Fear of Childbirth: Coping with Birth Anxiety During Pregnancy

Why does fear of childbirth develop and when is it more than ordinary worry? Learn practical steps to ease birth anxiety in pregnancy and how therapy helps.

In the first months of pregnancy, while you are excitedly planning the nursery, another question may settle in your mind as your bump grows: "So what will happen when the day comes?" Many expectant mothers feel some worry as birth approaches, and this is entirely understandable. In some women, however, fear of childbirth grows so large that it overshadows sleep, appetite, the relationship with their partner and the joy of pregnancy. Some cannot look at the screen during check-ups so as not to think about the birth; others replay, every night, scenes of losing control in the delivery room. In this article I will try to explain what feeds birth anxiety, at what point it calls for support and how you can build a calmer relationship with this fear throughout your pregnancy.

What Is Fear of Childbirth and How Does It Differ from Ordinary Worry?

Worry about giving birth is an ordinary part of pregnancy. Moving towards the unknown, thinking about pain and the baby's health, and preparing for an experience you will be having for the first time naturally create tension. This kind of anxiety usually eases as you gather information, as the birth plan becomes clearer and as your support network grows stronger.

Fear of childbirth, on the other hand, is a more intense, more persistent and more all-encompassing experience. In the literature its severe form is called "tokophobia". In this case the person perceives birth not merely as a demanding event but as a catastrophe they will not be able to bear, will not survive or in which they will lose control completely. In some women this fear begins so early that it leads them to postpone becoming pregnant for years.

Specialists generally speak of two types:

• Primary fear: Seen in women who have not given birth before. It is often fed by stories they have heard, a general sensitivity to pain, anxiety about medical settings or fears carried over from childhood.
• Secondary fear: Appears in women whose previous birth was difficult, involved emergency intervention or felt traumatising. Here the fear is attached to the possibility of a lived memory repeating itself.

This distinction matters, because in the first case the work is with the unknown, while in the second it is with an experience that is known and painful. Of course, the two can also be intertwined in the same person: a woman whose first birth was hard may, in her second pregnancy, be afraid both of that memory and of not knowing what will be different this time.

Symptoms of Fear of Childbirth in Pregnancy

This fear is sometimes voiced openly as "I'm scared", and sometimes it shows itself in indirect ways. Common signs include:

• Thoughts about the birth arriving involuntarily and frequently during the day
• Waking at night and thinking about the moment of birth, the pain or possible complications
• Noticeably avoiding birth videos, birth stories or hospital corridors
• Or, on the contrary, reading forums for hours and researching every possibility
• Silencing anyone who starts talking about birth, or changing the subject
• Physical signs of anxiety such as palpitations, a feeling of breathlessness or nausea
• Catastrophic scenarios such as "What if something happens to the baby, what if I die?"
• Making the decision about the method of delivery out of anxiety, almost as an escape route
• Finding it hard to bond with the pregnancy and the baby, a feeling of "I just want this to be over"

Experiencing a few of these from time to time does not on its own mean there is a problem. What matters is how much space the fear takes up, how much it wears you out and how far it narrows your life.

Why Does Birth Anxiety Happen?

Birth anxiety does not have a single source; usually several factors pile on top of one another.

Stories you hear. In Turkey, childbirth is one of the most talked-about subjects within the family. During a bayram visit (the religious holidays when relatives call on one another), an aunt describes how many hours she writhed in labour, and a neighbour shares a memory that begins, "The baby was the wrong way round, they took me into surgery at the last minute." Meanwhile, a mother-in-law dismisses the anxiety by saying, "We gave birth while working in the fields, what are you all so afraid of now?" When frightening stories and dismissive remarks meet at the same table, the expectant mother can end up both frightened and ashamed of her fear.

Social media and forums. A birth video opened in the middle of the night or a difficult birth story on a forum can leave lasting images in the mind. Negative experiences are shared far more than births that went smoothly, and the anxious mind mistakes this picture for the general truth.

The need for control. For women who are used to planning their lives and doing their work on time and properly, birth is a process in which control is largely handed over to others and to the body. This uncertainty can feel more frightening than the loss of control itself.

Previous experiences. A difficult previous birth, pregnancy loss, the strain of an IVF process or negative memories of medical interventions can feed the fear. For those who experienced a previous birth as traumatic, the article on traumatic birth may also offer guidance.

A general tendency towards anxiety. In people who were already prone to anxiety before pregnancy, or who have experienced panic attacks or health anxiety, fear of childbirth can run a more intense course.

How Does Fear of Childbirth Affect Daily Life and Relationships?

Let's say you are thirty-two weeks pregnant. During the day you go into meetings at work, in the evening you fold baby clothes, but the moment you lie down in bed at night your mind goes to the delivery room. Each time your partner says, "Don't worry, everything will go fine," you think to yourself, "How would you know?" This picture shows that fear of childbirth is not just an individual experience; it affects the relationship too.

Partners, with good intentions, often try either to shrink the fear or to come up with solutions. Unfortunately, both can leave the expectant mother feeling "I'm not being understood". The elders' warning, "Don't get upset while you're pregnant, it passes to the baby," multiplies the anxiety with guilt as well. The woman starts to think that she is not only afraid, but harming the baby by being afraid.

In some women, the fear leads to missed check-ups, skipping antenatal classes or avoiding any talk of the baby's arrival. Avoidance brings relief in the short term, but because it enlarges the unknown territory, it feeds the fear in the long run. If you notice that your mood is generally low during pregnancy and that you cannot take pleasure in things, I would also suggest reading the article on depression in pregnancy; anxiety and low mood often appear together in this period.

What Can You Do to Cope with Fear of Childbirth?

