Tokophobia

Written and Fact-Checked by: Jenna Carberg

What Is Tokophobia?

Tokophobia (also spelled tocophobia) is a severe fear of pregnancy and childbirth. It goes well beyond ordinary nerves about labor. For some people the dread is so strong that they avoid pregnancy altogether, even when they very much want a baby; for others it takes over a pregnancy, or drives an overwhelming wish for a cesarean.

The psychiatrist who first classified it described women who “dread and avoid childbirth despite desperately wanting a baby.” It is a real and often harrowing experience, and it is more common than most people realize.

There is no single agreed definition, and tokophobia is not listed as its own diagnosis in the DSM. Researchers generally reserve the term for fear that is intense, persistent and interferes with life or choices, as opposed to the normal worry most people feel before giving birth.

Types of Tokophobia

  • Primary tokophobia: fear of childbirth in someone who has never given birth, sometimes present since adolescence.
  • Secondary tokophobia: fear that develops after a previous birth, often a traumatic or difficult one.
  • Tokophobia linked to depression: fear of childbirth that appears as a symptom of depression during pregnancy.

Researchers also note that fear after a birth may be a different experience from fear before a first birth, and that for some people the fear centers on specific things, such as needles, blood or medical procedures.

How Common Is Fear of Childbirth?

  • A meta-analysis of 29 studies covering nearly 854,000 women found a pooled prevalence of about 14%.
  • A newer meta-analysis of 67 studies put severe fear of childbirth at about 16.5%.
  • Individual studies range from under 4% to more than 40%, because researchers define and measure it differently.

In other words, somewhere around 1 in 7 pregnant people have significant fear of childbirth, but the exact figure depends heavily on where the line is drawn. The most common research tool is the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). In one Swedish study, 15.8% scored in the range for intense fear and 5.7% in the range researchers labeled tokophobia.

Signs You May Have Tokophobia

Common experiences include:

  • Dread or panic when thinking about labor and delivery
  • Avoiding pregnancy, or delaying it for years, despite wanting children
  • Intense focus on everything that could go wrong for you or the baby
  • A strong wish for a cesarean mainly to avoid labor
  • Avoiding prenatal appointments, birth classes or conversations about birth
  • Nightmares, poor sleep or constant anxiety as the due date approaches
  • Flashbacks or distress if a previous birth was traumatic

What Causes It?

The research points to several factors:

  • A previous negative or traumatic birth, including an emergency or instrumental delivery, is the strongest predictor for people who have given birth before. In one study it raised the odds of severe fear more than fivefold.
  • Anxiety, depression and stress during pregnancy are closely linked with fear of childbirth.
  • Childhood abuse, including sexual abuse, doubled the odds of severe fear in first-time mothers in one study.
  • Low social support, especially from a partner, and an unplanned pregnancy are both associated with higher fear.

For first-time mothers, childhood abuse stood out as a risk factor; for mothers who had given birth before, a negative previous birth mattered most.

How Tokophobia Can Affect Pregnancy and Birth

These are associations from research, not certainties:

  • Cesarean requests: fear of childbirth is strongly linked to wanting a cesarean.
  • Longer labor: in a Norwegian study, labor was about 47 minutes longer on average for women with fear of childbirth after accounting for other factors.
  • Postpartum PTSD: fear of childbirth is one of the strongest pre-birth factors linked to post-traumatic stress after birth. About 3% of women report PTSD after childbirth.
  • Postpartum depression: in a Finnish study of more than 500,000 births, a diagnosis of fear of childbirth was linked to about 2.7 times the odds of postpartum depression in women with no prior depression.
  • Future pregnancies: some women delay or avoid having more children because of fear.

Treatment and Support

Fear of childbirth is treatable, and the earlier it is addressed in pregnancy, the more options there are.

Talking Therapies and Education

  • Counseling and therapy: in a Finnish randomized trial of women requesting a cesarean because of fear, 62% chose a vaginal birth after counseling, and intensive therapy reduced birth-related anxiety.
  • Midwife-led psychoeducation: an Australian trial found that phone-based sessions with trained midwives reduced high childbirth fear and increased confidence.
  • Cognitive therapy and group education with relaxation have been found effective in reviews, and prenatal education and mindfulness programs reduced fear in meta-analyses, though the certainty of that evidence is low to moderate.

Not everything has worked equally well. In a Swedish trial, internet-based CBT was no better than standard care right after treatment, and few women completed it. The honest summary is that talking-based support helps many people, the effects are modest, and the best format is still unknown.

