Pregnancy and childbirth an important life milestones. This transition phase is associated with major life decisions and commitments. Right from the moment of finding out about the pregnancy to the moment of delivery and having a tiny human in your hands, the woman goes through a myriad of mixed emotions. Though many women have a desire to get pregnant and enjoy the feeling, many develop stress and apprehension about handling it. It is normal to experience some worries and short-term negative emotions; mostly these concerns usually pass easily and do not affect daily life. Sometimes people develop deep, overwhelming, unreasoning, intense fear of childbirth called ‘Tokophobia’ which makes them avoid getting pregnant, develop disgust towards the idea or refuse to go through normal vaginal birth opting for cesarean section. Tokophobia is mostly experienced by childbearing females, sometimes it can also affect males with severe fear of the health and safety of their partner and child.
There are two types of Tokophobia:
Primary Tokophobia: Affecting the nulliparous female, usually develops during childhood or adolescence, with no firsthand experience of pregnancy or having never given birth. It is mostly seen in victims of sexual abuse or those who have gone through negative experiences of clinical examinations during routine health check-ups.
Secondary Tokophobia: Develops in women who have previously given birth with experiences of challenging situations of labor and delivery. It can occur after miscarriage, stillbirth, termination of pregnancy or unsuccessful pregnancy procedures.
Tokophobia is a type of specific phobia that causes fear of a particular situation affecting the person’s well-being, quality of life, and disrupting their sleep, food intake, and relationships. Some of the symptoms are:
– Fear of pregnancy-related physical changes, ill health issues, and maternal death
– Concerns of having a healthy baby, sometimes associated with mistrust of the medical professional
– Fear of hospitals, doctors, and treatment-related things
– Feeling of loss of control with loss of privacy
– Feeling ashamed, guilty, or miserable
– Do not want to reveal the news to others or think of terminating to avoid going through the process of childbirth
– Feeling of sadness, experiencing panic attacks or low tolerance to pain
It is completely normal to have concerns and worries about the pregnancy and its outcome and is seen in nearly 80% of expecting mothers as well as the family members. Majority of them are able to overcome it by talking and listening to others as well as consulting the healthcare providers. But if these fears become severe and debilitating, then it is diagnosed as Tokophobia. It is not very clear about the prevalence of this condition. Some research suggests a range of 2-15%. The condition remains unnoticed as there is a major taboo attached to it. It’s mainly because the patient might not open up about these symptoms, also the clinicians fail to recognise them as they do not actively look for them during the routine health visits. The understanding of this medical entity and awareness among the medical fraternity are growing in recent times. So there has been an attempt to probe further or make necessary referrals whenever the nodal clinician is able to notice any red flags.
Managing general fears by educating yourself and clearing the misconceptions related to them. But a condition like Tokophobia is a specific phobia that responds well to Cognitive behavioural therapy(CBT) and medications. CBT helps individuals by challenging their fearful thoughts and reframing the irrational thoughts, combined with coping strategies to manage the anxiety symptoms. Sometimes this needs to be combined with medications such as antidepressants or antianxiety medications. These medications are found to be safer in expecting mothers without causing any harm to the fetus. Do not shy away from talking about such fears or seeking help for such conditions.
Dr Krithishree Somanna, Consultant Psychiatry, KMC Hospital, Mangalore
