Tokophobia Therapy: When the Fear of Childbirth Feels Unbearable
Specialist CBT therapy for women whose traumatic birth has left them terrified to do it again – plus support for primary tokophobia. Based in Leicestershire, available online across the UK and EU.
What Is Tokophobia? (And Why It's Not "Just" Pregnancy Anxiety)
Tokophobia is an intense, overwhelming fear of pregnancy and childbirth that goes far beyond typical nervousness. While most pregnant women feel some anxiety about labour, tokophobia is different. It's a phobic-level fear that can dominate your thoughts, interfere with your daily life, and make the idea of giving birth feel absolutely unbearable.
Research shows that up to 14% of women experience tokophobia – though many suffer in silence, not realising there's a name for what they're experiencing or that help is available.
There are two types of tokophobia:
PRIMARY TOKOPHOBIA (Also Supported)
You've never been pregnant or given birth, but you've always been terrified of childbirth. Maybe the fear started in your teenage years, is linked to past medical trauma, sexual abuse, or frightening stories you've heard. The thought of pregnancy fills you with dread – even though part of you desperately wants a baby. While my main clinical experience is with secondary tokophobia, I also work with women experiencing primary tokophobia using the same evidence-based CBT approaches.
SECONDARY TOKOPHOBIA (My Primary Expertise)
You've given birth before, and that experience was so traumatic that you're now terrified to do it again. This is the most common form of tokophobia and is often a form of Post-Traumatic Stress Disorder (PTSD). Your last birth left you feeling helpless, out of control, or genuinely unsafe.
Maybe:
• You had an emergency C-section you weren't prepared for
• The pain was unbearable and medical staff didn't listen
• You thought you or your baby might die
• You experienced severe tearing, hemorrhage, or other complications • Medical interventions felt forced upon you
• You felt dismissed, ignored, or traumatized by staff
Now you're pregnant again (or thinking about getting pregnant), and instead of excitement, you feel absolute dread. The thought of going through labour again triggers panic attacks. You lie awake at night replaying your last birth. Every kick from your baby reminds you that labour is getting closer. You can't shake the feeling: "I can't do this again. I won't survive it."
This is my specialist area. I've spent over a decade in NHS mental health services working specifically with women whose previous traumatic births have left them terrified of giving birth again. I understand the unique challenge of processing past birth trauma WHILE managing overwhelming fear about your current or future pregnancy.
Here’s what tokophobia:
IS
✓ A recognised anxiety disorder
✓ Treatable with specialist support
✓ A real, valid mental health condition
✓ Something that affects how your brain processes threat
IS NOT
❌ Being "dramatic" or "overreacting"
❌ Something you can "just relax" your way out of
❌ A sign you don't want children
❌ Something that will go away on its own
When Birth Leaves You Shaken - or Too Afraid to Try Again
You desperately want a baby. But every time you think about actually giving birth, your chest tightens, your mind races, and the panic sets in.
Maybe you're not pregnant yet – but the thought of pregnancy and childbirth terrifies you so much that you're avoiding trying, even though you long to be a mum.
Or maybe you're pregnant right now – and instead of feeling excited, you're counting down the weeks with absolute dread. Every kick reminds you that labour is getting closer. You can't sleep. You can't think about anything else. The fear is taking over.
This isn't "normal" pregnancy anxiety. This is tokophobia – and you don't have to face it alone.
I'm Aleksandra Balazy-Knas, an Accredited CBT Therapist and Mental Health Nurse with over a decade of NHS experience. I help women work through their terror of childbirth using evidence-based CBT – so they can either move toward pregnancy with confidence, or get through their current pregnancy without living in constant panic.
