Why the word ‘Tokophobia’ is a problem

2nd August 2025

What are you scared of? Personally, my biggest phobia has always been centipedes (this link is to another blog, NOT a photo of a centipede!). I learned to cope with the tropical millipedes whilst living in Malawi, they are actually quite cute and in the local language are called Bongololos. A name which makes her sound like a many-handed extra in a marching band who just mooches around the forest eating leaf mulch, waiting for the call from her agent. I’m also totally fine with pretty much all other invertebrates - I am the one woman spider liberation front in our family and I took a large praying mantis landing on my shoulder with a calm not reflected by my partner, who screamed like the young day-tripper who invariably discovers the body at the start of an Inspector Morse episode. But centipedes. I, for one, take a stand that eight legs is a sufficiency and more than that is merely sabre rattling. I have a friend who is scared of cats, a family member who is frightened of fish (both living and edible) and my son has a mate with an irrational terror of baked beans. This is what a phobia is. There is no real reason for me to be scared of a rare, albeit horrifyingly alien, insect who probably doesn’t want to hang out with me any more than I would with Nigel Farage.

But more and more in my practice and in the wider discourse of the birth world in the UK, I’m coming across the word ‘tokophobia’ - the fear of childbirth. I am not a mental health professional. As a care leaver I’ve had my own mental health journey and I am still continuing to experience the joy and power of post-traumatic growth. But I haven’t studied psychology since A level, when me and my friend Shyam spent most of our time in class making fun of the odd shape of our teacher's head, to the detriment of my ability to remember who Pavlov was and why he had so many pets. I would never present myself as a clinician with more than the basic understanding of mental illness as appropriate to my work as a midwife. This post is not about the complexities of mental and physical suffering caused by our current birth system. PTSD, postnatal depression, complications in subsequent pregnancies are all on the rise and no one is disputing this. If you need support with these issues The Birth Trauma Association is a good place to start. This post is about how we are increasingly blaming women and birthing people for this harm.

Let’s go back to the context for this. We know that the UK has crossed the obstetric threshold whereby iatrogenic (medically caused) harm has overtaken the number of lives saved by the use of operative births a long time ago. We know that over-intervention is currently not just blossoming but has a tree canopy so high and roots so deep as to be an entire ecosystem of expensive, unnecessary and harmful procedures which cause mental and physical harm to whole families. In 2024, by NHS audit (so this is not statistical extrapolation, this is counting…) 43% of babies were born by cesarean section and a further 10% by instrumental (ventous or forceps) delivery. This means that babies born by ‘spontaneous vaginal birth’ (SVB) are now a minority in Britain. The word spontaneous cracks me up in this commonly used abreviation - very few people who have ever pushed their baby out would describe the experience as spontaneous, much as it can be joyous, its definitely a intentful and laborious process! Over my two decades in maternity I’ve seen the complex medico-cultural and political drivers of this trend manifest in practice and increasingly people are choosing to birth outside of the system, with independent midwife care or freebirths on the rise. However, these options are not affordable or possible for many people and decisions based on the imperative to avoid further harm are not free choices, even if the result is in the end a positive experience. 

I am not against intervention. I’ve worked in several countries where ‘Too Little Too Late’ has led to young mothers dying avoidable deaths in my arms, and the faces of their families still haunt my darker days. Also, interventions can be non-traumatic. Real, informed choice and Human Rights based care is what is necessary here. I’ve had clients chose elective ceasarian sections for their own reasons and found the experience to be both positive and supportive of their parenting. Emergencies can and do happen and with the right team, with the parent as the main agent of decision making, they are not inherently psychologically scarring in and of themselves. As Poincaré said, "To doubt everything, or to believe everything, are two equally convenient solutions; both dispense with the necessity of reflection,". Only he said it in French.

The epidemiological discourse, that the increase in ‘aging and obese’ primiparous (first time) mothers are responsible for the current situation is one big public health fallacy and makes the common mistake of conflating correlation with causation. Changes in demographics that alter health outcomes are often causatively bi-directional, and complex issues require complex interventions. Yes, population shifts do change medical needs, but the upward trend in both age of first pregnancy and BMI in the UK is not nearly large enough to explain the massive change in mode of birth outcomes above. Again, babies born by SVB are now a minority. If anyone wants, I’ll happily do the maths on the current data. Further, overall wellbeing, including weight, is inherently a product of social inequality and the UK is a more unequal society now than when your nan gave birth. Given the racialised (read: racist) discrepancies in harm for pregnant Women and People of Colour, we also know that there is a lot more going on here than just population health trends.

But the word Tokophobia literally means an extreme and irrational fear of childbirth. Perinatal Mental Health Services now routinely offer groups for people with tokophobia. ‘Birth reflection’ services by units, which can be done well and provide postitive healing, are unfortunately often experienced as yet another go around of the justification for why over-intervention in your birth was deemed necessary and can further compound your feelings of powerlessness and fear of death; the two awful ingredients to bake PTSD. Emergencies can be iatrogenically created. For instance the overuse of synthetic oxytocin is a known issue, and then the service may position itself as having ‘saved you’ from the PPH (bleed after birth) you may not have had at all, if a more careful and holistic consideration (and informed, non-coercive consent) to using the drug had happened in the first place.

Of course true tokophobia exists. If a person has managed to get to conception without ever having heard the stories of their friend’s and family, read any newspapers or watched a soap-opera and still has a fear of birth, go right ahead and use the word. But I’m skeptical that this is a common situation. People also have complex relationships to their own bodies and this can profoundly influence how they feel about pregnancy and birth. Much more importantly and beautifully, I meet so many pregnant women and people who have had personal or vicarious experiences of birth trauma and approach their own journeys to parenthoods with a strength, optimism and deep love which never fails to make me realise how incredibly lucky I am to be a midwife. Being a midwife keeps my love of the human spirit alive, which in these times is a blessing far beyond that which anything proasic, such as an adequate salary, could provide. But we need to talk about tokophobia and call it what it really is. In the vast majority of cases it is not an irrational fear but a reasonable and rational response to a perinatal service which, on the whole, can no longer provide optimal physiological birth support. It is victim blaming. If we want real change, we have to first shout to turn this discourse around. And also a global campaign to eradicate centipedes please. Those hell-dwellers can do one.