Sarah Maimone's whole life has been defined by this little-known but surprisingly common condition.
Sarah Maimone always knew she wanted a baby but her tokophobia - the pathological fear of pregnancy and childbirth - meant she almost missed out.
"It was the pain and the unknowns of labour that terrified me," said the now-43-year old from South Melbourne.
“And so I’d put it off every year. I was always saying to my partner, ‘Not this year, I've got something on,’” Sarah says. "Once he said to me, 'There isn't ever going to be a good year, is there?' I think he thought we'd never have a baby."
What is tokophobia?
Although the term tokophobia was only coined 20 years ago, new research indicates it may be more common than was initially thought. It could affect as many as 14% of women, although many fail to seek treatment due to a lack of awareness and the stigma that surrounds it.
Tokophobia is more common among women with a history of mental illness such as depression or anxiety, or if they have been a victim of sexual abuse. What’s known as ‘secondary tokophobia’ (as compared with primary tokophobia) can occur after a traumatic birthing experience.
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Sarah said her previous history of anxiety may have contributed to her fears – as did the horror stories she heard from friends and the media about giving birth.
“Because I’m older, I have so many girlfriends who have had babies and they all told me their stories,” she said. “Every woman likes to tell their birth story, even if it’s really bad. There is a huge focus on the stuff that goes wrong.”
Sarah was terrified at the thought of pregnancy or birth and almost didn't have children. Image: Instagram.
I wanted an elective caesarean
When Sarah fell pregnant last year, she wanted to have an elective caesarean to avoid what she thought would be unbearable labour pains.
“The first thing I said to my obstetrician was, ‘I am Sarah and I will be wanting a C-section.’
He said he’d do his best to talk me out of wanting that. After that initial discussion, we never really talked about it again.”
Sarah’s obstetrician, Dr Joseph Sgroi at Epworth Hospital in Melbourne, says telling a woman she has tokophobia may actually make things worse.
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“I don't label someone by saying, ‘I think you're fearful of birth,’ because I think that’s detrimental to being able to support and counsel my patients.”
Dr Sgroi said that creating trust and rapport during the pregnancy is an important part of helping his patients overcome their fears. If someone exhibits extreme tokophobia, Dr Sgroi will refer them to a psychologist.
First-time mothers feel a level of fear
The most extreme cases of tokophobia that have been documented include women undergoing sterilisation procedures to avoid pregnancy despite wanting their own children, as well as drug and alcohol abuse with the aim of inducing an aborted pregnancy - or even punching their own abdomens.
“Feticide [an intentionally induced miscarriage] may not necessarily be related to a fear of childbirth – it could also relate to an underlying psychiatric disorder,” said Dr Sgroi.
“It could also be linked to the events in which a woman actually became pregnant, such as rape. Fortunately, in most states of Australia, if a woman wishes to terminate her pregnancy, there is the capacity to do that in a humane fashion,” he explained.
Sarah's obstetrician, Dr Joseph Sgroi. Image: Instagram
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We've become isolated from the whole birthing process
Dr Sgroi said that only 1% of his patients have truly debilitating fears about childbirth. However he added that it’s very common for first-time mothers to feel some level of fear, simply because they don’t know what to expect.
“As society has evolved, we’ve become isolated from the whole birthing process.
Historically, women would've been involved in many births before they became mothers themselves – even if it was simply bringing water into the room.
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“Now we're divorced from all of that, so we have no idea about what the birthing experience involves – other than the little snippets that we get, which are often dramatised.”
And as for Sarah?
Sarah and her son. Image: Instagram
I had a dream pregnancy
She opted for a vaginal birth and gave her pregnancy and birthing experience rave reviews.
“In the end, I don’t know what I was worried about for so many years. I had a dream pregnancy and a pretty smooth labour – it was the best experience.”
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She said there was “absolutely no pain” after the epidural and urges other women to get one “nice and early”.
She credits being able to overcome her fear to her partner being supportive and Dr Sgroi highly professional.
“I was still quite petrified during the appointments but towards the end, because Dr Sgroi was so calm and collected, I started to feel more confident about just letting the chips fall on the day.
“I think one the most important things is to not over-analyse what you see on television,” said Dr Sgroi.
“If you've got any concerns, explore them with loved ones and your healthcare provider and seek the reassurance and guidance you need.”
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