How to Overcome Your Fear of Giving Birth

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.
Michaela Rehle / Reuters

My recent piece for The Atlantic on tokophobia received a lot of email from readers discussing their own personal fears of pregnancy and labor. Here’s Kelly in Los Angeles:

Incredible and timely piece, thank you so much. I actually am writing to ask a question. The article says over and over to get some help if you believe you have this phobia and want to have a baby. That's me, and I want to know how to get help. What are the concrete suggestions from Brian Salmon [a doula and lactation consultant] and his colleagues with regards to getting over this?

My story: I’m a 40-year-old woman, and I’ve only just come to decide that it’s time to be a mom. I don’t have the money to adopt, but I absolutely would if I could. I’m disgusted by being pregnant and terrified of giving birth. I’ve been pregnant before, more than once, and it felt like being invaded by a destructive alien force.

I would say that my phobia comes from the following experiences:

1. I’m a control freak. I’m a lawyer, alpha, eldest child, feminist, political activist, and conservator over my only sibling, who has DD. I fill with anxiety over mere annuals because I cannot STAND the idea of a stranger in my vagina unwantingly, without my guidance and oversight. I avoid them like the plague.

2. Those pregnancies and the subsequent abortions, ONLY with regards to the physical pain, and again, having all these people prod my privates.

3. My parents were open lefties who perhaps shared too much, including horrifying birthing stories that my mother identified (my birth especially) as “the most traumatic experience of her life.” She also showed me videos and books too early, like Our Bodies Ourselves, which depict women screaming in agony with their vaginas gaping in a room full of old white men.

To be fair, my mother’s OB/GYN was an Indian woman, and I have a dear friend who grew up on The Farm with the doulas and midwives who wrote the manuals. And I saw The Business of Being Born, so I know that, rationally, I have options outside the nasty hospitals and their profit-driven approach. And I know that there are oils and exercises to avoid tearing. But this fear isn’t rational, right?

So here I am, ready to do this, and paralyzed with fear. And your article just gave it a name, and the hope of fixing it. Please point me in some direction for fixing it.

When speaking with sources for my piece, I learned a lot about the options available to women who have tokophobia yet wish to have children someday (me being one of them). They recommend finding both a therapist and a midwife, both of whom specialize in tokophobia or have at least worked with it previously. They can not only help you discover the root cause of your phobia but also break it down into smaller related fears and work through each one specifically. They can educate you on the birthing process and your options for it—hospital vs. home, for example, or Cesarean vs. natural—and then advocate for you.

I followed up with Kirsten Brunner, MA, LPC to find out if there are any specific questions or concerns you should broach in therapy.

“Voicing your fears and reaching out for help is half the battle in overcoming tokophobia,” notes Brunner. “So many women sit in silence and shame with their fears, and that only causes the anxiety to grow.”

“Finding a professional who is familiar with tokophobia and/or reproductive mental health issues is essential.” Brunner suggests that you find a therapist comfortable working with couples, as it may be helpful for your partner to be in the sessions from time to time to better understand your tokophobia and help work through it with you.

When you start looking for a therapist, don’t feel like you need to choose the first one you visit. Brunner notes that having a connection with your therapist is shown by research to be the strongest predictor of a positive outcome. Should you encounter anyone in your search who responds to your fears with judgement or with shaming, they are not the therapist for you.

If you don’t know where to start in your search, Brunner suggests asking your ObGyn for referrals. “Make sure that your therapist, doula, or midwife feels confident that they can help you get to the root of your fears and overcome your phobia,” stresses Brunner. “You want to surround yourself with positive, optimistic energy, as Brian Salmon correctly stated in the original article. Pregnancy and childbirth can be a beautiful and relatively comfortable experience, and aligning yourself with professionals and friends who ascribe to these empowering beliefs is essential.”

There are many treatment options available—Cognitive Behavioral Therapy being the most traditional—but Brunner suggests that you also explore other anxiety-reducing aids such as yoga, mindfulness techniques, or even medication, since different solutions work for different people. You can begin to explore mindfulness at home, and Barbara Herrera, a former midwife and doula, recommends the book The Mindful Way through Anxiety: Break Free from Chronic Worry and Reclaim Your Life (2011). She also suggests the articles “How Does Meditation Reduce Anxiety at a Neural Level?” from Psychology Today and “Mindfulness Meditation Can Help Relieve Anxiety And Depression” from NPR.

Should you not be ready to reach out to a therapist, Herrera recommends having a lifeguard in place. “Have somebody who loves you pay attention to what is happening; if they see that you are having increased tokophobia or symptoms of postpartum depression or anxiety, then they get help,” stresses Herrera. “Have everything lined up, have a therapist lined up with your insurance whom your lifeguard can call.”

I hope this gives Kelly and other readers struggling with tokophobia a sense of where to start as you begin your journey to parenthood. Many of you, like Sacha Zimmerman, had the fear but didn’t know there was a name for it, and I want to remind you that you aren’t alone. You aren’t irrational or broken—you have a legitimate phobia—and asking for help is the best thing you can do to work through your fears.