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You probably do not have tokophobia, the unreasoning fear of delivering a baby, as it has recently been defined in the very few papers that have been written about it, but these feelings and concerns may well indicate an anxiety problem that would benefit from attention. Your boyfriend, your mom and a sympathetic doctor may be able to help with this.

Tokophobia, or unreasoned fear of childbirth, is a newly-recognized disorder that has not yet been formally accepted by American or European psychiatry. It was first described the British Journal of Psychiatry in 2000, and has been suggested to one of the phobic anxiety disorders. The name was taken from the Greek for "pregnancy" as well as the well-known Greek word for fear. The article described 26 young women who had psychiatric evaluation because of an unreasoning dread of childbirth despite very much wanting to have a baby. The symptoms included nightmares, difficulty concentrating on family activities, panic attacks and various psychosomatic complaints. The women in question were pregnant, and in several cases requested an elective cesarean section in order to end the pregnancy; when this request was declined, they were more likely to have psychological complications and psychiatric symptoms afterward. The authors defined two types of tokophobia, which they called primary and secondary. Primary tokophobia was a fear of pregnancy in general, predating the present pregnancy and sometimes beginning in childhood or adolescence, possibly because of something they were told by friends or the pregnancy experiences of their mothers. Secondary tokophobia involved a specific fear of complications or problems in the ongoing pregnancy, usually on account of recent upsetting experiences during the pregnancy, difficulties during a previous pregnancy or concerns and symptoms related to depression or anxiety disorder that were present before the pregnancy.

It has been known since the 19th century that anxiety is common in pregnancy, and that this increases during the third trimester as delivery approaches. A study in 1990 suggested that fear of death during childbirth, which has unfortunately been fairly common throughout history, is still present in modern women. The 2000 study included women who had experienced rape and childhood sexual abuse, and who relived these experiences when undergoing gynecological examinations and obstetrical care. Another group of women had hyperemesis gravidarum, and were admittedly afraid that the severe vomiting they were experiencing during the pregnancy would not stop. Ten of the pregnancies had occurred while either the patient or her partner were waiting to have sterilization procedures and two additional patients stated that they did not really want to have these children. These and several other women in the study had evidence of depression or post-traumatic stress disorder. The recommended treatments consisted of supportive psychotherapy and counseling in conjunction with obstetrical care.

The women in this study were all pregnant and feared the eventual outcome and aftereffects of being pregnant. Fearing pregnancy when one is not pregnant or when pregnancy is unlikely to occur, or regularly fearing being pregnant when one is not, are not quite the same thing as the primary or secondary tokophobia that was described in the British article. This is nevertheless an unreasoning fear in the same category, and most of the time these feelings are signs of anxiety, phobia or both. A past or family history of depression or anxiety, or previous episodes of depression or anxiety not related to possible pregnancy, would support this. These symptoms and other forms of phobia may respond to some of the newer antidepressants that increase levels of serotonin and norepinephrine within the brain; they are less likely to respond to older antidepressants, and most people believe that anxiety drugs like Xanax or Valium may cause more problems than they solve except when used for short periods of acute symptoms. Natural options are preferred by many doctors and perhaps most patients, and these include herbal medicines, vitamins and nutritional supplements and homeopathic remedies that are highly diluted and therefore quite safe. Herbal possibilities include chamomile, valerian, kava kava and passionflower, with St. John's wort also helpful if not combined with pharmaceutical drugs for depression and anxiety. Calcium, magnesium, B-complex vitamins and either 5-hydroxytryptophan, which is a precursor of the transmitter serotonin, or the calming neurotransmitter gamma-aminobutyric acid are over-the-counter nutritional alternatives. Homeopathic medicines that may help with anxiety include aconite, gelsemium and ignatia amara.

If fear of being pregnant or becoming pregnant is frequently present or disabling, evaluation or treatment by either a psychologist or a psychiatrist expert in anxiety, phobia and the medicines used for them may be appropriate. A sympathetic family doctor or obstetrician/gynecologist would be a good medical place to start, both for reassurance about the fear and for recommendations as to its treatment.

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