Tokophobia: when the fear of childbirth takes over

Fear of childbirth or tokophobia: what are we talking about?

Being afraid of childbirth is common. Under the heading of the “normal” emotional upheaval of pregnancy, the French national health insurance says that fear of the unknown, of the difficulties of pregnancy, of childbirth, of not being good parents, of losing the child or of having a sick child is frequently felt (Assurance maladie, 2026). Our article on fear of childbirth looks at where it comes from and ways to tame it.

The word tokophobia is used when the fear is severe. Reviews describe it as an intense fear of pregnancy and childbirth, considered a specific condition, which can cause distress, weigh on well-being during pregnancy and make the transition to parenthood harder (O’Connell et al., 2017 ; O’Connell et al., 2021).

There is no single definition. Studies measure fear with different questionnaires and cut-offs, the most widely used being the Wijma questionnaire (W-DEQ), and these tools and cut-offs are a main reason why figures vary so much (Nilsson et al., 2018 ; Maghalian et al., 2026). The word is therefore a landmark for a very intense fear: it is not a label to put on yourself, nor a diagnosis this text could make.

Primary and secondary tokophobia: the forms described

The distinction comes from a series of 26 women published in the British Journal of Psychiatry. It separates three situations (Hofberg and Brockington, 2000):

• primary tokophobia: a phobic avoidance of pregnancy, which may date from adolescence;
• secondary tokophobia: it follows a birth experienced as traumatic;
• the fear as a symptom of depression during pregnancy.

How many women are affected?

A 2017 meta-analysis (33 studies from 18 countries, 29 of them covering 853,988 women for the calculation) estimates the prevalence of tokophobia at 14% of pregnant women (95% confidence interval: 12 to 16%), with rates ranging from 3.7% to 43% across studies (O’Connell et al., 2017). A 2026 meta-analysis (67 studies, 905,504 women) puts severe fear of childbirth at 16.5% (13.8 to 19.5%), about one woman in six, with rates from 3.7% to 58.7% depending on the tools used (Maghalian et al., 2026).

These gaps come mostly from how fear is measured: the authors stress very high heterogeneity between studies. Keeping only the Wijma questionnaire with a cut-off of 85, a 2018 review finds rates of 6.3% to 14.8% depending on the country (Nilsson et al., 2018). Remember an order of magnitude rather than an exact figure: severe fear of childbirth is far from rare. We found no France-specific figure in the sources read for this article.

Signs that should prompt a conversation

French health authorities distinguish fear, which can be named and expressed, from anxiety, which blocks thinking and comes with physical symptoms (HAS, 2005). Being afraid of childbirth belongs to the first. When fear becomes intense, studies describe women who dread or avoid pregnancy or childbirth although they want a child (Hofberg and Brockington, 2000), and fear is a common reason for requesting a caesarean (Nilsson et al., 2018).

The French national health insurance says it is essential to see a professional when anxiety becomes unbearable and when these fears are permanent, obsessive, or show up as (Assurance maladie, 2026):

• panic attacks;
• constant irritability;
• a frequent need to be reassured;
• eating or sleeping problems.

What makes severe fear more likely

The factors most often associated with severe fear (a previous traumatic birth, anxiety or depression, too little support from those around you) are covered in our article on fear of childbirth (Maghalian et al., 2026). The same meta-analysis adds that this fear is somewhat more common in women expecting their first child (odds ratio of 1.36) and when the pregnancy was unplanned (odds ratio of 1.85). French health authorities also list, among vulnerability factors to look for, a difficult previous birth, difficulties within the couple, lack of support and domestic violence (HAS, 2005). English guidance gives abuse or a previous traumatic event as examples of what can lie behind it (NICE, 2021).

These associations do not mean that an affected woman will have tokophobia, or that a woman with none of them is protected. Mostly they explain why talking about your history, and not only the birth ahead, can help professionals support you.

According to the French national health insurance, 10% of pregnant women have a depressive episode during their pregnancy, and the co-parent can also be affected. Its most common signs are changes in appetite or sleep, lack of energy, deep sadness, tears for no reason and loss of interest in what you used to enjoy (Assurance maladie, 2026). If you recognise yourself, talk to your midwife or doctor without waiting.

Who to talk to, and when

As soon as the fear takes up space, without waiting for it to become unbearable. The NHS advises being honest with your midwife, GP or any professional caring for you about how you really feel, and speaking to your maternity unit or GP if you are worried about your mental health (NHS, 2026). In France, the national health insurance recommends raising your difficulties at every appointment with your midwife or doctor: only they can tell what belongs to the normal emotions of pregnancy and what is psychological suffering that needs care (Assurance maladie, 2026). Talking does not necessarily lead to a specialist referral: French guidance specifies that confidences should not automatically trigger a referral to a psychologist or psychiatrist (HAS, 2005).