The suggestions below aim not to eliminate the fear completely, but to help you build a more balanced relationship with it.

Name your fear

"I'm afraid of giving birth" is a very broad sentence. Try to find the real focus of your fear: is it the pain, something happening to the baby, losing control, being alone, medical interventions, or how life will change after the birth? Writing down on a piece of paper the three scenes you fear most turns a blurry fear into questions that can be worked on.

Get information from the right source and in the right dose

Note down the questions you want to ask your doctor or midwife before your appointment. Concrete information, such as the pain relief options during labour, which intervention is used in which situation, and whether your partner or a relative can be with you, can reduce anxiety. On the other hand, browsing forums at midnight accumulates fear more than information. Limiting your online reading to a set time and to reliable sources is a good balance.

Consider antenatal classes

Many hospitals and health institutions offer pregnancy schools or antenatal classes. Seeing the delivery room in advance, learning breathing and relaxation techniques and getting to know the stages of the process shrink the "unknown" territory. Attending these classes with your partner also allows them to learn how they can support you.

Build small habits that calm the body

Diaphragmatic breathing, relaxing the muscles area by area and short walks can lighten the load anxiety places on the body. Doing these exercises for a few minutes every day, not only when fear arrives, gives you a familiar tool you can also turn to when the day of the birth comes. Do not forget to get your doctor's approval for exercises during pregnancy.

Tell your partner what kind of support you want

Instead of saying "calm me down", you can ask for something more specific: "I just want you to listen, don't suggest solutions," or "Let's go to the doctor together, you listen to the answers too." Partners often either fall silent or close the subject because they do not know what to do. A clear request makes things easier for both of you.

Adjust the dose of stories

You can gently set a boundary with a relative who starts telling you a birth story: "Listening to difficult birth stories isn't good for me right now, shall we talk about it after the birth?" This sentence is not rude; it is a choice that protects you and your baby.

Make a flexible birth plan

A birth plan lets you share your wishes and priorities with your team. However, if the plan turns into an "everything must go like this" list, an unexpected change can increase disappointment. A flexible plan along the lines of "My preference is this, but if necessary I can accept that too" preserves the sense of control while leaving room for uncertainty.

When Should You Seek Professional Support?

If any of the following feel familiar, talking to a mental health professional may be a good step:

• The fear around birth takes up most of your day and disrupts your sleep and appetite
• You find it hard to attend check-ups or keep postponing them
• Your decision about the method of delivery is shaped entirely by fear and this leaves you at a dead end
• Images, sounds or smells from a previous birth come into your mind involuntarily
• Throughout the pregnancy you constantly feel low, hopeless or distant from the baby
• You have been postponing pregnancy for a long time because of fear

Psychological support during pregnancy can run in cooperation with your birth team. Whether medication is needed can be decided by a psychiatrist together with your obstetrician. If you are having thoughts of harming yourself or your baby, this requires urgent assessment; at such a moment do not hesitate to call 112 (emergency services).

How Is Fear of Childbirth Approached in Therapy?

The first step in therapy is listening to the story of your fear. When did it start, what images accompany it, how was birth talked about in your family, is there a previous experience? These questions help to understand what the fear is being fed by.

Cognitive behavioural therapy is one of the approaches frequently used in this area. The process usually includes the following elements:

• Examining catastrophic thoughts: Looking together at the evidence for, and alternatives to, thoughts such as "I won't be able to bear the pain, I'll faint, nobody will help."
• Gradual exposure: Approaching avoided subjects step by step; for example, first reading a birth account, then seeing the hospital's maternity floor, then discussing the birth plan with the doctor.
• Mental rehearsal: Imagining the day of the birth from start to finish, together with what you can do at the challenging moments.
• Body-based skills: Making breathing, relaxation and attention-shifting exercises usable during labour as well.
• Processing the previous birth: For women whose previous birth was difficult, putting that experience into words, making sense of it and separating it from the current pregnancy.

Preparation is not about making the birth flawless; it is so that, whatever happens, you do not feel alone and helpless.

It can be helpful for the partner to join one or more sessions in therapy. This way the partner learns how to stand by you without shrinking or magnifying the fear. You can find more information about individual work on anxiety on the anxiety and panic page. When travelling becomes difficult in the later stages of pregnancy, sessions can also continue online.

Frequently Asked Questions

Does having a fear of childbirth mean I won't be able to have a vaginal birth?

No. Fear is not the only factor that determines how a birth goes. Many women who start out with intense fear go on, with preparation and support, to experience their birth in line with their own preference. The decision about the method of delivery is made by talking with your doctor, taking both the medical assessment and your preferences into account.

Will the anxiety I feel during pregnancy harm my baby?

Anxiety that comes and goes is a natural part of pregnancy, and you do not need to blame yourself for it. Because long-lasting, intense stress is known to be draining both for you and for the course of the pregnancy, it makes sense to seek support if anxiety is making your life difficult. The aim here is not to forbid anxiety, but to make it manageable.

At what stage of pregnancy should therapy for fear of childbirth begin?

Any moment you notice the fear is weighing on you is a suitable time. Starting early allows more time for gradual work. Sessions that begin in the final weeks can also be useful for concrete preparation for the day of the birth and for calming skills.

Will this fear continue after the birth?

This anxiety usually stays behind once the birth has happened. However, in women who experience the birth as difficult, worries about later pregnancies or disturbing memories of the moment of birth may persist. In that case it is possible to seek support in the postnatal period too, and this is valuable preparation that can be done before a new pregnancy is planned.

• #fear of childbirth
• #tokophobia
• #anxiety in pregnancy
• #pregnancy psychology

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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