By SADIE NICHOLAS

Last updated at 15:13 27 October 2007

Rachel Smith shifted uncomfortably in her seat. Light-headed and desperate for air, she snapped shut the pages of the baby magazine she was reading and threw it across the room.







Her pregnant friend, whose house she was visiting, watched bemused as Rachel stood up and dashed for the door.

"I had to get out of the room," says Rachel. "I'd turned the page and seen a photograph of a woman giving birth. It was disgusting.

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"Her face was contorted in pain, the whole thing was one big bloody mess, and I suddenly felt sick. If I didn't get fresh air, I would have fainted."

Melodramatics? An over-reaction? Rachel, a 36-year-old London financier, insists not.

She suffers from a serious, but little-known condition called tokophobia - a morbid fear of childbirth which in many cases is so profound that it sometimes leads to a complete avoidance of pregnancy, even though many sufferers admit they would dearly love children.

This week Dame Helen Mirren admitted to suffering from the same fear. The Oscar-winning actress revealed her deeply held fear on an Australian television show, blaming a graphic video of childbirth shown to her as a 13-year-old schoolgirl for her childlessness ever since.

"'I swear it traumatised me to this day," she said. "I haven't had children and now I can't look at anything to do with childbirth. It absolutely disgusts me."

Like Dame Helen, Rachel's fears stem from her childhood. "I was three years old and my mother had just returned home from hospital with my new baby sister," she says.

"I overheard her talking to a friend on the phone, telling her it had been an 'horrific' birth, and that she was cut to ribbons.

"She went on to describe how she'd inspected herself using a mirror and counted 24 stitches. Mum was clearly deeply upset about the whole experience and it has stayed with me my whole life.

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"As a three-year-old, I obviously wasn't meant to hear the conversation and I couldn't bear the thought that my mummy had been through something that had really hurt her.

"It was a deep psychological trauma for me, and as I got older and was able to make sense of Mum's experience, it led to a profound dread and disgust of childbirth. I completely empathise and agree with everything Helen Mirren said.

"Even though I am a woman, birth sounds an horrendous experience. One friend was in labour recently and the baby got stuck in the birth canal, but was too far down for her to have a Caesarean. My friend was highly distressed, the baby was distressed, and it really was down to sheer luck that it survived.

"Another friend delivered her baby straight into a pile of her own excrement that had exited her body at the same time. It's utterly disgusting, but apparently fairly common.

"My mother has done nothing to allay my fears. Whenever we've spoken about childbirth, she is honest and says simply that, yes, it is a horrendous experience. But I've never mentioned to her the conversation I heard her having all those years ago."

The daughter of two teachers, Rachel grew up in Berkshire, and while currently single she would one day love to be a mother.

"I strongly feel that the only way I'd be able to do that, if at all, would be to have a Caesarean - which would be less gory because I could be sedated - and probably some therapy during pregnancy, because I find the thought of having my stomach cut open pretty horrifying.

"The truth is that the very thought of having something almost alien-like growing inside me is disgusting."

Of course, for most women, the anticipation of labour comes with a degree of anxiety. But as many as one in seven women are thought to suffer from tokophobia (a word which derives from the Greek "tokos" meaning childbirth).

Dealing with the condition is often difficult because it remains one of society's taboo subjects.

Despite her desire to find a way to have children, Rachel has been labelled "cold-hearted" and a "babyhater" by some friends she has discussed her fears with.

"Because there is the reward of a baby at the end of childbirth, it seems most people think that women should just stop whinging and get on with it," she says.

"In fact, plenty of mothers wear their stories of horrific deliveries like a badge of honour.

"I'd go as far as to say that there seems to be a breed of smug, yummy mummy types who are so self-righteous because they've given birth that they collude in the view that women like me don't have a right to feel sickened by childbirth."

It's a sentiment that Maureen Treadwell of the Birth Trauma Association hears on an almost daily basis from other tokophobia sufferers.

"There needs to be a big change in the attitude of other women towards those suffering from dread of childbirth," she says. "It's become a really big social problem, largely created by what has come to be known as the Mummy Mafia - the same women who are almost evangelical about breastfeeding and natural births.

"But they need to recognise that each woman is different and there are plenty who have a very genuine and morbid fear of pregnancy and birth, and they need support, not condemnation.

"There are few services out there to help tokophobic women, and many of them are made to feel ashamed if they try to speak out. Childbirth should not be held up as some sort of competition - but it frequently is."

There are two main types of the condition. Primary tokophobia relates to childless women who have a deep-seated dread of pregnancy and birth, often relating back to their own mother's experience or something they learned in school.

Secondary tokophobia affects women who have had a horrendous experience of childbirth already, which renders them emotionally unable to have more children.

Wine merchant Anna Walker, 30, admits that a Caesarean might be the only way she could have a child. She lives in Bristol with boyfriend James Richardson, 31, a surveyor.

"It's not too strong to say that the very thought of childbirth disgusts me in a big way," says Anna, a journalism graduate.

"And those feelings are more heightened now James and I are in our 30s and the subject of having a family has started to creep into conversation.

"I know that at some point I'm going to have to be brave enough to admit to James that I suffer from tokophobia. It's much more than an anxiety - I am actually physically repulsed by pregnancy and childbirth.