Birth Planning and Cesarean Requests

The American College of Obstetricians and Gynecologists (ACOG) recommends:

  • Exploring the reasons behind a request for cesarean and discussing the risks and benefits.
  • When there is no medical reason for a cesarean, a plan for vaginal birth is safe and appropriate and should be recommended.
  • If a cesarean on request goes ahead after counseling, it should not be before 39 weeks.
  • Considering future pregnancies, since the risks of serious placenta problems rise with each repeat cesarean.

In the early case series that first described tokophobia, women who were refused their choice of delivery had more psychological problems, and some reviewers consider a cesarean a valid option when fear persists despite support. A planned cesarean does not appear to reduce anxiety before birth, though, which is why treating the fear itself matters.

After a Traumatic Birth

If your fear comes from a previous birth, trauma-focused therapy can help. A single routine “debriefing” session after birth has not been shown to prevent trauma symptoms, so ongoing support from a therapist is more useful than a one-off conversation.

Find a therapist who treats perinatal anxiety and birth trauma

What You Can Do Now

  • Tell your ob-gyn or midwife early, and name it: “I have severe fear of giving birth.”
  • Ask for a referral to a perinatal mental health therapist.
  • Get screened for anxiety and depression; the GAD-7 and PHQ-9 take a few minutes on this site.
  • Involve your partner or support person; partner support is linked to lower fear.
  • Talk through birth options in detail so the unknowns become known.

If you are struggling, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), free and available 24 hours a day. If you have thoughts of harming yourself, call or text 988.

Frequently Asked Questions

What does tokophobia mean?

Tokophobia means a severe fear of pregnancy and childbirth. The word comes from the Greek “tokos,” meaning childbirth.

How common is tokophobia?

Studies estimate that about 14% to 16% of pregnant people have significant or severe fear of childbirth, though estimates vary widely depending on how it is measured.

What is the difference between primary and secondary tokophobia?

Primary tokophobia occurs in people who have never given birth. Secondary tokophobia develops after a previous birth, often a traumatic one.

Is tokophobia a mental illness?

It is a recognized clinical problem in research and obstetric care, but it is not listed as a separate diagnosis in the DSM. It often overlaps with anxiety, depression or post-traumatic stress.

Can you get a C-section because of tokophobia?

ACOG recommends counseling first and a plan for vaginal birth when there is no medical reason for a cesarean. If a cesarean on maternal request is chosen after counseling, it should not be before 39 weeks.

Can tokophobia be treated?

Yes. Counseling, therapy, midwife-led education and mindfulness programs have all reduced fear of childbirth in studies.

Does fear of childbirth affect postpartum mental health?

It is linked to higher rates of postpartum PTSD and postpartum depression, which is another reason to get support during pregnancy.

PostpartumDepression.org Team
Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in the following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

