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Why am I so anxious about childbirth?

Readers Lounge By Caroline Njoroge

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It is quite normal for a woman to be anxious about getting pregnant and giving birth for the first time. And since childbirth is a complex process that has varied outcomes for different women, both positive and negative, it is even more natural for a woman to be anxious about childbirth. 

However, some women find themselves paralysed by their anxieties over getting pregnant and giving birth. This fear is so great, it causes them to avoid the process altogether.

The extreme fear of childbirth, tokophobia, was first identified in 2000 by Dr Kristina Hofberg, a UK psychiatrist. Dr Hofberg first came across the condition while working in the Mother and Baby Unit at the Queen Elizabeth Psychiatric Hospital in Birmingham.

In an article titled Fear of Pregnancy and Childbirth, published in the Postgraduate Medical Journal, Dr Hofberg states that the condition, which is surprisingly common, affects one in six women.

She categorises the women who experience it into two: primary tokophobes, who fear childbirth before pregnancy, and secondary ones, whose fear is ignited by a traumatic birth. What separates tokophobia from the usual anxieties of other mothers-to-be is the depth of fear.

“More recently, pregnant women fearful of childbirth reported a lack of trust in the obstetric team, fear of their own incompetence and fear of dying,” she states. “Other studies have suggested that the greatest fear was of delivering a physically damaged or congenitally malformed child.”

According to Dr Margaret Kagwe, a counselling psychologist and senior consultant at Esteem Counselling Services, knowing of individuals who went through difficult births or who did not make it alive can also lead to tokophobia.

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“With the current age of information overload, videos of people giving birth can be easily accessed online and instead of being helpful, they can end up instilling fear,” she says.

“Some fears may be linked to discomforts associated with pregnancy. For example, some women fear gaining weight, others worry about morning sickness while others may worry about eating disorders during pregnancy,” she adds.

Winnie Wangari Kiumba, 30, is a mother of one and is currently expectant. She narrates that she was quite relaxed in her first pregnancy, probably because she was ignorant of a lot of things at the time.

“With this second baby, the experience has been totally different. I have gone for several ultrasound scans; this helps me deal with the fear that something might go wrong. I found out that with my blood group being of a negative rhesus I have to get an anti-D jab (an injection of Rh antibodies) so my body doesn’t harm the baby, something I had no clue of in my first pregnancy,” she says.

Linda Omutayi, 41, a mother of three says the degree and reasons for anxiety varied with each of her three pregnancies

“Every pregnancy is different. With my first born, I had a phobia of having a miscarriage; Doctors had told me that I have a short cervix which translated to an increased possibility of miscarriage. This was a dread I carried until I delivered my baby,” she narrates.

“With my third and fourth children, I had fears of giving birth to a child who was not healthy. Having lost my second child to cancer at a tender age, I dreaded delivering a child who had any kind of deformity or who was sick in any kind of way.

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“This fear was amplified by the fact that my third child was born with Down syndrome. This resulted in me having heightened concern when I found out I was pregnant with my fourth born child; although I ended up delivering a normal baby boy,” she says.

Linda's degree and reasons for anxiety varied with each of her three pregnancies (Photo: Courtesy)

She adds that she also dreaded labour pain, and this applied to all the pregnancies she has had.

“In fact, when I found out I was pregnant at any one time, my second thought was, ‘labour pains.’ I think our brains have selective amnesia when it comes to this, because as soon as one delivers a child, it’s as if nothing happened. The joy of having as a baby supersedes the pain of it all.”

Linda says her fears were probably made worse by the physical changes in her body.

“I felt like my body had been invaded by an alien, like I was no longer in control, like someone else was steering the wheel,” she says. “Sometimes I would cry for no apparent reason, I dreaded the morning sickness, the sudden sensitivity to different fragrances, the shortness of breath especially in crowded spaces.”

Coping with anxiety

To cope, the women say they have adopted many strategies including talking about their fears

“I have shared with my husband on the fears and challenges I have, but then again, I think at this point I am sharing with anyone and everyone who cares to listen; I blame that on the fatigue and hormones – those things turn you into a whole different person,” Wangari says, adding that she wishes people understood her feelings better.

“I wish my husband understood me more and realised it’s not business as usual. I know I tend to overreact sometimes, like if I am craving something and I don’t get it I hit the roof. But I don’t mean to be intentionally difficult,” she explains.

Linda agrees that having someone to share the demands of pregnancy with goes a long way in easing feelings of anxiety: “The emotional upheaval that comes with it… I wish our partners understood how we feel. I wish husbands took on the initiative to take us to all the clinic appointments – it’s not my pregnancy, it’s our child I’m carrying.

