Former tokophobia sufferer, mother of two fearless births, author of Betrayed By Your Biology and Fearless Birthing. Host of the Fear Free Childbirth podcast (2m+ downloads). The person who named Reproductive Anxiety Disorder.
When a woman tells me she is afraid of birth, the first thing I ask is: what is it about birth that scares you? Almost every time, once we follow the thread, we find the fear was never really about birth at all. Birth is just the thing that drags older, deeper fears into the light.
Ask most people what causes a fear of childbirth and they will say something obvious: birth is painful, birth is dangerous, of course women are scared. But after more than a decade of this work, I can tell you that the real causes of birth fear sit underneath all of that, and they are rarely about birth itself.
For most women with a serious fear of pregnancy and birth, birth is not the cause. It is the trigger. It forces them to stare straight at four deep, universal human fears they have usually been carrying for a long time. Name those four, and the fear finally starts to make sense.
In this post:
Why the real causes of birth fear are rarely about birth
Here is something I would go as far as to say plainly: for most women with tokophobia, the fear is not actually about birth. Birth is simply the event that exposes and intensifies deeper fears that are already there, the fears all humans carry of losing control, of the unknown, of pain, of death. Most of us get to avoid looking at those fears head on. Birth does not let you. It forces them to the surface.
This is exactly why treating a fear of birth as a simple phobia, with a few facts about labour or some breathing techniques, so rarely works. You cannot reassure away a fear whose real causes have nothing to do with the thing you are reassuring about. It is also why tokophobia is an anxiety disorder rather than a narrow phobia. So let us look at the four true causes underneath.
1. The fear of losing control
This is one of the biggest and deepest. For many women it is not the pain that terrifies them, it is having no control over what is happening to their own body. The thoughts sound like: “I won’t be able to stop it once it starts.” “People are going to make decisions about my body without my consent.” “I don’t want to feel trapped.”
Birth asks you to surrender, and for any woman who has experienced trauma, especially medical, sexual or childhood trauma, surrender can feel unbearable. Many women also carry a real fear of being violated or ignored during birth, of saying “no” and not being heard. Sadly, that is not an irrational fear, it happens. So the fear of losing control is often picking up on something genuinely true.
2. The fear of the unknown
Pregnancy and birth are a lottery, and for an anxious nervous system, uncertainty is its own special torment. Will you have morning sickness, or months of it? Will labour take thirty minutes or three days? Will there be complications? There is simply no way to know.
If you fear a needle, at least it is over in seconds. If you fear the dentist, you know it lasts an hour. Birth offers no such container. That open-endedness is unbearable for many women, and it is why some choose the predictability of a planned birth, not because they expect it to be painless, but because at least they know what to expect. The fear of the unknown is so central that I have given it its own post: do you have a fear of uncertainty?
Not sure which of these is driving your fear?
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3. The fear of pain, and not coping
Pain has a reputation, and our culture works hard to keep it that way. Films and television show women screaming in agony. People love to tell birth horror stories. So it is no wonder so many women fear it. But for women with tokophobia, the fear of pain is next level: not a worry, but a certainty that birth will be so painful they either will not survive it or will be permanently traumatised.
Underneath the fear of pain is usually a quieter fear: “I won’t be able to cope.” It is as much about a lack of trust in yourself to handle what comes as it is about the sensation itself. That is good news, because self-trust can be rebuilt.
4. The fear of death, damage and being trapped
At the very bottom sits the most primal fear of all: “I am going to die,” or “my baby is going to die.” For a heightened fear response, the small statistical possibility of maternal mortality can feel like a near certainty. Alongside it sit the fears of permanent physical damage, of tearing, of a body that will never feel the same, and a fear I hear surprisingly often: that the woman will somehow be sacrificed in favour of the baby.
And there is the fear of being trapped: in the pregnancy, in the process, in a body that has been taken over, with no way out. For some women this echoes their own birth, where being stuck or pulled out left an early imprint of exactly this.
What this means for healing it
If the true causes of birth fear are these deeper fears, then the way through is not more information about birth. It is working with the actual root: the fears of control, the unknown, pain and death that birth has dragged to the surface. When I work with women, most of what we clear has nothing to do with birth at all.
That is also why this fear can be cleared. These are learned, stored fears, often absorbed long ago, and stored fear can be released at the level it lives, in the nervous system. The first step is simply seeing which of the four are really driving you. From there, you are no longer fighting a vague terror of birth. You are working with something specific, and specific is workable.
Where to go deeper
If naming the real causes brought some clarity, here is where to take it next.
- The free Tokophobia Assessment – see which fears are actually underneath yours, and where to go from there.
- Betrayed By Your Biology – my book, which goes through these fears and their roots in depth.
- Reproductive Anxiety Disorder – the wider framework these fears belong to, and how they form.
Frequently asked questions
What are the real causes of fear of childbirth?
The real causes of birth fear are rarely birth itself. Underneath sit four deeper fears that birth forces to the surface: losing control, the unknown, pain and not coping, and death, damage or being trapped. Birth is the trigger that exposes these older, often long-held fears.
Why am I so scared of giving birth when others are not?
Because for you, birth is touching deeper fears that others may not carry as strongly, around control, uncertainty, pain or safety, sometimes rooted in earlier trauma or your own birth. It is not that you are weaker. It is that birth is pressing on a tender, often older wound.
Is fear of childbirth really about the pain?
Not usually, or not only. Fear of pain is real, but underneath it is often a fear of not being able to cope, and beneath that, fears of losing control or of death. This is why reassurance about pain relief rarely settles the fear: it is not addressing the true cause.
Can the causes of birth fear be healed?
Yes. These are learned, stored fears, often absorbed long ago, and stored fear can be cleared at the level it lives, in the nervous system. Healing works by addressing the deeper fears underneath rather than by giving more information about birth itself.
By Alexia Leachman, creator of the RAD framework and the Fearless Birthing method. Former tokophobia sufferer, author, host of the Fear Free Childbirth podcast.
About the author: Alexia Leachman coined Reproductive Anxiety Disorder to name what she lived through, and what she kept seeing in other women: a fear of pregnancy and birth that runs far deeper than ordinary nerves. She built the RAD framework, the Fear Funnel and the RAD Spiral, and makes the case for taking it seriously in her book Betrayed By Your Biology and two white papers. More about Alexia →
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