After a traumatic or difficult birth experience, it is understandable to feel concerned about the idea of giving birth again. In fact, somewhere between 20%-78% of pregnant people report fears about giving birth^(1,2). But if your birth-related anxiety is deeply affecting you, it is possible you might be experiencing what is known as secondary tokophobia. 

What is Secondary Tokophobia?

Secondary tokophobia is defined as an intense fear of childbirth developing after a traumatic obstetric event in a previous pregnancy⁽³⁾. This could have been a miscarriage, stillbirth, termination or a traumatic birth experience.

A fear is classed as a phobia when it is having a significant impact on an individual’s quality of life. Often, this is because a high level of fear leads to a high level of avoidance. Whenever we try hard to avoid a feared experience, this can have a significant effect on our day to day life.

With secondary tokophobia, fear of birth can be so strong that women take great lengths to avoid another pregnancy  – even when they would ideally like to have another child. Sex might be avoided due to this fear, or multiple different types of birth control used at once. This is often a reflection of how traumatic a previous experience can be, as women with tokophobia explain that the idea of going through another pregnancy or birth feels almost impossible.

Importantly, the intensity of fear also creates symptoms of anxiety and/or depression, which also have an impact on daily life. For example, women with tokophobia describe panic attacks, irrational worries, fatigue, mood swings, imsomnia, nightmares, body pain, decreased appetite or libido, or loss of interest in favourite activities.

Could it be PTSD?

Some women might develop a severe fear of childbirth after a traumatic birth experience because they actually have post-traumatic stress disorder (PTSD). It’s important to know that this is actually a separate condition to tokophobia and needs different treatment.

PTSD is characterised by flashbacks, nightmares and repeated intrusive memories of your experience, occurring alongside attempts to avoid reminders of the traumatic event. With PTSD, there is an ongoing sense of danger even after the threat has passed, so your body remains in a physically heightened, anxious state (hyperarousal) that can make you feel jumpy, irritable and stressed. Negative thoughts and feelings are common as well as a sense of emotional numbing.

If you think you might have PTSD, seeking out psychological treatment from a professional who understands birth trauma is an important first step. They can help you process your last birth, resolving the trauma as well as supporting you to address your fear surrounding another birth.

What types of experiences contribute to a fear of giving birth again?

Birth-related fears can be misunderstood and sometimes dismissed. There are actually many different experiences that can contribute to a fear of giving birth.

Research has found that having an emergency caesarean section or an instrumental delivery can increases the likelihood of birth trauma⁽⁴⁾. Unsurprisingly, these birth experiences also make it more likely you might develop anxiety about childbirth in a future pregnancy.

Importantly, there is now much more recognition that birth trauma can occur even if a birth is relatively straightforward in the eyes of others. Psychological factors are central to a traumatic birth experience, and research has highlighted the poor interpersonal care, lacking control over the birthing process and ineffective pain relief⁽⁴⁾. Distressing experiences immediately after the birth, perhaps involving separation from your baby, breastfeeding challenges or a physical birth injury, can also lead to concerns about going through childbirth again.

Whether or not your birth was traumatic can only be defined by you, the individual at the centre of it all – however ‘straightforward’ it might seem to others.

What can help me manage my fear of giving birth again?

If you think you might be experiencing secondary tokophobia, or PTSD, seeking out treatment for birth trauma is likely to be the most important first step in recovery. Acknowledging and addressing any trauma you have experienced can help reduce the intensity of your fear about giving birth again.

Psychological therapy can also help you learn how to tolerate uncertainty, manage anxiety and gently challenge any unhelpful beliefs you might be carrying about birth, your body, or your capacity to cope with another pregnancy.

Many parents also feel it is important to plan out the next birth carefully, in order to rebuild trust in themselves and their caregivers. Ask yourself, what might you might need in place to feel safe enough to give birth again? This might be additional midwifery support, a doula, or an obstetrician with particular expertise in an area that is relevant to you. Empowering yourself with additional education about birth and birth interventions, a clear birth plan and a supportive birth partner can all make a difference.

You might want to download our Better Birth decision guide to help you begin to plan. It guides you through five key decisions to help you figure out what you might need to feel safe, secure and in control in your next birth.

At the Birth Healing Collective, we believe that there is no right way to give birth, only what is right for you. If you decide that you want to have another child, there are ways to prepare psychologically and practically for a more positive experience next time. The right support, including support to manage anxiety, can help birth feel safe again and increase your confidence in your ability to cope.

1. Hofberg K, Ward MR. Fear of pregnancy and childbirth. Postgrad Med J. 2003;79:505–10.
2. Melender HL. Experiences of fears associated with pregnancy and childbirth: A study of 329 pregnant women. Birth. 2002;29:101–11.
3. Bhatia MS, Jhanjee A. Tokophobia: a dread of pregnancy. Ind Psychiatry J. 2012;21(2):158-159.
4. Harris R, Ayers S. What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’. Psychol Health. 2012;27(10):1166-77. doi: 10.1080/08870446.2011.649755. Epub 2012 Jan 31. PMID: 22292475.