‘Tokophobia’ is an intense anxiety or fear of death which leads to some women dreading and avoiding childbirth despite desperately wanting a baby.

 

A study of a series of 26 cases of women suffering from this condition is published in the January issue of the British Journal of Psychiatry. It concludes that:

 

Subjects for the study were referred from obstetricians in the West Midlands and from psychiatrists on the mother and baby unit at the Queen Elizabeth Psychiatric Hospital in Birmingham. They were seen over a two-year period in their homes by the same psychiatrist who was not the treating doctor.

 

24 of the women in the study were married and 24 had had all their children with the same partner.

Primary tokophobia. Eight of the women had a dread of childbirth which pre-dated pregnancy and had begun in adolescence. Sexual relations were normal but contraceptive use was scrupulous. Four of these women planned their pregnancy despite their intense fears; and two had an overwhelming desire to be a mother which overpowered their avoidance but did not allay their fear.

 

Most women with primary tokophobia strongly desired a Caesarian birth. Four achieved this, bonded well with their baby and enjoyed excellent psychological health. Three women endured vaginal deliveries against their will; all suffered postnatal depression, two suffered symptoms of PTSD and two had delayed bonding with their infants.

 

Secondary tokophobia occurs after a traumatic or distressing delivery. 14 women in the study developed a dread of childbirth after a previous delivery. Their dilemma was that the family felt incomplete but they were terrified of a further delivery. Nevertheless 13 of them proceeded with further pregnancies, of whom three had miscarriages ( and felt enormous relief that delivery was avoided). All 13 women were extremely anxious during their pregnancies.

 

11 of the women in this study group arranged a Caesarian birth; one had a successful vaginal delivery and a good psychological outcome; and the other suffered postnatal depression, PTSD and a bonding disorder with her baby.

 

Four women developed tokophobia as a symptom of depression in the prenatal period and believed that they were unable to deliver their baby – if made to, they would die. Two who tried to end their pregnancy were treated psychologically and recovered. One woman who responded well to antidepressants arranged a Caesarian birth and bonded well to her baby. By contrast, another women who declined antidepressant medication and was refused a Caesarian had a traumatic vaginal delivery, suffered from postnatal depression and felt detached from her baby.

 

Five women in the sample reported sexual abuse in childhood and three a traumatic rape. The authors comment that a history of sexual abuse may be associated with an aversion to routine obstetric care associated with primary tokophobia or tokophobia as a symptom of depression. The trauma of a vaginal delivery may cause a resurgence of memories of abuse and contribute to secondary tokophobia.

 

Two women in the study terminated a pregnancy because they could not face delivery, even though both babies were much wanted. This outcome may be the only choice in the absence of an empathic professional listener or access to relevant medical literature.

 

There was a high rate of hyperemesis gravidarum in the study, and a psychological component to this has been postulated.

 

Dr Kristina Hofberg is now working in Grand Cayman in the British West Indies and is assessing the frequency of tokophobia in GP attenders.

For further information, please contact Liz Fox or Deborah Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127

E-mail: efox@rcpsych.ac.uk or dhart@rcpsych.ac.uk