Several appointments are suited to it:

• any pregnancy check-up with your midwife or doctor;
• in France, the early prenatal interview (entretien prénatal précoce), individual or as a couple: a time for talking and listening, advised from the 4th month (never too late), to talk about your expectations, your fears and your birth plan (Assurance maladie, 2026);
• antenatal or birth preparation classes, where you can share your fears with other expectant mothers (Assurance maladie, 2026);
• a health professional trained in perinatal mental health (a psychologist or psychiatrist, for example) when the fear is severe: in England, guidance offers this referral when a woman asks for a caesarean because of tokophobia or severe anxiety about childbirth (NICE, 2021).

If you are in distress

The number to call depends on where you are. We list only lines we could check on an official source, country by country:

• In France, 3114, the national suicide-prevention number: for psychological distress or suicidal thoughts, or if you want to help someone who is suffering. It is free, answers 24 hours a day, 7 days a week, throughout France including overseas, and a health professional trained in suicide prevention takes the call (3114.fr, 2026).
• In France, for a medical emergency: 15 (Samu) or 112, the European emergency number, which directs you to the right service. Both are free and answer 24 hours a day, 7 days a week; 112 works in every country of the European Union (Service-Public, 2026).
• In England: call 999 if someone’s life is at risk, and for urgent help with your mental health call 111 and choose the mental health option (NHS, 2023). For the rest of the United Kingdom, call 999 if someone’s life is at risk. Samaritans, 116 123, is free and open any time (Samaritans, 2026).
• In the United States: the 988 Suicide & Crisis Lifeline, by call, text or chat, free, confidential and open 24 hours a day, 7 days a week (988 Lifeline, 2026).
• Elsewhere: your local emergency number, and your midwife, doctor or maternity unit.

Helplines with limited hours

Helplines for parents do not all answer around the clock, and some close. The French national health insurance still lists Allô Parents Bébé, open 10:00 to 13:00 and 14:00 to 18:00 (the page does not give the days; Assurance maladie, 2026), but the association that ran it, Enfance & Partage, announced in an article dated 8 September 2026 that the line is ending (Enfance & Partage, 2026): we therefore do not publish its number. Apart from the lines above, talk about what you are going through with your midwife or doctor, at every appointment (Assurance maladie, 2026).

What helps, according to the research

No approach makes fear disappear on demand, but several have been studied. A 2021 Cochrane review (7 trials, 1,357 women with high or severe fear of childbirth) assessed non-drug interventions: psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. They may reduce fear, but the measured reduction may not be clinically meaningful (low-certainty evidence). They probably reduce the number of caesarean births (risk ratio of 0.70) and the number of women who prefer a caesarean (risk ratio of 0.37), with moderate-certainty evidence; the authors consider the effect on fear itself uncertain (O’Connell et al., 2021).

For a woman who asks for a caesarean because of fear, English guidance asks teams to discuss the benefits and risks of each way of giving birth and to offer referral to a professional with expertise in perinatal mental health, who can also visit the planned place of birth before the birth to help overcome fears about labour and birth (NICE, 2021). These recommendations apply to England: elsewhere, the question is one to discuss with your own team.

Antenatal preparation in general, relaxation and support from those around you are covered, with the studies, in our article on fear of childbirth. What you can do now:

• say your fear out loud, to your partner and to your midwife;
• ask whether your maternity unit offers a visit and a chance to meet the team before the day;
• write down what worries you and what would reassure you in a birth plan: the 2023 French national directive includes a question on this (Audipog et al., 2023);
• if pain is what worries you most, read our article on the epidural and mental preparation, which sets out what health authorities say and how preparation stays useful with or without it;
• prepare together, with a preparation for childbirth and by preparing the birth partner’s role.

Where couple support fits in

The Méthode Souffle is non-medical emotional and relational support, designed by Amélie Paterne, who is not a midwife. It does not treat tokophobia, makes no diagnosis and replaces neither medical care nor psychological support. It can, as a complement, give a couple time to name their fears, share them and prepare each person’s place.

If your fear is intense, talk to a health professional first: you can then choose, with them, what suits you.

Frequently asked questions about tokophobia

A few short answers, sourced in the article.

Further reading

• Fear of childbirth: where it comes from and how to ease it
• Preparing for childbirth: methods, when to start and what is covered in France
• The birth partner’s role during labour: preparing together
• Birth plan for two: what it is for, what to put in it, how to discuss it with your team