The Signs You're Dealing with Tokophobia (Not "Normal" Anxiety)
Tokophobia affects both your mind and your body. You might be experiencing:
In your thoughts:
• Constant, intrusive thoughts about childbirth that you can't shake
• Catastrophic thinking: "I'm going to die," "Something terrible will happen," "I won't survive this"
• Obsessing over every possible thing that could go wrong during pregnancy or birth
• Feeling trapped in your own body if you're already pregnant
• Ruminating about pain: "I won't be able to cope," "It will be unbearable"
• Researching pain relief options compulsively, or avoiding all information about birth entirely
In your emotions:
• Panic attacks when you think about labour or childbirth
• Overwhelming dread as your due date approaches (if pregnant)
• Feeling terrified instead of excited about your pregnancy
• Intense fear of losing control during labour
• Fear of dying during childbirth
• Guilt or shame for feeling this way when "everyone else" seems fine
• Feeling misunderstood or dismissed when you try to explain your fear
In your behaviour:
• Avoiding trying to get pregnant, even though you want a baby
• Using multiple forms of contraception simultaneously to prevent pregnancy
• Avoiding sex or intimacy because of pregnancy fears
• If pregnant: avoiding antenatal appointments or feeling sick before each one
• Avoiding anything that reminds you of pregnancy (TV shows, pregnant friends, baby shops)
• Requesting an elective C-section to avoid vaginal birth
• Considering termination solely because of fear of labour (not because you don't want the baby)
Physical Symptoms:
• Heart racing, sweating, trembling when thinking about birth
• Difficulty sleeping (even when pregnancy insomnia isn't a factor yet)
• Nausea or stomach problems when confronted with pregnancy/birth topics
• Feeling constantly on edge or hyper-alert
If you're nodding along to several of these, you're likely dealing with tokophobia – not just typical pregnancy nerves.
The good news? With the right support, you can work through this fear.
Where Does Tokophobia Come From?
Tokophobia doesn't happen in a vacuum. There are usually specific reasons why your brain has learned to see childbirth as a catastrophic threat.
Common causes of tokophobia:
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Your last birth was frightening, painful, or out of control. Maybe you had an emergency C-section, severe tearing, a long labour with inadequate pain relief, or medical staff who didn't listen. You felt helpless. You thought you or your baby might die. Now the idea of doing it again feels impossible.
→ If this is you, you might also benefit from my Birth Trauma Therapy page, as processing your previous birth is often key to reducing tokophobia.
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Tokophobia often stems from other medical experiences: invasive procedures, feeling ignored by doctors, painful examinations, or hospitalisations that left you feeling out of control. Your brain has learned: "Medical situations = danger."
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For survivors of sexual trauma, pregnancy and childbirth can feel unbearably triggering. The loss of bodily autonomy, medical examinations, and the intimate nature of labour can bring up overwhelming feelings. This is a deeply valid reason for tokophobia – and therapy can help you reclaim a sense of safety.
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If you have a low pain tolerance, previous painful experiences (like kidney stones), or a generalized fear of pain, the thought of labour can feel terrifying. "What if I can't cope?" becomes a constant loop.
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Maybe you grew up hearing horror stories about childbirth. Maybe you saw a traumatic birth scene in a film or TV show at a young age. Or perhaps well-meaning friends have shared their "awful" birth stories, and now you can't shake those images from your mind.
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Some women with tokophobia have an intense fear of dying during childbirth. This might be linked to knowing someone who died in childbirth, reading about maternal mortality, or a general anxiety about death.
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For some, tokophobia is rooted in a deep need for control. The unpredictability of labour – not knowing when it will start, how long it will last, or what interventions might be needed – feels unbearable. The idea of your body taking over feels terrifying.
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If you already struggle with anxiety, panic disorder, or OCD, you're more likely to develop tokophobia. Your brain is already wired to see threats everywhere – and childbirth becomes another thing it fixates on.
Here's the important part: whatever the cause, your tokophobia is VALID.
You don't need to have had "the worst" experience to deserve help. If childbirth feels unbearable to you, that's enough.
How CBT Helps You Work Through Tokophobia (Step by Step)
I know what you're thinking: "How will talking about my fear make it better?"
Here's the truth: CBT for tokophobia isn't just talking – it's about retraining your brain to see childbirth as something you CAN cope with, rather than a catastrophic threat. Right now, your anxiety is running the show. CBT helps you take back control.
✿ Here's how tokophobia therapy works:
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We start by mapping out YOUR tokophobia:
• What exactly terrifies you most? (Pain? Death? Loss of control? Specific medical interventions?)
