When we think of women making a decision about whether or not to start a family we have a general preconceived notion about what goes into that decision. How their partner feels, the financial implications, career impact, managing childcare if needed, housing are just a few that come to mind. But there is one factor that weighs into some women’s decision making process that isn’t often discussed. A hidden fear of pregnancy and childbirth.
Tokophobia is a deep, overwhelming, and intense fear of pregnancy and childbirth. While some anxiety about pregnancy, labor and delivery is completely normal—after all, there’s a lot at stake—this level of fear goes far beyond the typical concerns of potentially expectant mother.
When Fear Becomes a Phobia
Up to 80% of pregnant women report some worries about pregnancy and childbirth. They might stress about changes to their body, loss of control, pain, complications, or the health of their baby. But for about 13% of women, this fear is so overwhelming that they delay pregnancy—or avoid it altogether. Some may even terminate a wanted pregnancy rather than face childbirth.
Unlike postpartum depression, which is now widely recognized and discussed, tokophobia is still relatively unknown. Tokophobia isn’t even listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as distinct disorder. This is in spite its real and serious impact on women’s mental health and life choices.
There are two types of tokophobia:
Primary Tokophobia
This affects women who have never been pregnant. It often develops in early life—perhaps after hearing a traumatic birth story, seeing distressing images of childbirth, or experiencing sexual trauma.
Secondary Tokophobia
This occurs after a previous difficult pregnancy or delivery. A traumatic birth, miscarriage, stillbirth, or emergency C-section can leave emotional scars that turn into an extreme fear of giving birth again. In many cases, it resembles post-traumatic stress disorder (PTSD).
What Are Women with Tokophobia Afraid Of?
Tokophobia isn’t just about fearing the pain of childbirth. Women with this condition may be terrified of:
- Changes to their body during pregnancy
- Losing control during childbirth
- Not being listened to by medical professionals
- Birth injuries to themselves or their baby
- Medical complications or even death
- Permanent physical trauma to their body
- The unpredictability of labor and delivery
For some, even seeing a pregnant woman or watching a birth scene in a movie can trigger intense anxiety. Women with severe tokophobia may experience nightmares, panic attacks, crying spells, or even physical symptoms like nausea or sweating when the topic of potentially becoming pregnant or childbirth arises.
Breaking the Silence
For years, tokophobia wasn’t something women talked about openly. But that’s slowly changing. In 2007, actor Helen Mirren shared that watching a childbirth film at age 13 left her so traumatized that she never wanted children. Stories like hers are helping more women recognize that they are not alone.
Still, a stigma remains in our culture. Society assumes that women are supposed to embrace pregnancy with joy and excitement, which can leave those who feel differently drowning in shame. While more women feel free to talk about how they may not have loved being pregnant, there are still very limited conversations beyond that. Rarely do women talk about about the idea of pregnancy and childbirth being so overwhelming that it would cause someone to consider not having children at all.
Women who do not yet have children but have passed all of the more traditional “readiness” markers such as: a committed partnership, established careers and a secure residence may feel particularly intense pressure to “want” to become pregnant. They may feel isolated in their fears, not realizing that many other women share them but feel their concerns will be minimized, dismissed or seen as strange or unloving. Thus they suffer in silence.
Fear of Disappointing Their Partner
Many women indicate that they did not share their fear or minimized the intensity when discussing it in the early stages of their relationship with their partner. One woman said
It’s not that I didn’t tell him I had some fear of getting pregnant. I did. I just allowed him to minimize those fears and didn’t clarify just how intense my fears were. I felt like if I told him there was a part of me that feared I would never be ok with becoming pregnant that’d he reject me. Or that he’d take it personally like I didn’t want to have his child. So by the time we were talking about marriage he thought we were in the same place because I do want kids, I just don’t want to be pregnant or go through childbirth. When I finally felt I could bring up adoption he was a little surprised but still didn’t get it and said that’d he’d be open to that after we had one or two biological kids. He wasn’t at all open to the idea of not ever trying to become pregnant. I panicked and told him I’d figure it out. But now we are in our mid-thirties and he’s been ready to start a family for a few years and I keep making excuses. I just don’t know if I can do it and I’m terrified he’s going to divorce me and find someone at least willing to try to carry his child.
The fear of disappointing one’s partner is very real. It adds to the complexity of tokophobia as the desire to want to want to be pregnant complicates working through the anxiety. Fear of losing your partners love, trust or respect can leave you feeling even more paralyzed, misunderstood, alone and unsupported.
Overcoming the Fear
If you feel that you do want to have a child but feel paralyzed by fear, know that there are ways to work through tokophobia. Here’s where to start:
Educate yourself—Fear often comes from the unknown. Learn about childbirth from reliable sources, and steer clear of horror stories or sensationalized media portrayals. Even well-meaning family members can spread misinformation that fuels anxiety.
Talk about it—Speak with a supportive doctor, therapist, or close friend. You’re not broken, and you don’t have to handle this alone.
Consider therapy—A mental health professional can help you work through past trauma, anxiety, or PTSD that may be contributing to your fear. A therapist familiar with tokophobia can help you find ways to feel safer during pregnancy and childbirth. They can also assist in advocating for appropriate accommodations when possible.
Try mindfulness techniques—Prenatal classes that incorporate relaxation techniques, guided meditation, EFT tapping or hypnobirthing can help give you tools to approach childbirth with more calm and confidence.
Advocate for yourself—If you decide to move forward with pregnancy, choose a healthcare provider who understands, listens to and respects your concerns. This should include a birth plan that makes you feel as safe and supported as possible. Some women find comfort in hiring a doula or discussing planned medical interventions that give them more control.
You’re Not Alone
Fear of pregnancy and childbirth is real, and women need to be acknowledging it without shame. If tokophobia is holding you back from the life you want, know that help is available. By taking small, informed steps, you can begin to shift your relationship with pregnancy and birth—and allow you to reclaim the choice that feels right for you.