"I even struggle to be around friends when they are pregnant and can't bear to watch or listen to anything about the process of having a baby.

"It all seems so medieval and I find it astonishing that there is nothing in this modern, technical age to make childbirth easier for women."

Unlike Rachel, Anna can't trace her own terror to anything in her childhood. The daughter of an accountant mother and businessman father, she says it's a phobia she's had for as long as she can remember.

"I've long had an aversion to anything to do with pregnancy and birth, right back to sex education and biology lessons at school. I'm quite squeamish and I don't particularly want to know how the human body functions.

"If I thought about it rationally, getting pregnant now when I'm in a loving, eight-year relationship wouldn't be the end of the world.

"But my tokophobia means it would actually be the biggest nightmare imaginable.

"Six months ago, when I was suffering dizzy spells and nausea, my doctor tested me for a number of possible causes including diabetes, inner ear trouble and pregnancy. I was utterly terrified and knew I'd rather deal with diabetes than being pregnant. I couldn't cope with a birth.

"There's an idea out there that all women want to experience the joy of giving birth and that it's the most natural thing in the world. This makes it very difficult for me to speak out about tokophobia.

"Only two close friends know the full extent of my problem, because I know it's an emotive topic that will undoubtedly leave many people accusing me of being cold-hearted.

"But what they don't understand is that I would be very happy for James and I to have the end result, a baby. But emotionally I can't get past pregnancy and birth. It's a pathological problem and people should recognise that before they criticise women like me."

Like countless women suffering tokophobia, Amanda Campbell, a 23-year-old marketing executive from Notting Hill, London, is nervous discussing the condition publicly, fearful that it will spark what she would regard as an unjustified and emotive backlash.

"People think my feelings of disgust about pregnancy and childbirth are just a phase I'm going through, but they're so wrong," she says.

"Just like Helen Mirren, I was 13 or 14 when we were shown a video of childbirth in a sex education lesson at my all-girls' school, and I can see it vividly to this day.

"It was barbaric, like watching a horror film, and I remember everyone covering their eyes with their hands in disgust. The woman giving birth was in a terrible way and I couldn't believe the amount of blood.

"I watched through my fingers and I've spent the past nine years wishing I hadn't."

Although Amanda has a boyfriend, she speaks of her relief that they are both too young even to contemplate parenthood.

"I can't listen to conversations about babies or birth," she adds. "And I have to leave the room if something comes on TV. My phobia is so bad that I can't imagine ever being pregnant or giving birth. Why on earth would I want to go through what the woman in that sex education video experienced?"

Amanda says: "Even when a friend recently announced she was pregnant, all my thoughts then and since have been about that video and how that will be my friend in five months' time. It might be natural, but it's disgusting and so undignified."

For now, Amanda takes a belt-and-braces approach to ensuring that she won't have to face her phobia, taking the Pill and insisting that her boyfriend also uses a condom.

And she is resigned to the fact that, for her, adoption may be the only way she will be able to have a child in the future.

Ashley Hall, a 21-year-old PA and freelance model from Glasgow, empathises, attributing her own tokophobia to a sex education book she was privy to as a ten-year-old.

"My friend's mother was a doctor and had given her a graphic book on how babies are made and born," she says, grimacing at the memory. "My friend brought it to school and I remember feeling nauseous at the images on its pages of reproductive organs and birth.

"Other people may say I'm young so naturally I'm not going to embrace the thought of childbirth at my age, but they're missing the point.

Ashley's repulsion of childbirth leads her to admit that, as she gets older, she will be unable to have relationships with men who want biological children of their own.

"I worked in America for six months last year and dated a lovely man in his early 20s. We spoke very generally about the future and he said he'd love to be a father ten years down the line. I realised that I couldn't build a long-term relationship with a man like that because I don't think I'll be able to endure the pain and indignity of childbirth.

"My phobia also relates to a fear that I would resent a baby for causing me the pain of birth; the split muscles, stitches, prolapsed bladder, and even the loss of my independence and sex life.

"My friend has just endured a 36-hour labour, but I've refused to hear the details. It's just repulsive."

Sadly, there is no treatment for the condition, but retired obstetrician Michael Pawson, who devotes a whole chapter on the subject in his new book, Psychological Challenges In Obstetrics And Gynecology, insists tokophobia is a very real problem, and that the medical profession should be more understanding.

"Every woman has some degree of anxiety about giving birth," he says "but tokophobia is a fear so intense it may lead a woman to avoid pregnancy altogether. Some are so frightened they will use three methods of contraception.

"Doctors can be very arrogant and don't take kindly to women who tell them what they want - such as pain relief or a Caesarean. Obstetricians should be sympathetic to the needs of tokophobic women who are frightened to death of childbirth, and offer them Caesareans and extra guidance from a midwife or counsellor to help alleviate their fear."

Ashley Hall agrees: "It's a serious psychological phobia that many women are suffering from. If it's not treated with respect, it will mean adoption or fostering may be our only route to motherhood."

No doubt many mothers will argue that for all its trauma, the miracle of birth is the most powerful moment in a woman's life.

But for those who insist they would rather be childless than face the delivery room, it remains a prospect that is simply too horrific to contemplate.