’re due, care options are limited,” admits Professor Jomeen, who says more research is needed into the causes, diagnosis and treatments of the phobia. “We might not be able to get rid of the phobia, but we can put support mechanisms in place to help.”
While tokophobia is still a relatively new field of research, advancements are being made. A scale of severity has been developed to help with diagnosis, and in the UK caring plans are being rolled out so pregnant women have the right support from both a mental health practitioner and a midwife throughout their pregnancy.
As a leading expert, Professor Jomeen wants people to know that tokophobia exists, but that it’s a very distinct, extreme condition. “Women who feel they might have tokophobia should come forward and speak to their health care practitioner. We want to be able to identify and support those with the condition, but we don’t want to overuse the label for cases of normative worry,” she says.
The final message Professor Jomeen wants to share is one of hope: “Women with tokophobia can still have a positive birth experience with the right care and support.”
PROFESSOR JOMEEN’S ADVICE FOR ADDRESSING TOKOPHOBIA
Talk About It
“The earlier women speak up about their concerns, the better. With early intervention, we can offer meaningful and effective support. We’ve come a long way in the last 10 years. Midwives are more comfortable speaking with women about mental health, and women are more open about disclosing mental health issues without fear of stigma.”
Consider Cognitive Behavioural Therapy
“The best evidence we have at the moment suggests Cognitive Behavioural Therapy (CBT) is a good approach for dealing with tokophobia. CBT enables women to pull on their own resources and manage the fear.”
Identify options for Continuity of Care
“One of the most important things when it comes to treating tokophobia is continuity of care. Ideally, patients would see the same midwife and mental health care nurse on an ongoing basis. It’s hard for women to have to continually retell their story to new people. Having the same practitioners throughout their pregnancy can help women build trust and maintain control.”
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