• When did this fear start? (After your traumatic birth? Earlier?)
• How is it affecting you right now?
• What are your goals? (Get through pregnancy without constant panic? Feel confident about birth? Decide whether to try for a baby?)This creates a clear roadmap for treatment.
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Before we tackle the big fears, we build practical skills you can use immediately:
• Grounding techniques for when panic hits
• Breathing exercises that actually work
• Body-based strategies to release tension
• Ways to interrupt catastrophic thinking spiralsThese aren't just "relaxation tips" – they're evidence-based tools that help you function day-to-day while pregnant or managing fertility decisions.
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This is the core of CBT.
We work on both changing your thinking AND gradually facing what you've been avoiding – always at YOUR pace.
Challenging thoughts:
We identify the thoughts fueling your terror and test them against reality:
Catastrophic thought: "I'm going to die during childbirth."
Reality check: Maternal mortality in the UK is around 9 per 100,000 births. Your emotional fear feels absolutely real, but the actual statistical risk is very small. We work on separating your feelings from facts – not to dismiss the fear, but to help your brain see childbirth differently.
Catastrophic thought: "The pain will be unbearable and I won't cope."
Reality check: Pain IS intense, but "unbearable" means "impossible to survive" – and millions do it every year with modern pain relief options. We redefine what "coping" actually looks like. (Spoiler: it's messier than you think, and that's completely okay.)
Catastrophic thought: "I'll lose all control and it will be humiliating."
Reality check: Yes, labour involves loss of control – but that doesn't mean complete powerlessness. We identify what you CAN control (your choices, your support team, your birth preferences) and work on accepting what you can't.Gradual exposure (woven throughout):
At the same time, we gently reintroduce you to pregnancy/birth content you've been avoiding:
• Reading about labour in a supported, contained way
• Watching a calm, positive birth video together (when you're ready)
• Visiting the labour ward before your due date
• Practicing visualizations of a manageable birth
• Discussing specific triggering scenarios (e.g., medical interventions) in sessionImportant: This is GRADUAL and CONTROLLED. You're always in charge of the pace. We never force exposure before you're ready.
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One of the most powerful parts of tokophobia treatment is creating a psychologically-informed birth preference plan. This isn't just "what music do you want playing."
We work on:
• Identifying your specific triggers and planning around them
• How to communicate your needs to medical staff clearly
• Setting boundaries (e.g., "All procedures must be explained to me BEFORE they happen")
• Creating backup plans for different scenarios so you feel less helpless
• Building a support team who understand your tokophobia
• Discussing all your options (including elective C-section if that's what you need)When you have a plan that honors your fear AND keeps you safe, the terror often starts to lift.
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If your fear stems from a previous traumatic birth, we'll also process that trauma using Trauma-Focused CBT (Ehlers & Clark model) – an evidence-based approach specifically designed for PTSD.
This involves:
• Safely revisiting the stuck moments from your previous birth in a controlled way
• Updating your trauma memory with new information (e.g., "I survived. It's over now. This pregnancy is different.")
• Challenging self-blame and shame ("It was my fault" → "It was a medical emergency beyond my control")
• Reducing the emotional charge around what happened
• Helping your brain file the traumatic birth as "past event" instead of "current threat"This dual approach – processing past trauma AND managing current fear – is essential for secondary tokophobia.
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What tokophobia therapy is NOT:
❌ Forcing you to "just face it" without support
❌ Telling you to "think positive" or "just relax"
❌ Pushing you toward vaginal birth if you don't want it
❌ Making you feel weak or dramatic for being scaredWhat it IS:
✓ Practical, evidence-based techniques that work
✓ Working at YOUR pace, always
✓ Respecting your choices about birth
✓ Helping you feel like you CAN survive childbirth (even if it's hard)The goal isn't to make you excited about labour. The goal is to help you feel like you can get through it.
