I usually write my posts with an air of humour about them because nothing is more true than the old saying ‘if you don’t laugh you’ll cry’ but today my post has a more serious tone to it. That’s because the subject isn’t something that can be dismissed with wit, it is a subject very close to my heart as I suffer from Tokophobia myself and because of this I went through one of the toughest years of my life while pregnant. One of the things that makes Tokophobia harder is the fact that it is not widely known about and certainly not well understood even by medical or antenatal staff.
The Industrial Psychiatry Journal. 2012 defines Tokophobia as:
A pathological fear of pregnancy that can lead to avoidance of childbirth. It can be classified as primary or secondary. Primary is morbid fear of childbirth in a woman, who has no previous experience of pregnancy.
I agree with this ‘in a nutshell’ explanation however the reality of Tokophobia is much more complicated with a huge number of variants. It is not just childbirth itself that many sufferers have a fear of, for some it is the reality of having a baby growing inside of them, for others it is the loss of control and for many it is the fear of medical procedures of any kind. For those with secondary Tokophobia it is often due to their experience of a previous pregnancy or labour or due to them having suffered abuse or having been through a traumatic experience in the past. No matter what the reason, if there is one, the thought of enduring pregnancy and childbirth can not only be unbearable for the sufferer but can also ruin the relationships they have and stop them from having the opportunity to become parents even if their greatest wish is to have a child.
Tokophobia is not a new thing, in fact it was being studied as far back as 150 years ago, so why is it that Tokophobia is still not taken that seriously, seen as irrational or is responded to with ‘oh its normal to be worried about pregnancy’? After all, having a phobia of spiders, snakes, heights, small spaces etc. are all given credit as being legitimate fears yet it could certainly be argued that these are irrational, couldn’t it? Let’s face it, unless you come face to face with a deadly spider or snake they can’t harm you, heights are easy to avoid if you wish to and small spaces may make you feel uncomfortable but, if we’re talking about being rational, then they can’t harm you at all. But when it comes to having a fear of pregnancy, in whatever shape that may take, it is unaccepted, laughable and even a taboo subject. Pregnancy that involves the responsibility of growing another human inside you; of possible wretched feeling side effects; of losing control of your body; of endless intrusive medical checks; painful labour, or worse, complications during labour which could put both the life of the mother and child at risk, the possibility of major surgery; potential lasting physical and phycological damage, how can it not be plausible to have a phobia of putting yourself through this ordeal?
I am not wishing to demean any of the different phobias I have mentioned above, all phobias can be truly debilitating to the sufferer, my point is that Tokophobia should be taken more seriously than it currently is. Often medical staff have never even heard of such a thing and diagnose anxiety or pre-natal depression instead. Both of which can be symptoms of Tokophobia but are not the full extent of what the sufferer may be going through.
Tokophobia made the duration of my pregnancy a nightmare, I have known for years that I would always struggle with pregnancy, I clam up and feel my anxiety levels rise just being near a pregnant woman and I find the whole procedure of how pregnancy is handled intrusive and undignified. Regardless of these feelings, I did know I wanted to become a mum and it was a planned decision for me and my husband to become parents. I became pregnant quickly after we started trying and for a very limited time I felt ok but that was short lived as the reality of living with my fears for 9 months sent my anxiety flying through the roof. For a time, I wouldn’t have anything to do with the pregnancy, I didn’t want to talk about it at all and didn’t want to plan for when the baby arrived. I hated people knowing I was pregnant and really didn’t want to announce it but at the same time I didn’t want to deny my husband the joy of doing so and felt awful when I could see all he wanted to do was talk to me and get excited about what lay ahead. I couldn’t stand people asking me questions about the pregnancy especially intrusive questions like how different parts of my body might be feeling! I just wanted to snap at people if they saw fit to mention my size or, even worse, try and touch me.
I often felt judged during my pregnancy especially when I tried to explain my phobia to others, it may have not been malicious or intentional the majority of the time but nevertheless peoples’ comments and questions made me feel lonely and less of a woman when I didn’t match up to the social construction of the glowing mum-to-be. I had to put up with a number of comments that made me feel this way such as ‘well don’t you think you should have thought about all this before you became pregnant?’ or ‘you need to make a decision soon if you want to have an abortion’ the confusion here seemed to be that, by explaining my phobia, people would automatically assume I didn’t want my child which couldn’t have been further from the truth. I was also laughed at, either by people who found the concept of Tokophobia ridiculous or found the fact that I was pregnant while having this phobia hilarious. However, I was lucky that I had an extremely supportive husband and family, even if they didn’t always understand my reactions to some things, they were always there to listen. I also had the most amazing midwife who specialised in mental health and became my advocate during my pregnancy right up until she handed me my baby. I truly believe I would not have gotten through the 9 months if it hadn’t been for her and she held my hand (quite literally) every step of the way. She was the only specialist midwife in the area and therefore I had to wait 3 months just to get an appointment with her but once I did things got a whole lot easier knowing she understood. There are many situations that most pregnant women wouldn’t think twice about that became a living hell for me, for example sitting in the waiting room for antenatal appointments surrounded by other pregnant women and posters advocating different birth techniques and breastfeeding. This kind of thing made me feel like I had already failed as a mum before I had even become one. I remember going into my first appointment with my new midwife and, after having to sit in the waiting room for 30 minutes, I was a complete hysterical wreck to the point where I could barely speak. I also remember the day I heard my little girl’s heartbeat for the first time and, instead of being filled with hope and love, I got home, went to bed, and sobbed for hours. I was diagnosed with pre-natal depression during my pregnancy but, due to not wanting to risk any harm to my baby, refused the medication although this in itself was risky. This resulted in me no longer being able to function well at work as I couldn’t bare being around people constantly commenting on my appearance or asking questions about my body which made me want to lock myself away. Which I often did, I became very acquainted with the bathroom cubicle to the point where I was no longer able to do my job and had to be signed off work. As we got closer to the end of my pregnancy I remember my husband and consultant desperately trying to console me when the date for my Caesarean Section was booked and I completely broke down as the inevitable reality of what was about to happen hit me like a train. Due to the level of my anxiety I didn’t attend any antenatal classes as I knew I wouldn’t be able to listen so my midwife tried her best to prepare me as best she could. When that inevitable day came, I had managed to keep myself calm, having done a great deal of crying and panicking in the days leading up to it. However just before I was due into surgery I had unknowingly started with contractions and then my waters broke. Shear panic and fear swept through me and I had to be calmed as much as possible before we went into theatre, my amazing midwife held my hands throughout and there was another member of the medical team stood next to me explaining what was happening and why at each point of the surgery as well as my husband who sat right next to me and was my absolute rock.
