A new study found that tokophobia—an extreme fear of childbirth—is something a majority of women in the United States experience. The research found tokophobia to be significantly more common among Black individuals, those with lower household incomes, and those with lower education levels

A Majority of U.S. Women Have an Intense Fear of Childbirth, Survey Finds

A new study found that tokophobia—an extreme fear of childbirth—is something a majority of women in the United States experience. The research found tokophobia to be significantly more common among Black individuals, those with lower household incomes, and those with lower education levels

• A new study found that tokophobia—an extreme fear of childbirth—is something a majority of women in the United States experience.
• The research found tokophobia to be significantly more common among Black individuals, those with lower household incomes, and those with lower education levels.
• Tokophobia screening and treatment is not currently a standard of pregnancy care in the United States.

Many women in the United States have an extreme fear of childbirth—known as tokophobia—which was only exacerbated by the COVID-19 pandemic, new research shows.

Though tokophobia has been well-studied in other countries, including in Scandinavia where screenings are considered the standard of care for pregnant people, there’s been an lack of research on the mental health condition in the U.S.

In an April study, published in Evolution, Medicine, and Public Health, Dartmouth researchers sought to look at tokophobia in the U.S. to determine which factors may predict a fear of childbirth in some pregnant people, and how the COVID-19 pandemic impacted rates of tokophobia.

“Our results showed really high rates of childbirth fear in our sample,” first study author Zaneta Thayer, PhD, associate professor of anthropology at Dartmouth College, said in a news release.

“Since there’s no pre-pandemic U.S. data, we cannot compare our data to that context,” Thayer continued, “but we know that the rates are very high compared to other international studies on the subject that have been published pre-pandemic.”

These high rates of tokophobia may also be a reflection of the highly distressing birthing landscape in the U.S., where maternal mortality rates reached an all-time high in 2021.

“Our findings illustrate that pregnant people are stressed in the U.S. birth environment and that they are not getting the emotional support they need,” Thayer said. “And the COVID-19 pandemic just added to those fears.”

High Rates of Tokophobia Among Historically Underrepresented Groups

Worries about the entire process of pregnancy and birth—whether first-trimester morning sickness or possible complications during labor—are not abnormal, but researchers clarified that the fear of childbirth exists on a spectrum.

“Most women experience some level of worry or fear before birth,” said Sharon Ben-Rafael, PsyD, a licensed clinical psychologist with expertise in prenatal mental health, who was not involved in the study. “If we were to place these worries and fears on a continuum, tokophobia will be at the extreme end.”

To determine the rates of tokophobia in the U.S., researchers analyzed data from the COVID-19 and Reproductive Effects (CARE) study. The online survey examined how COVID affected the healthcare experiences and wellbeing of pregnant people.

Prenatal data came from 1,775 participants, some of whom also shared postpartum data, between April 2020 and February 2021—during the height of the COVID-19 pandemic. Researchers also gave each participant a score on the fear of birth scale (FOBS) to identify clinical tokophobia.

The majority of women surveyed—62%—were found to have tokophobia. Black women in particular were significantly more likely to have a fear of childbirth, a compared to white mothers.

Participants in the lowest household income category, with the least amount of education, and who had high-risk pregnancies or pre-existing health conditions also had higher rates of tokophobia.

COVID Exacerbated Tokophobia in the US

The study took place during the first 10 months of the pandemic, when lockdowns were common and the U.S. healthcare system was stretched past its limits; those sentiments were reflected in the data.

“That was a time of very intense anxiety and fear for people who were having babies,” Thalia Robakis, MD, PhD, associate professor of psychiatry at Icahn School of Medicine and co-director of Mount Sinai's Women’s Mental Health Program told Health. “[Fear] was really quite a rational response to the very unusual and unfortunate circumstances at the time.”

Most participants reported concerns that COVID would impact their health, the health of their infants, or their overall birthing experience. Tokophobia was significantly associated with fears that having COVID-19 would affect an unborn child, or that a baby would be taken away birth if a parent tested positive for the virus.

Potentially having to give birth alone was also a common source of fear—86.9% of participants shared concerns that they would not have extra support during labor.

“At the beginning of the pandemic, there was a phase when hospitals were severely restricting visitors and some people had to deliver without their partners,” Dr. Robakis said. “The lockdowns also meant that new parents were deprived of many of the other supports they would normally have expected from friends and family.”

Tokophobia’s Effects on Pregnancy Outcomes

People who experienced tokophobia during pregnancy were 91% more likely to have a preterm birth, or birth before 37 weeks of pregnancy. However, an infant’s birth weight did not seem to be affected by fears of childbirth.

“When the fear response is triggered during labor it may affect progression, length, and delivery outcomes,” Ben-Rafael said.

Though more research is needed to determine how and why tokophobia impacts birth outcomes, researchers noted that this study and previous research suggests any kind of maternal stress can impact gestation length, as well as other pregnancy outcomes.

“Active depression and anxiety in pregnancy are associated with shorter pregnancies, lower birth weights, [and] higher risks of complicated deliveries and admissions to the NICU,” Dr. Robakis said, adding that it’s also associated with “developmental changes in the baby’s brain as well as measurable long-term impacts on children’s emotions and behavior.”

Ben-Rafael added that tokophobia has the potential to affect childbirth-related choices regarding medical care. Dr. Robakis noted that tokophobia especially requires treatment if it gets to that point—for example, if that intense fear drives decisions like having a C-section.

Addressing Tokophobia Among Pregnant People

The high rates of tokophobia in the U.S. aren’t necessarily surprising to experts, as America is fraught with health disparities, including for expectant parents.

“The fact that we have no national system of public health insurance makes childbirth much more fraught here than elsewhere,” Dr. Robakis said. “Between variable healthcare coverage and no mandated national paid maternity leave, having a baby puts many new parents under significant financial strain.”

Inequities in the U.S. healthcare system—including racism in obstetric care for Black mothers, according to study authors—may also help explain the high rates of tokophobia in historically underrepresented groups.

Statistically, minorities face more birth-related deaths. Black women are three times more likely to die from a pregnancy-related cause than white women. People of color are more likely to be uninsured than their white counterparts, creating a bigger divide in available resources.

“I would speculate that tokophobia could be a not-totally-illogical response to the reality of the birth outcomes landscape,” Dr. Robakis emphasized.

A small step toward alleviating tokophobia in the U.S. may be to include screening and treatment for it as standard maternal health care. “Prior research has shown that treating childbirth fear can reduce it and improve confidence in one’s ability to give birth,” Thayer said in the news release.

More research on fear of childbirth in the U.S. would also be beneficial to help inform healthcare providers about care and treatment options.

In the meantime, people who know they have a strong fear of childbirth should bring it up to their physician who may be able to provide help, or resources to find another healthcare professional who has experience treating and managing tokophobia with tools like cognitive behavioral therapy (CBT).

“Trepidation about childbirth is very common,” Dr. Robakis said, “but [you should] probably start thinking seriously about treatment if the fear becomes impairing.”

This story originally appeared on: Health News - Author:Lily Moe