Primary and Secondary Tokophobia

Tokophobia is a condition in which a woman has an excessive and unreasonable fear of harm or death as a result of pregnancy and childbirth, which leads to her avoiding or even terminating a pregnancy. Tokophobia may be classed as either primary or secondary.

Primary tokophobia

In this condition, the woman dreads childbirth before she becomes pregnant. Primary tokophobia is not just worrying about whether the mother and baby will make it through the delivery process safe and sound. Such fears occur in almost all women who, nonetheless, choose to become pregnant when they feel the need for children. Even unplanned pregnancies are often accepted once the child is born, despite the initial anxieties and resentments.

In tokophobia, it is common for the woman to be prone to anxiety, and therefore dread fatal harm if she is compelled to undergo a vaginal delivery. Another reason is that women with primary tokophobia might be reacting to negative information they have received from friends or family about their own experiences of childbirth. This may include birthing videos seen during childhood, sex education classes at school, or past experiences of rape, childhood sexual abuse, or eating disorders which reflect a sense of lack of control.

Secondary tokophobia

Here the woman has already undergone at least one pregnancy, which may have been normal or abnormal in medical terms. In other words, secondary tokophobia may follow a normal delivery or a traumatic one, such as a miscarriage, termination of pregnancy, or a stillbirth.

Why a woman feels so very anxious about childbirth after having undergone one or more deliveries already may depend upon whether she is an anxious person.

State anxiety, in psychological terms, means that the woman feels anxious when she perceives that what is happening to and around her may cause danger to her or her child. This is especially so when she feels that she has no control over what happens to her, reducing her ability to cope with the danger and difficulty of the situation. Thus a successful outcome usually alleviates the anxiety state in such a woman.

The anxiety trait is more stable or permanent than the anxiety state. Such women may have negative past experiences which have reinforced the trait, which results in a tendency to fear childbirth rather than expect that she will be able to deal with it. Women with secondary tokophobia may have natural or acquired personality traits which drive them to view a previous birthing experience negatively, whether or not it was objectively traumatic or not. That is, they may be programmed to view events and experiences during childbirth as invasive, uncontrollable, and life-threatening.

Women with secondary tokophobia often let their thoughts run continuously on possible events and outcomes of future deliveries. This gives them the typical anxiety traits of hypervigilance, jitteriness, and the perception of normal or neutral events as fulfilling their worst fears. As one researcher observed, “During labor, [these] women experience what they are afraid of.” This negative appraisal of events makes them feel great dread of future similar events. Thus even though nulliparous women feared labor and delivery more than parous women did, the latter have shown a higher rate of trait anxiety which could result in secondary tokophobia.

Secondary tokophobia may be a result of a traumatic birth experience which led to the development of post-traumatic stress disorder (PTSD). Due to this, it bears the hallmarks of feelings of fear, helplessness, and horror when faced with a perceived threat of serious injury or death to the mother or the child. This threat may be in the form of actual or perceived physical tearing, or unexpectedly intense pain.

The distinction between a traumatic childbirth and one which induces tokophobia may be in the way the woman perceives it. That is, childbirth is usually a process which the woman endures voluntarily, usually with a positive outlook, and which may even include elements of joy despite the pain. The outcome usually makes the woman feel that the painful and other negative aspects of childbirth are richly compensated for by the baby’s birth.

However, a woman who later develops tokophobia may retain the perception of trauma, invasive examinations, loss of control through pain and emergency procedures, and violation of her privacy, as central to the experience, rather than the birth itself. This may lead to delayed bonding with the infant, isolation from other ‘happy’ mothers, strife with the father, and depression in the postnatal period. The final step is a thorough disgust, aversion, fear, and avoidance of pregnancy and childbirth.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742837/
2. https://www.nice.org.uk/guidance/cg45/documents/antenatal-and-postnatal-mental-health-review-decision2
3. https://www.ncbi.nlm.nih.gov/pubmed/10789333
4. http://bjp.rcpsych.org/content/176/1/83.long

Further Reading

• All Tokophobia Content
• Tokophobia – Fear of Pregnancy and Childbirth
• Causes of Tokophobia
• Management of Tokophobia
• Tokophobia Consequences

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.