During my pregnancy, I became part of an online Tokophobia support group made up of many different women from all around the world all with varying degrees of Tokophobia. Before I became part of this group I only knew about how I felt however I soon learnt that Tokophobia has many faces. For some of these women their fear is so crippling they are having to make some of the hardest decisions of their life. Some have so much anxiety over accidently finding themselves pregnant it has led to obsessive compulsive tendencies like taking multiple forms of birth control or testing for pregnancy daily. Others have had to make the decision to terminate pregnancies even when the pregnancy has been planned as they have no way of safely getting themselves through it. For some they have made the decision to never have children and have lost partners because of it. I have even seen women have adoption applications refused due to their fear. For those whose last hope of being a mum was to adopt so they could have the opportunity to love and care for a child, in the same way as if they had given birth to them, this is truly heart breaking. The majority of these women have tried a variety of different therapies to help them, many of these with very limited success. Each member of this group is fighting their own individual battle when it comes to the decision to have a child or not yet they always find the time to give each other priceless support and encouragement. Priceless because it gives sufferers the safe space to be honest about how they feel without judgment which seems to be common when trying to explain their fears to those who do not see Tokophobia as a legitimate fear.
I, like many Tokophobic women, was put forward for an elective C-section. This isn’t the answer for all as often Tokophobia is linked with a phobia of medical procedures however this wasn’t the case for me. My consultant concluded that my body would most likely reject labour and shut down altogether with the shock which would be dangerous for both me and baby and no doubt result in an emergency C-section anyway. However even though this was the safest and best option for me to deliver my baby I felt judged by some people because of it. I had the all too common phrase of ‘oh your too posh to push, are you?’ thrown at me on more than one occasion which made me feel like I had been punched in the face. There seems to be a cultural opinion of C-sections being an easy way out or that is not actually ‘giving birth’. The choices you make during your pregnancy are yours and makes no difference to how you will be as a mother. It’s been four months now since I had my baby and I still feel like I am being judged for this, only the other day I had to take my little girl to the doctors as she has eczema. The doctor asked me about her birth and the second I said she was a section delivery due to mental health reasons I was questioned about my current diagnosis and my reasons for this choice of birth…what does that have to do with a prescription for eczema cream? Yet there he was writing it all down in her notes as if my phobia had caused her skin condition. A phobia that he openly said he had never come across.
As I’ve already mentioned, I was lucky in the fact that both my midwife and consultant where brilliant during my pregnancy, as were the medical team on the day of my baby’s arrival. At my appointments, I was always informed of all my options but not once was I questioned on my decisions or made to feel like I should have been doing things differently and this was what made a world of difference for me as I felt they had my wellbeing as a priority. My choice to formula feed wasn’t met with the ‘breast is best’ campaign as they knew that my choice was the right one for me. I have heard from many others though that were not as lucky as me and have been denied their wishes when it comes to giving birth. Some have been made to feel like they didn’t matter or their feelings where not important and this fills me with sadness. I can’t think of anything more barbaric than being forced to go through labour against your wishes. Tokophobic pregnant women are already more susceptible to both pre-natal and post-natal depression but forcing a woman to go through such a potentially traumatic event as childbirth against her wishes could cause serious lasting issues, most commonly Post Traumatic Stress Disorder as well as a potential resentment towards their baby after the birth. A greater understanding of the condition and less judgment about the way the baby is delivered could go a long way towards reducing these after effects.
The aim of this post was to make people aware of Tokophobia and so I hope I have done that, many will never have heard of it and of those who have they may not realise just how serious it can be. Next time you know someone who is pregnant ask them how they are coping, you never know how much it may help them to have someone listen to them and try to understand their feelings. If that person happens to suffer from Tokophobia then having someone not assume they are happy being pregnant or not judging their decisions and disagreeing with whatever way they may be choosing to give birth or raise their child may go a long way. The choice to have a child is the hardest choice in the world for someone who has Tokophobia but the way a person handles their pregnancy has no bearing on the type of mother they will be and that is why many still choose to put themselves through something they know will be incredibly hard for them. I didn’t go to any antenatal classes as I didn’t feel able, I chose to have a C-section because I knew I couldn’t endure labour, I took medication to stop the production of milk and I bottle fed my baby formula. None of this means I am any less of a mother, I feed my baby when she needs feeding, I console her when she is upset, I kiss her, cuddle her, sing to her, and love her with every part of me. That’s what makes me a mother not the way I got through my pregnancy even though it was the hardest battle ever for me to get to this point.