  1. Hofberg K, Brockington I. “Tokophobia: an unreasoning dread of childbirth. A series of 26 cases.” Br J Psychiatry. 2000;176:83-85. https://doi.org/10.1192/bjp.176.1.83.
  2. O’Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O’Neill SM. “Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis.” Acta Obstet Gynecol Scand. 2017;96(8):907-920. https://doi.org/10.1111/aogs.13138.
  3. Maghalian M, Alizadeh-Dibazari Z, Mirghafourvand M. “Global prevalence and associated factors of severe fear of childbirth: a systematic review and meta-analysis.” Arch Womens Ment Health. 2026;29(1):1. https://doi.org/10.1007/s00737-025-01648-0.
  4. Wijma K, Wijma B, Zar M. “Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth.” J Psychosom Obstet Gynaecol. 1998;19(2):84-97. https://doi.org/10.3109/01674829809048501.
  5. Nieminen K, Stephansson O, Ryding EL. “Women’s fear of childbirth and preference for cesarean section: a cross-sectional study at various stages of pregnancy in Sweden.” Acta Obstet Gynecol Scand. 2009;88(7):807-813. https://doi.org/10.1080/00016340902998436.
  6. Dencker A, Nilsson C, Begley C, et al. “Causes and outcomes in studies of fear of childbirth: a systematic review.” Women Birth. 2019;32(2):99-111. https://doi.org/10.1016/j.wombi.2018.07.004.
  7. Lukasse M, Vangen S, Øian P, Kumle M, Ryding EL, Schei B. “Childhood abuse and fear of childbirth: a population-based study.” Birth. 2010;37(4):267-274. https://doi.org/10.1111/j.1523-536X.2010.00420.x.
  8. Adams SS, Eberhard-Gran M, Eskild A. “Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery.” BJOG. 2012;119(10):1238-1246. https://doi.org/10.1111/j.1471-0528.2012.03433.x.
  9. Ryding EL, Lukasse M, Kristjansdottir H, Steingrimsdottir T, Schei B. “Pregnant women’s preference for cesarean section and subsequent mode of birth: a six-country cohort study.” J Psychosom Obstet Gynaecol. 2016;37(3):75-83. https://doi.org/10.1080/0167482X.2016.1181055.
  10. Ayers S, Bond R, Bertullies S, Wijma K. “The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.” Psychol Med. 2016;46(6):1121-1134. https://doi.org/10.1017/S0033291715002706.
  11. Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. “Fear of childbirth predicts postpartum depression: a population-based analysis of 511 422 singleton births in Finland.” BMJ Open. 2013;3(11):e004047. https://doi.org/10.1136/bmjopen-2013-004047.
  12. Olieman RM, Siemonsma F, Bartens MA, Garthus-Niegel S, Scheele F, Honig A. “The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.” BMC Pregnancy Childbirth. 2017;17(1):195. https://doi.org/10.1186/s12884-017-1371-z.
  13. American College of Obstetricians and Gynecologists. “ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request.” Obstet Gynecol. 2019;133(1):e73-e77. https://doi.org/10.1097/AOG.0000000000003006.
  14. Saisto T, Salmela-Aro K, Nurmi JE, Könönen T, Halmesmäki E. “A randomized controlled trial of intervention in fear of childbirth.” Obstet Gynecol. 2001;98(5 Pt 1):820-826. https://doi.org/10.1016/s0029-7844(01)01552-6.
  15. Toohill J, Fenwick J, Gamble J, et al. “A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women.” Birth. 2014;41(4):384-394. https://doi.org/10.1111/birt.12136.
  16. Rondung E, Ternström E, Hildingsson I, et al. “Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: randomized controlled trial.” JMIR Ment Health. 2018;5(3):e10420. https://doi.org/10.2196/10420.
  17. Larsson B, Karlström A, Rubertsson C, Hildingsson I. “The effects of counseling on fear of childbirth.” Acta Obstet Gynecol Scand. 2015;94(6):629-636. https://doi.org/10.1111/aogs.12634.
  18. Striebich S, Mattern E, Ayerle GM. “Support for pregnant women identified with fear of childbirth (FOC)/tokophobia: a systematic review of approaches and interventions.” Midwifery. 2018;61:97-115. https://doi.org/10.1016/j.midw.2018.02.013.
  19. Karaçam Z, Ofei P, Uzunoğlu G, Güneş Öztürk G. “The effect of prenatal education on the fear of childbirth: a systematic review and meta-analysis.” Arch Womens Ment Health. 2026;29(1):37. https://doi.org/10.1007/s00737-025-01635-5.
  20. Wang R, Wang Y, Huang Y, Chow KM. “Effectiveness of mindfulness-based interventions for fear of childbirth among pregnant women planned for normal birth: a systematic review and meta-analysis.” Worldviews Evid Based Nurs. 2026;23(1):e70101. https://doi.org/10.1111/wvn.70101.
  21. Jomeen J, Martin CR, Jones C, et al. “Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research.” J Reprod Infant Psychol. 2021;39(1):2-15. https://doi.org/10.1080/02646838.2020.1843908.
  22. Rondung E, Magnusson S, Ternström E. “Preconception fear of childbirth: experiences and needs of women fearing childbirth before first pregnancy.” Reprod Health. 2022;19(1):202. https://doi.org/10.1186/s12978-022-01512-9.
  23. Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. “Debriefing interventions for the prevention of psychological trauma in women following childbirth.” Cochrane Database Syst Rev. 2015;(4):CD007194. https://doi.org/10.1002/14651858.CD007194.pub2.
  24. Rondung E, Ekdahl J, Hildingsson I, Rubertsson C, Sundin Ö. “Heterogeneity in childbirth related fear or anxiety.” Scand J Psychol. 2018;59(6):634-643. https://doi.org/10.1111/sjop.12481.
  25. Alizadeh-Dibazari Z, Maghalian M, Mirghafourvand M. “The relationship between perceived social support and fear of childbirth in pregnant women: a systematic review and meta-analysis.” BMC Psychol. 2025;13(1):709. https://doi.org/10.1186/s40359-025-03047-7.
  26. 988 Suicide and Crisis Lifeline. “988 Suicide and Crisis Lifeline.” https://988lifeline.org/. Accessed September 15, 2026.
  27. Health Resources and Services Administration, Maternal and Child Health Bureau. “National Maternal Mental Health Hotline.” https://mchb.hrsa.gov/programs-impact/national-maternal-mental-health-hotline. Accessed September 15, 2026.

Get Answers to Your Postpartum Depression Questions

Find a Therapist