A study of factors associated with tokophobia and its effect on pregnancy

Padmasri Ramalingappa, Raksha S. Gowda, Shruthi Holavanahalli Srinivasamurthy


Background: Tokophobia is pathological fear of childbirth which has bearing on the women’s health with the physical and psychosocial morbidity. It includes fear of injury to the baby, genital tract, death and is a common cause for which a woman opts for caesarean section. Recognition of tokophobia and close liaison with  obstetricians/specialists can help to reduce its severity and ensure treatment. Aim of the current study was to assess the incidence of tokophobia and correlation with the sociodemographic variables to evaluate the possibility of reducing the requests for caesarean section.

Methods: 150 pregnant women attending the antenatal OPD and labour ward in a tertiary care centre constituted the study population. Data was gathered using standard questionnaire to assess fear of child birth, anxiety associated and was analysed with chi-square test for statistical significance.

Results: 150 women included in the study, the incidence of tokophobia was 55.3% and severe tokophobia was 30.7%. Of these 62% were primigravidae and 38% multigravidae.15.3% of the total requested for caesarean section with the major reason being fear of childbirth. However, 84.7% of the study population did so without any such request for caesarean section. Higher incidence of tokophobia was observed in women with intermediate education as against those who completed their graduation and post-graduation.

Conclusions: Tokophobia is associated with pregnant women in different severity. It’s influenced by sociodemographic variables like educational and socioeconomic status. Improvement in sociodemographic conditions could reduce tokophobia.


Caesarean section, Fear of childbirth, Tokophobia

Full Text:



Bhatia MS, Jhanjee A. Tokophobia: A dread of pregnancy. Ind Psychiatry J. 2012;21(2):158-9.

Melender HL. Experiences of fears associated with pregnancy and childbirth: A study of 329 pregnant women. Birth. 2002;29:101-11.

Hofberg K, Ward MR. Fear of pregnancy and childbirth. Postgrad Med J. 2003;79:505-10.

Alehagen S, Wijma K, Wijma B. Fear during labor. Acta Obstet Gynecol Scand. 2001;80:315-20.

Billert H. Tokophobia--a multidisciplinary problem.Ginekol Pol. 2007;78(10):807-11.

Saisto T, Halmesmäki E. Fear of childbirth: a neglected dilemma. Acta Obstet Gynecol Scand. 2003;82(3):201-8.

Melender HL. Experiences of fear associated with pregnancy and childbirth. Birth 2002;29:101-11.

Kristina H, Ian B. Tokophobia: an unreasoning dread of childbirth . A series of 26 cases. British J Psychiat. 2000;176:83-5.

Rouhe H, Salmela-Aro K, Gissler M, Halmesma¨ki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG. 2011;118:1104-11.

Kola ST, Hofoss D, Daltveit AK. Indications for caesarean deliveries in Norway. Am J Obstet Gynecol. 2003;188:864-70.

Hilde N, Lotta H, Tore S, Pal Ø. Maternal request for caesarean section due to fear of birth: can it be changed through crisis-oriented counseling?. Birth. 2006;33:221-8.

Katarina S, Sanna R, Hanna R, Erja H, Maiju I, Rukka A. Promoting positive motherhood among nulliparous women with intense fear of childbirth: RCT intervention . J Health Psychol. 2011;17(4)520-34.

Rouhe H, Salmela-Aro K, Halmesma¨ki E, Saisto T. Fear of childbirth according to parity, gestational age, and obstetric history. BJOG. 2009;116:67-73.

Rouhe H, Salmela-Aro K, Gissler M, Halmesma¨ki E, Saisto T. Mental health problems common in women with fear of childbirth. BJOG. 2011;118:1104-11.

Gunilla S, Louise A, Sofie P, Marie B, Adam S, Ann J. Secondary fear of childbirth prolongs the time to subsequent delivery. Acta Obstet Gynecol Scand. 2013;92:210-4.