Who I Work With (And How Tokophobia Therapy Looks Different for Each)
Tokophobia affects women at different stages, and therapy looks different depending on where you are:
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Your situation:
You want a baby desperately, but you're too terrified to try. Or you've been avoiding pregnancy for years because the thought of childbirth fills you with dread. Maybe you're on multiple forms of contraception "just in case." Maybe you've told your partner you're not ready, but the truth is you're just too scared.
How therapy helps:
We work on processing the origins of your fear, challenging catastrophic thoughts, and building confidence so that when you DO get pregnant, you're not starting from a place of absolute terror. For some women, therapy helps them decide pregnancy IS something they want to pursue. For others, it helps them make peace with choosing not to have biological children – and that's okay too.
Timeline:
We have time to work through this properly before pregnancy adds urgency. -
Your situation:
You just found out you're pregnant – and instead of joy, you're feeling trapped. Every day, the anxiety builds. You're having panic attacks. You can't stop Googling "pain-free birth" or "elective C-section." Part of you is thrilled to be pregnant, but the other part is screaming, "What have I done?"
How therapy helps:
Early pregnancy is the BEST time to start tokophobia therapy because we have time to work through your fears before labour feels imminent. We focus on anxiety management, processing past experiences (if relevant), and gradually building a sense of control through birth planning.
Timeline:
We typically recommend weekly sessions. Most women find 8-12 sessions helpful, which fits well within the pregnancy timeline. -
Your situation:
You've been trying to push the fear down, but it's not working. Now that you're showing, now that you can feel the baby move, now that everyone keeps asking about your "birth plan" – the anxiety is becoming unbearable. You're having nightmares. You're avoiding antenatal classes. You've mentioned a C-section to your midwife, but she brushed it off.
How therapy helps:
Mid-pregnancy is still a good time to start therapy. We have enough time to make real progress before your due date. We work on managing the immediate anxiety, challenging fears, and creating a birth plan that feels manageable rather than terrifying.
Timeline:
Weekly or fortnightly sessions, aiming for at least 6-8 sessions before third trimester. -
Your situation:
Labour is approaching and you're in crisis mode. Every twinge feels like the start of labour. You're not sleeping. You're having constant panic attacks. You're begging your obstetrician for a C-section. You feel guilty, ashamed, and desperate.
How therapy helps:
Late pregnancy therapy is more focused and intensive. We prioritize: 1. Immediate anxiety management tools you can use NOW 2. Crisis planning: What happens if labour starts early? 3. Fast-track birth planning with your medical team 4. Processing any urgent trauma that's fueling the fear 5. In some cases, advocating for an elective C-section if vaginal birth would be detrimental to your mental health
Timeline:
We work quickly and intensively. Even a few sessions can make a significant difference in how you approach labour.
Important:
According to NHS guidelines, if anxiety is severe and unlikely to respond to treatment in the time available, an elective C-section at 39 weeks may be recommended. -
Your situation:
You have secondary tokophobia – your last birth was traumatic, and now you're pregnant again and terrified it will happen again. You might also need to process your previous birth trauma.
How therapy helps:
We often work on BOTH: 1. Processing your previous birth (similar to birth trauma therapy) 2. Managing your tokophobia about this upcoming birth → You might benefit from reading my Birth Trauma Therapy page as well, as these often overlap.
Timeline:
Ideally, we start as early in pregnancy as possible so we have time for both trauma processing and tokophobia work.
Why You Need a Therapist Who Understands BOTH Anxiety AND Childbirth
Tokophobia isn't like other phobias. You can't just "avoid" childbirth the way you might avoid spiders or flying. If you want biological children, you HAVE to go through pregnancy and birth. That makes tokophobia uniquely challenging – and it's why you need someone who understands both the psychology of phobias AND the realities of perinatal care.
I'm Aleksandra Balazy-Knas, and here's why I'm qualified to help:
✿ Specialist Perinatal Mental Health Training:
- Accredited CBT Therapist with specialist perinatal expertise
- Mental Health Nurse (NMC Registered) with over 10 years in NHS
- Currently completing EMDR training (for trauma-linked tokophobia)
- CBT Clinical Supervisor
✿ I Understand the NHS Maternity System:
I've worked in NHS mental health services for over a decade. I understand how maternity care works, what your options are, and how to advocate for your mental health needs within the system. I know the NHS tokophobia guidelines inside and out.
