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If You're Feeling Really Afraid of Childbirth (Tokophobia), You're Not Alone

Pregnancy and birth come with a lot of unknowns. Some level of anxiety or apprehension before such a big change is totally normal — it helps us seek support and take steps to prepare. But a certain level of fear can get in the way. And a recent study shows that extreme fear of childbirth is actually a lot more common than you might think.

What is tokophobia?

Tokophobia is the clinical term for an intense fear of childbirth. While it’s standard in Scandinavian countries to screen for tokophobia, it’s not common practice in the U.S. So, until recently, this clinical fear of childbirth was thought to be pretty rare. But in 2020 (yes, right at the beginning of Covid), a researcher named Dr. Thayer polled 1,800 women about their thoughts and fears around pregnancy and childbirth. And a whopping 62% of them met the criteria for tokophobia, reporting high levels of fear and worry about childbirth.

These fears are valid. It doesn’t help that we get almost no information about birth in our culture until we’re already pregnant. And the little information we do have often comes from TV and movies, which usually show a fast, painful, medicalized birth (think: a woman screaming in pain in a hospital bed). Then, we start consulting Dr. Google, where there’s plenty of conflicting and concerning info at our fingertips. Add to that the harrowing statistics about maternal mortality in the U.S., particularly for Black birthing people who are three times more likely to die from a pregnancy-related cause compared to white birthing people. It’s no wonder that many pregnant people today are experiencing stress and this clinically “extreme” fear of childbirth.

Covid intensified childbirth fears for many

In early Covid, many birthing people in the U.S. felt afraid of giving birth alone, masked, getting Covid, giving their baby Covid, and being separated from their baby — fears that in some cases did come true.

Not having adequate labor support is associated with tokophobia. So, you can imagine how the early Covid hospital restrictions left many people feeling even more fearful and alone. Some people didn’t have access to pain management strategies they counted on. And the looming possibility of testing positive for Covid and being separated from their infant increased fear.

86.9% of study participants worried that, because of the COVID-19 crisis, they would not be able to have the people they wanted with them to support them during labor.

86.4% of study participants worried that if they get sick with COVID-19 their baby will be taken away from them at birth.

Dr. Thayer reports, “Since the social context of birth influences childbirth fear, the COVID-19 pandemic—which substantially affected maternity care experiences—likely impacted this measure.” In the words of a 30 year-old study participant, “I’m terrified all the way around as it is my first pregnancy. You name it, I’ve worried about it. The COVID-19 stuff just adds more fear.”

Discrimination increases likelihood of tokophobia

Black birthing people, who again have almost three times the risk of dying from pregnancy-related complications, were almost two times as likely to have a strong fear of childbirth compared to white birthing people.

The study found the odds of a Black birthing person having tokophobia was 90% higher than a white birthing person. Considering experiences of obstetric racism, it makes sense that a Black birthing person would feel more fearful in a system that actively discriminates against them. A 34-year old study participant with a low-risk pregnancy shared, “We chose our doctor because she was POC (though not black)...We are deeply aware of how race plays out in care.”

The study also found that birthing people who were pregnant with their first child, had a high-risk pregnancy, were experiencing prenatal depression, or were receiving OB care (rather than midwifery care) were also more likely to be more fearful. Fear of childbirth was also higher among birthing people with lower incomes and birthing people with less education.

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How tokophobia can affect birth outcomes

Tokophobia is, as you’d imagine, very distressing emotionally. It’s been shown that psychological stress during pregnancy is a predictor of adverse birth outcomes. Dr. Thayer’s study confirmed that this is indeed the case for tokophobia. The fear of childbirth experienced by the study participants (and the intense stress of giving birth during early Covid) appeared to significantly impact their birth outcomes.

People who experienced tokophobia were significantly more likely to give birth preterm (before 37 weeks) — study participants with tokophobia were almost twice as likely to have a preterm birth. People with tokophobia were also found to be more likely to have postpartum depression and to use formula to supplement breastfeeding. A study conducted in Europe showed Tokophobia was associated with elective cesarean birth, possibly due to fear of giving birth vaginally.

4 Ways pelvic floor physical therapy can help with tokophobia

If you’re feeling anxious or fearful about birth, seeing a pelvic floor physical therapist at any point (or throughout) your pregnancy can make a difference.

1. Feel more connected to your body

Fear can sometimes feel like an out-of-body experience. People can feel shaky, ungrounded, or disconnected from themselves. Using a combination of exercises and breath work, pelvic floor physical therapists can help you work slowly and safely to develop a feeling of connection with your body, especially your pelvic floor.

2. Demystify the birthing process

There’s a lot of anxiety in the unknown. Pelvic floor physical therapists can help demystify the birthing process so you can feel more prepared and in control. You’ll gain a deeper understanding of how your pelvic floor works in pregnancy, birth, and postpartum. Looking at the process head-on with someone you trust can help you feel more prepared.

3. Prepare your pelvic floor for birth

In preparation for labor, your physical therapist can help you address any tightness, weakness, or instability in your pelvic floor. Your PT can also help you unwind tension caused by the feedback loop of stress about birth. Through exercises, manual therapy, and breath work, you’ll learn how to strengthen and relax your pelvic floor (both of which will be key for a smoother, safer birth).

4. Get compassionate, nonjudgmental support

Your physical therapist has deep experience working with people experiencing fear around the childbirth process. Physical therapy is a judgment-free, shame-free zone, where you’re free to share what’s really on your mind.

At Origin, our pelvic floor PTs are experts at helping you get comfortable talking about how you really feel about pregnancy, birth, and postpartum. They’ve seen and heard it all, and they’re here to give you the support you truly need. Within the first 5 minutes (whether in-person or online) you’ll quickly realize that a pelvic floor PT visit is nothing like a rushed gyno exam. There’s time for your PT to learn about your current relationship to your body and birth, and to listen to any concerns you might have.

If you’re looking for a stigma-free and supportive guide who will help you prepare your physical and emotional body for birth, don’t hesitate to book a visit.

Ryann Summers
Ryann Summers

Ryann Summers is a freelance writer, birth doula, and trauma-informed yoga teacher. Whether she's writing an article or attending a birth, Ryann's always working to support people in making empowered choices about their bodies and health. She lives in Brooklyn with her partner and two very vocal cats.

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