Tokophobia is a serious psychological condition which is defined as a woman’s unreasonable and excessive fear of death or serious harm as a result of childbirth, to the extent of actively avoiding pregnancy despite her desire to have children.
1. Maternal guilt
Women with primary or secondary tokophobia may often love children and long to have their own offspring, but be disabled by fear of childbirth. This makes them feel guilty.
In addition to their self-perceived contrast with other women who bear children without such difficulty, they feel that the world dubs them as loveless, or abnormal, particularly by other women.
Prenatal and postnatal depression and insomnia are more common in this group of mothers.
Women with tokophobia may actually feel worthless because they cannot cope with a natural female experience. They may feel that they lack the courage to deal with pain as other women do. This often leads to depression and isolation as a result of being unable to share these feelings with their spouses, families, or friends.
Women with secondary tokophobia may be even worse off as they are cut off from the normal network of mothers who offer support to each other, but may not have patience with someone who apparently over-dramatizes her birthing experience.
Thirdly, such patients are impelled to practice careful and foolproof contraception lest they become pregnant.
Even if such patients overcome their fears sufficiently to become pregnant, they may be driven by growing panic to terminate the healthy fetus before it is too late. This may lead to gnawing guilt and depression.
2. Pregnancy denial and complications
Tokophobic pregnant women often deny their pregnancy. For this reason they do not receive the antenatal care that is normally given. They register late, attend appointments irregularly, and often turn up for the first time soon before the expected date of delivery.
Tokophobia is associated with hyperemesis gravidarum. A psychological basis is thought to exist, due to the subconscious terror of pregnancy, failure to feel that the pregnancy is welcomed, resentment at the fetus, and planned termination of pregnancy.
Women with tokophobia often request an elective Cesarean section to avoid facing vaginal delivery. Even when this is granted, the medical implications are far from simple.
However, such requests are not usually regarded as valid in many cultures and regions. When a tokophobic woman is denied her request, she may feel forced to go through with what a terrifying experience for her. Several studies show that women in such cases fall into postnatal depression, suffer post-traumatic stress disorder symptoms, and do not bond early with their babies. Many of them even identify the baby as an alien who forced its way into the world without her consent. They resent the severe pain and bodily injury that they endure during childbirth, because of their perceived risk and loss of control.
When epidural analgesia is used to help the laboring tokophobic woman, it may prolong the duration of labor and may increase the rate of Caesarean section or instrumental delivery.
Tokophobia is strongly associated with both prenatal and postnatal depression, and is a risk factor for maternal suicide. This is a serious issue as maternal suicide remains one of the leading causes of maternal death in developed countries.
Tokophobic mothers often fiercely resent the child as the cause of all their pain and trouble, but fear to show their anger. This increases the level of stress within them and may exacerbate their depression risk.
More low-birth-weight (below 2.5 kg) infants are born to tokophobic mothers, and more newborns born to them are admitted for newborn intensive care.
Tokophobic women who had to go through with the delivery often bond poorly with the baby, making them feel like useless mothers.
Their terror of pregnancy may drive them to seek early sterilization, or to refuse to have any more children, irrespective of the other partner’s wishes. Guilt at making their spouses suffer the loss of more babies acts to perpetuate the vicious cycle without freeing them to have more children.
Post-traumatic stress disorder is more common in tokophobic women who feel they were compelled at the risk of their lives and their health, to proceed with vaginal deliveries. Its effect on marital relationships, the upbringing of the child, and on the woman’s own capacity to live normally, is disabling without timely and adequate treatment.
Long term consequences
Over the long term, tokophobia negatively affects the child’s emotional health as well.
Thus tokophobia needs to be recognized as a distinct disorder with serious consequences on both maternal and child health. Women with this condition should be offered caring and competent counseling and cognitive behavioral therapy, with medication if required to alleviate prenatal depression. This may help them to achieve a normal vaginal delivery with satisfaction and achieve bonding with the baby. The positive experience may reinforce the psychotherapy and prevent further tokophobic manifestations.
Reviewed by Afsaneh Khetrapal BSc (Hons)