“Sometimes during clinic visits, you want someone else to queue on your behalf because one feels perpetually tired. You want someone to be there in case you receive bad news. You know, one just wants to feel that they are not alone.”

She adds that the challenges of pregnancy have heightened her emotional sensitivity.

“Every pregnancy is different and I think I came into my second one expecting smooth sailing but it has been rough. I’ve only started gaining weight like a month ago. I vomited so much the first four months that I hardly ate anything. Now am beginning my third trimester and I can now eat better,” she says.

There is an upside to pregnancy that Wangari appreciates; strangers can be extremely lenient and kind to pregnant women.

“One gets fast service, the best seats, for example, at church and matatus, attendants offer to carry one’s luggage,” she says.

“Motherhood is not an easy journey but it is a rewarding one. My advice to a first time mum would be, ‘You can’t learn everything at a go. There are these things you will have to discover on your own, as you walk out your own path,” she says.

She adds that rest is important in easing anxiety. “Get all the sleep you can right now and accept all the help you can get, and yes… have some me time.”

Winnie, expecting her second baby, has gone for several ultrasounds to help her cope with the anxiety

Genuine concerns

Jane Wangari Gioko is a 58-year-old mother of four. She says that the concerns that pregnant women have can seem trivial but are genuine.

“As a mother one always worries about what the baby will look like, will it be normal, dark, light skinned...,” she says, revealing that she got her first pregnancy when she was 22 years old.

“I was quite scared since I didn’t know what to expect in the journey of nine months. I lived upcountry then, so information was also scarce. I was very naive and ignorant but each day was a different learning experience,” she narrates.

For Judy Njoroge, a 47-year-old mother of two, her mind was filled with endless questions during her first pregnancy.

“I wondered how the next nine months going to be. Was it a boy or a girl? How healthy would the pregnancy be? How would I manage the pregnancy both physically and emotionally? How would I cope with the changes in my body shape?”

She says the fact that she had been caught off-guard by the pregnancy probably worked against her.

“I was really just not ready. My mind was on going to college. My husband, who was my boyfriend then, encouraged me to keep the pregnancy. Morning sickness, feeling frequently tired, change of diet, were some of the things that disturbed me,” Judy says.

Jane says that women today are fortunate to have access to information on the internet from the convenience of their phones.

“My first pregnancy was smooth but I ended giving birth in a car, having no knowledge of what real labour pains were. I expected excruciating pain (as I had often heard that was what one was to expect) but that was not my experience at the time,” she says.

She narrates that her second pregnancy was a different ball game altogether.

“The baby was too big and there was no theatre around but finally I gave birth naturally,” Jane says.

“The pregnancies and birth became harder with subsequent children; the third was particularly hard when it came to dealing with the labour pains.”

Then why go on to have more children? One might ask.

“Once you hold a child as a mother, the joy of holding the newborn supersedes the pain and inconvenience of those nine months and the drama that the labour ward can come with. I always thought, ‘I’ll get over it, as I did with the previous child,’” she says.

Heal from inside

Wangari says that prayer, mediation and self-care have gone a long way in calming her anxieties.

“I do online yoga and watch a lot of musicals. Finally, remember to pray for yourself, your family and your little bundle of joy,” she says.

Judy, says prayer helped her too. “I started praying and talking to God to help me. Consequently, I never got fear of miscarriage or having a premature baby. Prayer helped me not to meditate on all the things that could go wrong. So, it’s not that I could not have struggled with diverse fears that come with being pregnant; I just found an antidote to those fears early enough,” she says. “I used to declare, “I will give birth like the Hebrew women that the Bible talks about. And truly, that became my reality.”

Men’s take on the issue

Josphat Githua, father of one

“For me, the pace at which my wife began to walk was a bit disturbing. She would seemingly walk at 0 km per hour! I had to adjust. Even my driving speed had to be lowered; going through a pothole was a nightmare.

If she had any fears, then she never shared with me. But what I learnt at that time is that I had to make major adjustments so as to make her pregnancy journey as comfortable as possible. Sometimes waking up in the middle to turn her over as she would request – especially in the ninth month of her pregnancy – having to pass things to her that were literally steps away had become my new normal. For me, the pregnancy journey taught me to be extremely patient with my wife. I’ve also had to permanently learn how to obey traffic rules and drive sloooowly.”

Kenneth Lamu, father of three

“I have three children, and all pregnancies were different. For our firstborn, there was a lot of uncertainty; not knowing what to expect. Being in a foreign land at the time did not make things particularly simpler (we were in Nigeria at the time, for work related reasons).

The one phobia I remember my wife having at the time was the possibility of having a stillbirth -- to this I just responded by taking her for ultrasound scans.

We (my wife and I) also did a lot of research from the internet. Handling the second and third pregnancies was easier.”

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