Tocophobia: an uncontrollable fear of childbirth

Although most women dread the pain of childbirth, those suffering from tocophobia fear it to such an extent that they may even avoid becoming pregnant or have an abortion in spite of really wanting to have a child.

Some English psychiatrists are now lifting the covers off this strange and largely unknown illness, known as tocophobia. There are many possible explanations for this sometimes-uncontrollable fear of childbirth, which continues, particularly in the Western world, despite medical progress and birth complications being more and more uncommon. Tocophobia can be caused by a fear of pain, a tendency to worry a lot, depression, previous obstetric trauma and even sexual trauma.

19th century fear of dying or suffering great pain in childbirth

Women the whole world over look upon the moment of childbirth as a barrier to cross, a stage to get through. In his 1858 “Treatise on the madness of pregnant women, new mothers and wet nurses”1, Dr. Louis Victor Marcé described the fears of the mother-to-be in these terms: “If they are giving birth for the first time, waiting for unknown pain worries them beyond all measure and they are plunged into an indescribable state of anxiety. If they are already mothers, they are terrified by the memory of the past and the prospect of the future; they are privately convinced that they are going to die from the ordeal which awaits them”.

Marcé added that “this idea becomes absolutely fixed in their heads and triggers a melancholy frame of mind which takes over all their thoughts”, which corresponds in other words to a real depressive phobia which the author returns to at great length in his book.

The foremost explanation for this, particularly in that era, were the accounts of appalling deliveries passed down through the generations. Also, up until the 20^th century, the mortality rate during childbirth was very high, bringing some reality to women’s fears.

Tocophobia: persistent fear despite medical progress

Nowadays, thanks to wider provision of medical care, maternal mortality rate in western countries has gone down considerably, even though it is still significant in some places. According to the French Institute for Public Health Surveillance, the rate is estimated at between 9 and 13 deaths in every 100,000 births2, which represents the deaths of around sixty women each year. Although this number seems low, compared to developing countries where the mortality rate can reach 500 for the same number of births, it is still high and doesn’t allow total reassurance to today’s women.

Moreover, paradoxically, the current provision of medical care for childbirth, which has allowed the mortality rate to fall, is the subject of other fears, such as the fear of hospitals, doctors and medical instruments. And so some women prefer to abandon the idea of having a child, even though they may desperately want one, because the fear of the pain or dying in childbirth takes over. These women are suffering from an illness called tocophobia (from the Greek word “tokos” meaning childbirth).

Tocophobia can take many forms

Psychiatrists distinguish between three forms of tocophobia, according to the circumstances that set it off. Two psychiatrists, Kristina Hofberg and Ian Brockington from Queen Elizabeth Psychiatric Hospital in Birmingham3, have shown this by looking closely at 26 women who suffer from tocophobia:

Primary tocophobia, which affected 8 women in the study, precedes the first delivery and goes back to adolescence. Sexual relationships are normal but contraception is “scrupulous” and excessive, with several contraceptive methods being used at the same time because of an intense fear of pregnancy and childbirth. Nevertheless, 4 of these women suffering from tocophobia fell pregnant intentionally, their desire to have a child finally overcoming their fear. However, they wanted to give birth by caesarean section, scheduled if possible.

Secondary tocophobia, which affected 14 of the women in this study, comes about after a difficult delivery, for example an emergency instrumental delivery because the foetus was in distress or quite simply because they were in great pain which traumatised them. 12 out of the 14 women thought “they were going to die or that their baby was already dead”. However, these women had another child despite their secondary tocophobia, but their pregnancy was extremely stressful with the recurring fear of not being able to deliver. Moreover, only 2 had a natural delivery; the others had a caesarean section.

Tocophobia as a symptom of prenatal depression - carrying their pregnancy through with its implications can lead to a depressive syndrome, of which tocophobia is a part (this was the case for 4 women in the aforementioned study). This depression can be treated and does not necessarily transform into postnatal baby blues, especially if the delivery goes well after all.

It should be noted that 5 women suffering from primary tocophobia or depression in this study were victims of sexual abuse during their childhood and 3 were victims of rape, which leads you to suppose that the eventuality of delivery is associated with the memory of this vaginal trauma³.

Consequences and possible complications of tocophobia

As we have seen, tocophobia can prompt a woman to request a caesarean section. Furthermore, in certain cases, the fear is so intense that the pregnant woman can actually ask for her pregnancy to be terminated, as was the case for two women in the study. If health professionals empathise and listen to women, this type of radical solution can be avoided.

Other possible consequences are severe vomiting, which was seen in more than half of the women suffering from primary tocophobia. This vomiting, which is a lot more serious than during normal pregnancy, can be linked to a rejection of the pregnancy, failure to bond with the unborn child while it is developing, or even a wish to “get this pregnancy over and done with”.

Primary or secondary tocophobia can also lead to genuine post-traumatic stress syndrome after delivery, which a psychiatrist or psychologist treat. Post-natal depression can also occur.

Finally, women often ask to be sterilised after they have delivered to avoid having to face this severe phobia again. 10 out of the 26 women in the English study had themselves sterilised after their delivery or either they or their male partner were on the waiting list to be sterilised.3

This uncontrollable fear is therefore a very real one and can have serious consequences. If you are affected by it, don’t be afraid to speak to your family doctor or your gynaecologist. They will advise you on the ways you can deal with the disorder, possibly with psychological support. As with any phobia, it can be cured and you can have a pleasurable pregnancy and delivery.

1. Dr Louis Victor Marcé, "Traité de la folies des femmes enceintes, des nouvelles accouchées et des nourrices", 1858, p. 34-35
2. "La mortalité maternelle en France : bilan et perspectives, Bulletin épidémiologique hebdomadaire de l'Institut de Veille Sanitaire", 12 Dec, 2006
3. Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Kristina Hofberg et Ian Brockington, Br J Psychiatry. 2000 Jan;176:83-5

Karine Touboul, Dr Jean-Philippe Rivière

Posted 15.07.2010

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