For many expectant parents, the prospect of childbirth can be a daunting one. But some experience the fear more acutely, so much so that it becomes a phobia. Tocophobia — "a severe fear or dread of childbirth", according to the Guardian — is reportedly on the rise, and some experts suggest that birth stories shared on social media could be contributing to the increase. Let's look a little closer: what is tocophobia, and just how common is it?
A 2017 study published in Acta Obstetricia et Gynecologica Scandinavica indicated that 14% of pregnant people experience tocophobia (also spelled tokophobia); what's more, the study concluded that the prevalence has increased since 2000. The Pan-London Perinatal Mental Health Network breaks tocophobia down into two forms: primary tocophobia, or a "longstanding" fear of childbirth, and secondary tocophobia, which results from a traumatic childbirth experience. Secondary tocophobia is more common, the network says, and is often considered a form of post-traumatic stress disorder.
A previous traumatic birth isn't the only risk factor that might make someone more likely to develop tocophobia. A person might have experienced medical trauma unrelated to childbirth, or witnessed somebody else's difficult birth experience. They might have miscarried, given birth to a stillborn baby, or lost a child soon after giving birth. People with pre-existing mental health conditions are at greater risk of developing tocophobia, as well as those with a history of "sexual dysfunction", abuse, or rape.
At the British Science Festival earlier this month, University of Hull midwifery lecturer Catriona Jones pinpointed another potential trigger of tocophobia: social media. "You just have to Google childbirth and you’re met with a tsunami of horror stories," Jones said, as the Guardian reports. "If you go on to any of the Mumsnet forums, there are women telling their stories of childbirth — oh, it was terrible, it was a bloodbath, this and that happened. I think that can be quite frightening for women to engage with and read about."
She added, "I wouldn’t say social media is leading women to be afraid of childbirth, but it plays a part."
Professor Louise Kenny, executive pro-vice-chancellor at the University of Liverpool, supported Jones' statement, telling the Guardian that "some women are predisposed to developing a phobia due to stories taken out of context or experiences that are graphic. It is not a major cause of tocophobia but a recognised one."
Others, however, have contested Jones' claim, saying that sharing birth experiences can be informative and a vital source of solidarity for those who've experienced trauma. Mumsnet CEO Justine Roberts told the BBC, "Mumsnet users are, in the main, impatient with the idea that adult women aren't entitled to discover the truth about the full spectrum of birth experiences, from the blissful to the terrifying."
She continued, "Understandably, a great deal of NHS messaging about labour focuses on the positive, but the downside of this is that mothers who have traumatic experiences feel, in retrospect, that they were given a deeply partial account: one of the most common complaints we see on this topic is, 'Why on earth didn't anyone tell me the truth about how bad it could be?'"
And Sophie Walker, leader of the Women's Equality Party, told the Guardian, "Giving birth is not a medical problem to be fixed by doctors, but women in labour are treated as patients. These are the problems that need to be reviewed and critiqued, not the women sharing their experiences of birth via platforms like Mumsnet, where they seek solidarity and understanding."
So how can a typical apprehension of childbirth be distinguished from tocophobia? The Pan-London Perinatal Mental Health Network lists symptoms including "distress and heightened anxiety when a pregnancy is confirmed", as well as fear of pain, harm, or death as a result of childbirth, and increasing anxiety and distress towards the end of pregnancy. People with tocophobia might think about terminating their pregnancy as a result of their fear, or experience intrusive thoughts or flashbacks from a previous difficult birth. They might also avoid talking or thinking about the pregnancy or impending birth altogether.
If those symptoms sound familiar, the Pan-London Perinatal Mental Health Network recommends speaking to your consultant obstretrician or midwife, who should refer you to a mental health professional, specialist mental health midwife, or consultant midwife. You might be offered a form of psychological therapy, such as cognitive behavioural therapy (CBT); those experiencing PTSD from a former traumatic experience might be referred for eye movement desensitisation reprocessing or trauma-focused CBT. Your healthcare team might also suggest steps including creating a thorough birth plan, or visiting the labour ward in advance.
Most importantly? Don't hesitate to speak to someone about it: as the network stresses, "the earlier you can get help the better."