When Does a Rational Fear of Child Birth Become a Phobia?

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

Our latest reader testimony comes from Jennifer:

I have tokophobia and two kids. My mother and both grandmothers were ripped apart during childbirth. They all had lifelong incontinence and sexual dysfunction after countless surgeries. It destroyed one of my grandmother’s marriages. My father just resorted to affairs but stayed with my mother despite her complete inability to orgasm and having to wear basically adult diapers most of her life. (She still does.)

When I became pregnant, I thought I could rationalize through my fears of ending up the same way, but I was terrified. My OB ended up performing an elective cesarean at 40 weeks. I had a healthy baby and excellent recovery. I did it again two years later with the birth of my second daughter. Both times I was walking around the halls with my new baby within 12 hours.

So far I’m the ONLY woman in my family to give birth without incontinence and sexual dysfunction. I’ll advise my daughters to also have surgical births. Sometimes tokophobia is valid.

But this next reader, Diane, thinks that term is being tossed around too loosely:

It’s not a PHOBIA! I’m sure I’m not the first person to point this out. It’s a legitimate and rational fear. Walk through an older cemetery sometime and check out the dates of death for the women vs. the men.

And you DON’T know what’s going to happen to you. I have three children and I was scared every time (and every experience was different). I know people who have had placenta previa [when the placenta covers the cervix] and almost died. I know people who have had pre-eclampsia [high blood pressure and signs of organ damage] and almost died.  

The doctor did not make it on time to ANY of my deliveries. Not one. And the practice at the time was to force me to wait for the doctor to show up, even though the baby’s head was showing. My last baby was delivered by the nurse because the baby wasn’t waiting any longer, and it was the best delivery I had.

Here’s the book I read before my second childbirth: Immaculate Deception by Suzanne Arms. [The New York Times in 1975 named it Book of the Year.] It helped me be able to argue with the medical professionals that I did NOT need pain medication. (And it helped me prepare my husband to back me up and not side with them, because they tended at the time to use a tactic of turning to the husband, while you were in labor, and saying something like, “You don’t want your wife to suffer, do you?”)

But I still wound up having an IV inserted that I did not need, “just in case,” and after the birth I still wound up getting pitocin [a synthetic hormone used to induce labor] to “shrink my uterus,” which caused worse contractions than childbirth.

Here’s how Jennifer Block describes The Immaculate Deception in her own book, Pushed: The Painful Truth about Childbirth and Modern Maternity Care:

[Suzanne Arms’s] groundbreaking exposé reported how women in childbirth were routinely separated from their partners, physically restrained at the wrists and ankles, lowered into the stirruped lithotomy position, administered drugs without their consent, given episiotomies without their consent, discouraged from breastfeeding, and denied their babies following delivery. At the time of that publication, most obstetric practices hadn’t been studied rigorously, if at all.

The most shocking part of Block’s description of that era: “60% to 90% of women giving birth got episiotomies”—an episiotomy being an incision down the perineum, or the area between the vagina and the anus, to allow for quicker and ostensibly safer delivery and the prevention of tearing. At least 60 percent. Nowadays that figure is much, much lower, thank god:

In 2006, the American College of Obstetricians and Gynecologists released a recommendation against the routine use of episiotomy, finding that except in relatively rare cases, the procedure benefited neither mothers nor newborns. In 2008, the National Quality Forum also endorsed limiting the routine use of episiotomies.

Since then, the use of this surgical incision has dropped significantly — from 21 percent of all vaginal births in California in 2005, for example, to fewer than 12 percent in 2014. National trends have been similar.

This last reader, Marina, says she isn’t sure if her aversion to getting pregnant qualifies as tokophobia:

I’m a 31 and have been with my spouse for seven years (and married for three). I can remember in first grade knowing I never wanted to be pregnant or give birth. I figured there are enough kids who need parents that I didn’t need to create my own. (I probably had a vague idea of pregnancy and birth from National Geographic animal documentaries at the time.) When I would tell adults that I wanted to adopt, I was always told that I would change my mind when I got older.

A few years down the road, the addition of learning the biological process (and viewing the infamous video) and my feelings towards childbirth were only strengthened. I also started to strongly dislike the thought of the pregnancy and dealing with a newborn. When puberty hit, my feelings didn’t waver. In fact, the drive to never get pregnant caused me to delay having sex until quite a few years into my twenties. But I also started taking birth control in my teens just in case. (I grew up in a pro-choice family, so this was driven by going overkill on pregnancy prevention.)  

Even in my mid twenties, as all my friends became baby crazy, I still wanted nothing to do with having a baby. When I reached my late twenties, I was diagnosed with Ehlers-Danlos Syndrome [a connective tissue disorder]. If I were to get pregnant, I would likely have a difficult pregnancy, the pregnancy would cause a permanent decline in my health (the opposite of what pregnancy often does to those with autoimmune disorders), and there would be a 50 percent chance that the baby would also have Ehlers-Danlos.

In the past year or so, I have been feeling a stronger desire to be a parent. However, I would still avoid pregnancy and childbirth at all costs. My spouse and I recently got a puppy and it is has reminded me that I would be happy to be a parent if my body is able to handle it … but my ideal scenario is probably adopting a potty-trained toddler.

I am not sure if my situation is tokophobia (I normally lack phobia and anxiety; I am way too comfortable with heights, snakes, taking tests, etc.). Or maybe I was innately aware of how faulty my genes are. Regardless of why, I have always, and assume will always be, opposed to personally being pregnant or giving birth.