The thought of giving birth can make most women feel anxious. It may incite dread, alarm and even terror.

However, this fear usually subsides when a woman decides that she is ready to have children.

For some, however, the fear is so serious that they develop a phobia, said Dr Helen Chen, the head and senior consultant of Mental Wellness Service at KK Women's and Children's Hospital (KKH).

'It's possibly universal that most women have some degree of anxiety about labour,' said DrChen. 'But there are cases where the fear is so morbid and overwhelming, they become constantly preoccupied with the dread of labour and experience high levels of anxiety.'

This abnormal and persistent fear of childbirth is known as tocophobia. Phobia is an anxiety disorder that describes an exaggerated fear of an object, a situation, or an activity.

Tocophobia can lead to tragic consequences in some cases.

Dr Chen recalled a patient who had planned to get pregnant, but when she did, she harboured such an intense terror of childbirth that she aborted her twin foetuses without informing her husband.

While the causes of tocophobia are not known, Dr Chen said that it usually occurs in women who suffer from antenatal depression.

'The other vulnerable group are women who had experienced past sexual trauma,' she said. 'The notion of giving birth is terrifying because it brings back painful memories.'

Women who experience severe morning sickness may also develop the phobia in the later stages of pregnancy. Also, women with an unwanted pregnancy and who later fail to bond with the foetus or to obtain an abortion may dread the impending birth, she said.

However, there are no fixed rules. Some cases simply do not fit into any specific category.

'I had a patient who saw me for her second pregnancy. She had previously given birth naturally without any problems, but was terrified as it had been 10 years since the birth of her first child,' said Dr Chen.

Treatment involves counselling to address the fears of the patient, relaxation therapy to reduce tension and medication.

'For some women with severe symptoms, labour rehearsal can be helpful,' said Dr Chen. 'We'll walk a patient through the delivery suite and explain to her what to expect at each stage of delivery.'

While some patients may request a caesarean section in place of a normal vaginal delivery, it is important to know the risks involved, said Dr Chee Jing Jye, the head of the peripartum unit at KKH.

'We will counsel them on the risks and advise them against having an elective caesarean section in the absence of other valid medical conditions,' he said.

Instead, patients are encouraged to explore other options.

'As most are afraid of the pain, we may advise them on the use of epidural or other forms of analgesia,' said Dr Chee.

He added: 'In my experience, most women are agreeable to normal vaginal delivery after counselling.'

This article was first published in The Straits Times.