What to do if you are scared of giving birth again

Written by Dr Rosie Pajak - Perinatal Psychologist and Founder of The Birth Healing Collective

After a traumatic or negative birth experience, it’s only natural to feel worried about the idea of giving birth again. Somewhere between 20%-78% of pregnant people report fears about giving birth^(1,2) – and birth anxiety tends to be higher if you’ve already had a birth experience that didn’t go to plan. 

If birth-related anxiety is deeply affecting your daily life, 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⁾. The fear can follow a range of different experiences, including a pregnancy loss, a 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 find ourselves working hard to avoid a feared experience, this is likely to have a significant effect on our day-to-day life.

With secondary tokophobia, the 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 completely avoided due to this fear, or multiple different types of birth control used at once. For someone with tokophobia, the idea of going through another pregnancy or birth feels almost impossible.

Importantly, living with the intensity of the fear in tokophobia creates symptoms of anxiety, depression or both. This can include panic attacks, irrational worries, fatigue, intense mood swings, imsomnia, nightmares, body pain, decreased appetite or libido, or loss of interest in favourite activities.

Hang on though… could it be PTSD?

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

PTSD is characterised by flashbacks, nightmares and repeated intrusive memories of a traumatic experience, occurring alongside attempts to avoid reminders of the traumatic event. With PTSD, parents often describe living with an ongoing sense of danger even after the original threat has passed. If you develop PTSD after a traumatic experience, your body can remain 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 pregnancy/birth trauma can make a huge difference. You may benefit from support to help your mind fully your last birth to treat trauma symptoms before addressing the fear that surrounds a possible future birth.

I’m not sure my birth ‘counts’ as birth trauma… What types of experiences can lead to a fear of giving birth again?

Birth-related fears can be easily misunderstood or dismissed. The reality is that many different experiences can contribute to a fear of giving birth, both physical and psychological.

The term birth trauma is used to describe a woman’s experience of interactions and/or events related to childbirth that cause overwhelming distressing emotions and reactions, leading to short and/or long-term negative impacts on a woman’s health and well-being (Leinweiber et al, 2022).

Research has shown that having an emergency caesarean section or an instrumental delivery can increase the likelihood of birth trauma⁽⁴⁾. These birth experiences might be quite common, but we also have very high rates of birth trauma.

Importantly, you may have experienced parts of your birth as traumatic even if the birth was relatively straightforward in the eyes of others. Research (and major government enquiries into birth trauma) highlights the impact of poor interpersonal care when it comes to birth. We know that birth can be traumatic when parents feel that they lack control over the birthing process, or have ineffective pain relief⁽⁴⁾. In addition, distressing experiences immediately after the birth, perhaps involving separation from your baby, breastfeeding challenges or a physical birth injury, can also lead to trauma – and to concerns about going through childbirth again.

The important thing to know is that 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.

So what can help me manage my fear of giving birth again?

If you want to have another child but you’re worried about the birth, it’s important to know that you can prepare both psychologically and practically. Getting the right support can reduce your anxiety, help birth feel safer and increase your confidence in your ability to cope.

If you think you might be experiencing secondary tokophobia (or PTSD) seeking out specific psychological treatment is likely to be the most important first step. Acknowledging and healing any trauma you have experienced can significantly reduce the intensity of the fear about giving birth again. Psychological support 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 very carefully, in order to rebuild trust in birth and their caregivers. Remember, there is no right way to give birth, only what is right for you! So 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 specific expertise or a gentle, trauma-informed approach to birth. Empowering yourself with additional education about birth interventions, writing a clear birth plan and skilling up your birth partner can all make a difference to your confidence.

Want to learn more about how to prepare to birth again after a previously difficult birth? Then make sure you get a copy of my Prepare Guide. Inside I guide you through five key steps you can take to help you feel safe, secure and in control for your next birth.

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.  

About Dr Rosie 

Dr Rosie Pajak is a perinatal clinical psychologist and founder of The Birth Healing Collective. She has a range of resources and supportive programs for parents preparing to give birth again after traumatic birth experiences available here. You can follow her @birth_healing_collective.