Tokophobia and what it means to some women

Most mothers say that childbirth, for all its trauma, is one of the most powerful experiences in a woman’s life. Yet, some women prefer to remain childless to facing the delivery room. Kaylene Tan brings you up to speed on tokophobia - the fear of childbirth.

Pregnancy is a life-changing event. It may be planned for but when the time comes, one is never fully prepared. It causes huge physical and psychological changes. It is normal to have fears.  Seek out positive birth stories and stop: Listening to your friend’s horror birth stories; reading stories of traumatic births in magazines;  watching birth being depicting in a negative or disrespectful way on TV.  Apart from educating yourselves to make you less fearful, husbands are also very important during the whole process. Women, especially those who are experiencing some anxieties, should feel supported and loved.

Fact: In the UK, at least one in six women is so terrified of giving birth that she induces a miscarriage or avoids becoming pregnant altogether, even though she desperately wants children, according to a 2000 UK study. This fear of giving birth is called tokophobia, derived from the Greek words “tokos” meaning childbirth, and “phobos”  fear. 

Mother & Baby expert Dr Adrian Wang of Adrian Wang Psychiatric and Counselling Care, notes that tokophobia is not commonly diagnosed in Singapore, so there aren’t any statistics for this condition. He explains, “Pregnancy is a life-changing event. It may be planned for but when the time comes, one is never fully prepared. It causes huge physical and psychological changes. It is normal to have fears. But calling it a phobia is serious.” 

Mother & Baby expert Dr Christopher Chong, a consultant obstetrician, gynaecologist and urogynaecologist, points out that it’s normal for every mum-to-be to experience anxiety or worry since they want everything to go well for themselves and their babies. 

He says, “They are embarking on a journey into the unknown. As no one can predict the outcome - even with tests - no one can be absolutely sure that everything will go well. In fact, it is unusual not to have any anxieties or worries, but not to the extent of upsetting your life or needing psychiatric treatment.”

In 2007, Oscar-winning actress Helen Mirren admitted to suffering from tokophobia. Blaming her childlessness on a graphic childbirth video shown to her as a 13-year-old schoolgirl, she said it “traumatised” her and childbirth “disgusts” her.

PRIMAL FEARS
There are two types of tokophobia - primary and secondary:
• Primary tokophobia A fear of death in childbirth, disgust or dread of the process. The woman goes to great lengths to avoid getting pregnant. Sufferers often have poor perceptions and distorted views of pregnancy and childbirth.
• Secondary tokophobia Caused by a previous experience of traumatic birth, poor obstetric practices or previous postnatal depression. Some of these women are afraid of feeling out of control during delivery and several have distressing flashbacks of their labour. 

Both Drs Chong and Wang agree that Post Traumatic Stress Disorder (PTSD) should not be ruled out from some women’s previous birthing experiences. As they may have suffered physically and psychologically, they are prepared for the same thing to happen again. 

Di Bustamante, a director at ParentLink, which conducts childbirth classes, who has a different take on this illness, reckons that tokophobia is rooted in a fear of pain and also the unknown. Bustamante points out that during the Dark Ages, women lost information about childbirth that midwives provided after they were stamped out for being “witches”. 

She says, “Our bodies are designed to give birth. Without the knowledge, without the medical care when something did go wrong, women became fearful. We have passed this fear from generation to generation to where it is instilled today requiring women the need to drug themselves to ‘get through’ this normal, physiological process.” 

ROOT OF THE PROBLEM
Dr Wang notes that it is normal for many women to feel squeamish about blood and pain and the size of the baby’s head pushing through. However, traumatic experiences during childhood can give rise to fears and a total aversion to childbirth. These may include sexual abuse and a poor relationship with parents. Like Dame Helen Mirren, a graphic film or horror stories about childbirth could put some women off having children altogether. 

Because this unreasoning dread is one of society's taboo subjects, dealing with the condition is often difficult. Tokophobia is an unspoken topic about because many women hold up their childbirth experiences as a badge of honour, and women who do not want children are often labelled “cold-hearted” or “babyhaters” or even “frigid”. 

Dr Wang explains that women who choose not to have children or have tokophobic tendencies often live with a lot of guilt - towards their husbands and families. He adds, “They feel abnormal or defective, and that they are not worthy to be mothers.” 

GETTING A GRIP
If a woman suffers from pregnancy anxieties and depression, Dr Wang suggests treating it with intensive counselling and psychiatric management, where some medication may be prescribed. And if you really can’t face the birth process, a Caesarean section is the only option. 

Boning up on childbirth should help diminish one’s dread. Fear, Bustamante explains, creates a chemical response in the body. “If fear is present during a woman’s labour, catecholamines are released, the oxygenated blood leaves the uterus and rushes to the hands and feet for the flight or fight response. The muscles can no longer work in harmony as the body fights itself ? the cervix tries to open, the fear causes tension and constriction results in pain.” 

Hypnobirthing, she suggests, is a technique that can reduce and sometimes even eliminate the fear-tension-pain syndrome. Such classes feature empowering birth DVDs, relaxation and visualisation of beautiful birth experiences. Decision-making role-playing sessions help you make informed choices about your baby’s birth. 

Bustamante points out, “Even with a birth plan agreed upon with your maternity care providers, no one can absolutely foresee how your labour will progress. Learn how to make the right choices for you and your baby to ensure you are happy with your outcome.” 

FEELING GOOD
During labour, the body secretes oxytocin and endorphins - feel-good hormones - high levels of these can ease the labour and delivery process for women. Bustamante also suggests ways in which women can help themselves cope with their childbirth fears:
• Educate yourself to relieve your fears.
• Read birth books written to alleviate your fears, not reinforce them.
• Seek out positive birth stories and stop: Listening to your friend’s horror birth stories; reading stories of traumatic births in magazines; watching birth being depicting in a negative or disrespectful way on TV.
• Take classes outside the hospital setting to learn all your birthing options.
• Seek counselling to find the source of your fear - options available include talk therapy and hypnosis.
• Surround yourself with maternity care providers who will support you in your goal to have a great birth experience.
Indeed, supportive husbands and obstetricians during the pregnancy and labour process help to create a less stressful environment during childbirth. 

Dr Wang says, “Apart from educating yourselves to make you less fearful, husbands are also very important during the whole process. Women, especially those who are experiencing some anxieties, should feel supported and loved.” 

If you have any comments or practical suggestions, write to us at editor@family.sg 

- Mother & Baby
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