✿ My Specialist Experience with Secondary Tokophobia:
The majority of my NHS perinatal work has been with women experiencing secondary tokophobia – those who've had a previous traumatic birth and are now pregnant again and terrified. I've worked extensively with the dual challenge of processing past birth trauma WHILE managing overwhelming anxiety about current or future pregnancy. This combination – trauma processing + anxiety management – is my area of specialist expertise. I understand that secondary tokophobia isn't just fear – it's fear layered on top of trauma, and both need addressing.
✿ I Know CBT Works for Tokophobia:
CBT is the evidence-based, NHS-recommended treatment for tokophobia. I don't use unproven techniques or promise "quick fixes." I use methods that are backed by research and proven to help.
✿ I Won't Dismiss Your Fear:
You won't hear "just think positive" or "millions of women do this every day" from me. Your fear is valid. My job is to help you work through it – not minimise it.
✿ I Support ALL Choices:
Whether you want a vaginal birth, an elective C-section, or you're still figuring it out – I'm here to support YOUR choice, not push an agenda. If you decide a C-section is right for your mental health, I'll help you advocate for that.
✿ I Work Throughout Pregnancy (and Beyond):
Tokophobia doesn't magically disappear after you give birth. If you need postpartum support to process the birth or work through residual anxiety, I'm here for that too.
✿ This isn't generic anxiety therapy. This is specialised tokophobia treatment from someone who gets it.
Exactly What Happens in Tokophobia Therapy (Step by Step)
I know uncertainty makes anxiety worse. So here's exactly what happens when you work with me:
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We start by understanding YOUR tokophobia:
- When did the fear start?
- What exactly are you most afraid of?
- How is it affecting your life right now?
- Are you pregnant? Planning pregnancy? Unsure?
- Have you had previous trauma (birth or otherwise)?
- What are your goals for therapy? By the end, you'll have:
- A clear understanding of your specific type of tokophobia
- A personalised treatment plan
- One anxiety management technique to try before our next session
No pressure, no judgment. Just clarity. -
If you're not pregnant yet:
We focus on processing the origins of your fear, challenging catastrophic thoughts, and building confidence so pregnancy feels less terrifying when/if it happens.If you're pregnant:
We work more intensively because we have a deadline. We focus on: - Managing daily anxiety and panic - Challenging specific fears about labour - Birth planning that feels empowering - Practicing coping strategies for labour - Working with your medical team to communicate your needsIf you have secondary tokophobia:
We often spend time processing your previous traumatic birth first (similar to birth trauma therapy), then move into managing your current pregnancy fear. -
After 4-6 sessions, we review:
"How are you feeling? Do we need to continue, or are you ready to finish?" Most women find 8-12 sessions helpful, but it varies. If you're in late pregnancy, we might work more intensively over fewer weeks.What Each Session Looks Like (50-60 minutes)
- Check-in: How have you been? Any panic attacks? New fears coming up?
- Main work: CBT techniques, exposure work (if appropriate), birth planning, trauma processing
- Practice: What will you try this week to manage anxiety?
- Reflection: What helped? What didn't? -
Online therapy only – via secure video call. You can be anywhere in the UK (I'm based in Leicestershire) or worldwide.
Sessions are £130 per session.
Q&AYour Questions About Tokophobia Therapy, Answered
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Answer: Absolutely not. Tokophobia therapy is about helping you make an INFORMED choice – not pushing you toward vaginal birth. If, after working through your fears, you still feel an elective C-section is right for you, I'll support that. If you decide you want to try vaginal birth with lots of support and pain relief, I'll help you prepare for that. If you're unsure, we'll explore both options without pressure. According to NHS guidelines, if your tokophobia is severe and unlikely to respond to treatment in the time available during pregnancy, requesting an elective C-section is a valid option – and I can help you advocate for that with your medical team.
