Tokophobia is a profound fear of childbirth that affects far more people than the statistics suggest. Here's what it is, and what genuinely helps.

You're not just nervous. You're not being dramatic.

If the thought of giving birth fills you with a level of dread that feels completely out of proportion, if it keeps you awake at night, affects your daily life, makes you question whether you can go through with the pregnancy, there's a word for what you're experiencing.

Tokophobia.

And if you've never heard that word before, you're not alone. Despite affecting a significant number of pregnant people, tokophobia is rarely named in standard maternity care. People are often told to 'try not to worry' rather than to be offered appropriate support.

Why this matters. Because when we name something, we can treat it. And tokophobia is treatable.

What tokophobia actually is

Tokophobia is a specific phobia of childbirth, although this might also be related to a fear of pregnancy. It's classified as a mental health condition and recognised by the World Health Organisation. Like all phobias, it exists on a spectrum, from significant anxiety about birth that interferes with daily functioning, to a level of fear so profound that it leads some people to avoid pregnancy altogether, opt to end the pregnancy, or to request a caesarean section on grounds of mental health.

There are two types. Primary tokophobia occurs in people who have never given birth, the fear is anticipatory, often rooted in things they've seen or heard, or in a generalised sense of threat and loss of control. Secondary tokophobia develops after a difficult or traumatic birth experience. The nervous system was overwhelmed during the previous birth, and now pregnancy triggers the same alarm.

Both are real. Both are valid. Both can be helped.

Why most people never get a diagnosis

Part of the problem is that birth anxiety exists on a continuum, and our maternity system often doesn't have good language for the middle ground between 'a bit nervous' and 'in crisis.'

People tell me they minimised their fear to their midwife because they didn't want to seem difficult, or because they'd already been told it was normal, or because they couldn't find the words for something that felt so physical and overwhelming at a time when they were expected to be happy and excited. Some blame themselves for not being able to cope with something other people seemed to manage, and others sometimes normalise their fears.

These people weren't being dramatic. They were experiencing a diagnosable condition that deserved proper attention and support.

What doesn't work, and why

From my clinical experience working with people with tokophobia and birth trauma in the NHS, a few commonly suggested approaches can fall short, or in some cases make things harder.

Graduated exposure therapy, whilst effective for many phobias, presents a unique challenge with tokophobia during pregnancy. You can't create a truly safe, stepped approach to something you're already moving toward and can't avoid. This is why working with someone who understands the specific nature of birth fear matters so much, a generic approach to phobia treatment rarely gets close enough to what's actually happening for you.

Generic hypnobirthing, while genuinely helpful for many people with birth anxiety, can be less effective, and occasionally distressing for those with tokophobia or birth trauma. Many hypnobirthing programmes place significant emphasis on how fear itself can negatively affect birth physiology and labour progress. For someone without severe fear, this is useful information. But for someone with tokophobia, it can backfire, creating an additional layer of anxiety, a worry that their level of fear will somehow prevent them from being able to birth their baby. If a practitioner isn't aware of the severity of what someone is carrying, that message can do more harm than good. Hypnobirthing can absolutely have a place in supporting someone with tokophobia, but it needs to be handled with real sensitivity and adapted accordingly.

Being told to 'focus on the positive' or 'trust your body' can feel invalidating at best. For someone whose trust in their body, or in their care team, was broken by a previous experience, those words don't land as reassurance, they can land as dismissal.

What actually helps

The approaches with the strongest evidence base for tokophobia include Cognitive Behavioural Therapy (CBT), Compassion Focused Therapy (CFT), and trauma-informed birth preparation that works with the nervous system rather than against it.

Midwife-led specialist support, sometimes called a 'birth afterthoughts' or 'birth reflections' service in the NHS, can also be enormously valuable for people with secondary tokophobia, providing space to understand what happened and what can be different this time.

And practically: detailed, personalised birth preferences. A care team who understands your history. A support person whose role is specifically to advocate for you. These aren't luxuries, they're part of how we make birth safer and less traumatic for people with significant birth fear.

Asking for help

If what I've described feels familiar, I want to encourage you to name it to your midwife or GP. You're allowed to say: 'I think I have tokophobia and I need more support than I'm currently getting.' You're allowed to ask for a referral to a perinatal mental health midwife.

The NHS provision varies by area. But naming it is the first step to getting the right support.

My Birth Without Fear course is built for people with significant birth fear. It combines techniques from my NHS mental health practice with practical, trauma-informed birth preparation. Find out more at birthcare.co.uk.

With compassion,

Katie

NHS Mental Health Midwife | Perinatal Trauma Specialist