This chat is hosted by Maeve O'Connell (Research Midwife and PhD candidate at the Irish Centre for Fetal and Neonatal Translational Research, University College Cork’ and Bank Midwife at GSTT NHS Foundation Trust, London) and Kathryn Guttridge (Consultant Midwife and doctoral student Sandwell & West Birmingham Hospitals NHS Trust)

Tocophobia is a severe fear of birth that affects approximately 6-10% women. While it is normal to feel a degree of worry or anxiety in pregnancy around the upcoming birth, for some women this fear can become a phobia affecting their everyday lives in the form of sleep disturbance, insomnia, nightmares and may even experience panic attacks. 

Tocophobia may be divided into primary and secondary conditions. Primary is when a woman has never had a completed pregnancy, she may well have avoided childbearing by contraceptive and can include extreme medical methods such as hysterectomy.  It is generally present from puberty and has its roots deep within the psyche.  Whereas secondary tocophobia is following a pregnancy or childbearing experience that has resulted in a deep trauma and behavioural adaptation.  This association causes ongoing problems in relation to other pregnancies.  Secondary tocophobia is the more common condition and will be seen by midwives early in a subsequent pregnancy.

This is a relatively new area of research and has become more commonly seen in clinical practice as women have begun to request a Caesarean Section as a way of controlling their birth expectations. However, while a Caesarean Section maybe appropriate for some women, there is evidence that having a vaginal birth can promote a positive, healing experience for women with tocophobia. Recognising tocophobia as early in pregnancy as possible and discussing a woman’s fears is beneficial to allow time for a woman to express her birth preferences and dispel any myths or beliefs she holds about the birth process,providing reassurance for her. NICE Guidelines currently recommend CBT, although this is not commonly available, a number of treatments have also been trialled for tocophobia, such as midwifery psycho-education, and internet CBT. In the UK, a multi-disciplinary approach has been used involving obstetricians and usually midwives with psychotherapy training.

Here are some relevant articles:

Tocophobia: The New Hysteria

Who’s afraid of the Big Bad Birth?

Why Fear is Childbirth's worst enemy 

Do you have an extreme fear of childbirth? It could be tocophobia 

So, for the chat......

Q1. What has been your experience of pregnant women with tocophobia as their midwife ante-natally?

Q2a. What has been your experience of pregnant women with tocophobia as a midwife in intrapartum care?

Q2b.Do women ever request a C-Section? If so, what is the outcome in general?

Q3. Any stories of positive vaginal birth experiences for women with tocophobia with birth plans?

Q3. What has been your experience of midwives/ doctors attitudes towards women with tocophobia as a midwife? Are they supportive?