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Answer: It's NEVER too early. In fact, getting help BEFORE you're pregnant is often the best time because:
1. There's no time pressure (no approaching due date making you feel rushed)
2. We can work through the fear thoroughly without pregnancy adding extra anxiety
3. When you DO get pregnant, you're starting from a more confident place Many women with primary tokophobia put off getting help until they're already pregnant and panicking. Don't wait. Start now. -
Answer: It's not too late. Even in late pregnancy, therapy can help. We'll work more intensively and focus on: - Immediate anxiety management tools - Fast-track birth planning - Working with your medical team on your options - In crisis situations, advocating for an elective C-section if needed Even a few sessions can make a significant difference in how you approach labour. Many women in late pregnancy say, "I wish I'd started sooner, but I'm so glad I got help now rather than trying to white-knuckle through it alone."
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Answer: If you want this baby but the fear of labour is making you consider termination, please reach out URGENTLY. This is a mental health crisis, and you deserve immediate support. Tokophobia is treatable – and there are options (including elective C-section) that might make continuing your pregnancy feel possible. If you're in this situation, contact me immediately for a discovery call. We can discuss intensive support and work with your medical team quickly.
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Answer: Yes. If you're already working with a psychiatrist, taking medication for anxiety/depression, or receiving other mental health support, tokophobia therapy can work alongside that. In fact, it's often helpful. Let me know what other support you're receiving, and we'll coordinate.
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Answer: Great question! They overlap but have different focuses:
Birth Trauma Therapy: Processing what already happened (your past traumatic birth). Focus: healing from the past.
Tokophobia Therapy: Managing fear of what MIGHT happen (the upcoming birth). Focus: reducing anxiety about the future. If you have secondary tokophobia (fear of birth after a previous traumatic birth), you might need BOTH – processing the past AND managing current fear. Many women work on both simultaneously. -
Answer: Tokophobia is a recognised mental health condition – not you being "dramatic." If your partner is dismissive, it might help to:
1. Share NHS information about tokophobia (it's in the official guidelines)
2. Explain: "This is a phobia, like fear of flying. I can't just 'snap out of it.'"
3. Invite them to a session so they can understand what you're dealing with I also offer partner support if needed – helping them understand tokophobia and how to support you. -
Answer: The discovery call is a 20-minute, no-pressure conversation where we:
- Talk about what's been going on for you
- Discuss whether tokophobia therapy is the right fit
- Answer any questions you have
- See if we're a good match to work together You'll leave the call knowing exactly what therapy involves and how I can help.
No obligation to book – just clarity.
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let's get startedYou Don't Have to Live in Terror of Giving Birth
Tokophobia doesn't just go away on its own. Avoiding thinking about it won't make it better. And you can't "positive think" your way out of it. But here's what DOES work: specialist CBT therapy with someone who understands both anxiety and perinatal care.
Whether you're:
- Too terrified to try for a baby
- Pregnant and panicking every single day
- Facing your due date with absolute dread
- Considering options you never thought you'd consider
You deserve support that actually helps.
I've spent over a decade in NHS mental health services. I've seen how tokophobia traps women in fear – and I've seen how the right therapy can set them free.
Book your free 20-minute discovery call and let's talk about what's keeping you stuck – and how CBT can help you move through it.
About Me
I'm Aleksandra Balazy-Knas, an Accredited CBT Therapist, Registered Mental Health Nurse, and CBT Clinical Supervisor.
Qualifications:
• MSc Psychology
• BSc Mental Health Nursing
• PGDip Cognitive Behavioural Therapy (CBT)
• NMC Registered Mental Health Nurse
• Currently completing EMDR training with UK-registered training centre
Experience:
• Over 10 years working in NHS mental health services
• Specialist training in CBT for anxiety disorders and phobias
• Expert in tokophobia treatment following NHS best practice guidelines
• Work with women before pregnancy, throughout pregnancy, and postpartum
Location & Availability
Online therapy across the UK and worldwide. Based in Leicestershire, but available to anyone with an internet connection.
Related Services
If you're also dealing with birth trauma (not just fear of future birth), you might find my Birth Trauma Therapy page helpful. Many women need support for both.
Read more about me and my approach HERE.