I want to have kids but I'm terrified of pregnancy and childbirth. How can I get over my fear?

• "Tokophobia," a fear of pregnancy, can lead to worse birth outcomes or prevent people from fulfilling life dreams.
• Working through your fears with a professional can help you feel more prepared and less afraid.
• Pregnant with questions? Submit your question to Anna anonymously here for nonjudgmental answers.

Dear Anna,

Ever since I witnessed my nephew's birth at age 16, I've been terrified of pregnancy and labor. The delivery was quite the ordeal: The mom's water broke before she got to the hospital, and she didn't have time for an epidural. She developed preeclampsia. They did an episiotomy and used forceps to pull the baby out.

I recognize this is not what happens with every birth, but it was the one I was introduced to and I can't unsee it.

Now I'm in my mid-30s, newly married, and eager to start a family. I love kids and don't worry about actual parenting. But the idea of pregnancy and birth disgust me. I'd consider adoption if it wasn't so darn expensive. What can I do?

- Beth, Baltimore

Dear Beth,

That does sound like a traumatic introduction to childbirth, no wonder you're still shaken. Your brain is just doing its job to protect you against something it's perceived as threatening. Can you blame it?

Plus, as Maryland-based therapist Melissa Weinberg told me, it's understandable to be afraid of something full of unknowns, historically dangerous (and still more risky among people of color), painful, and uncomfortable.

But people don't often air these fears because, sadly, there can be a lot of shame around not feeling enthusiastic about something society makes us believe "should" come naturally, said Weinberg, who specializes in anxiety and wrote about the fear of pregnancy and childbirth for Psychology Today.

In reality, research suggests anywhere between 20% and 78% of pregnant women have some fears or anxiety around pregnancy and childbirth. And in non-pregnant women, one study showed 13% said fears were strong enough for them to delay or avoid pregnancy altogether.

But "the more you avoid [facing your fears,]" Weinberg said, "the more you reinforce them." So let's start facing yours now.

This fear, also known as tokophobia, can become a self-fulfilling prophecy

A fear of childbirth is sometimes called tokophobia, or it can be appear as depression, anxiety, or post-traumatic stress disorder in cases where it is triggered by a traumatic event like an earlier life-threatening childbirth experience.

It can also look like OCD, Weinberg said, where people avoid sex and compulsively try to reassure themselves they're not pregnant.

Some of the common fears she hears among clients with some level of tokophobia is that they won't be able to handle pregnancy, especially the discomfort and body changes. "They often feel disgusted by the idea of something growing inside them and hate the idea of being trapped and out of control," Weinberg said. Some may even feel appalled just watching a TV show with a pregnant character.

Some clients ruminate on all that could go wrong, and some experience physiological reactions like shortness of breath and an increased heart rate just thinking about it.

If you don't address the fear before becoming pregnant, it can become a self-fulfilling prophecy: A fear of pregnancy and childbirth is linked to higher rates of emergency cesarean deliveries, induced and augmented labor, long labors, and postpartum depression.

It can also prevent you from seeking necessary medical appointments, or to obsessively call your healthcare team. Not mention the toll it can take on your relationship. "If the partner of someone struggling with tokophobia is eager to have a baby, there can be fights, tensions, and resentment within the relationship," Weinberg said.

Get help to learn how to manage your negative thoughts, without expecting them to totally vanish

Weinberg recommends rallying a crew of family and friends who know how you're feeling and can be patient with you. Being open with a trusted healthcare provider is critical too, as they can put your specific fears into perspective and dispel misconceptions that may be fueling them.

The more knowledgeable you are about pregnancy and childbirth, the less intimidating it becomes.

Weinberg also suggests working with a therapist trained in acceptance and commitment therapy, which focuses on mindfulness and behavior change strategies, or exposure therapy, which is what it sounds like: facing your fears.

"As you get more and more exposure to it, your anxiety diminishes," Lara Honos-Webb, a clinical psychologist in Walnut Creek, California, told me for a story on this topic back in 2016. There are even classes, she said, that require women to repeatedly imagine giving birth.

The key is to find a provider "who won't do too much co-ruminating or disputing of thoughts and worries, but help you practice getting some distance from your thoughts and making values-based decisions," Weinberg said.

Finally, Weinberg said, don't expect your fears to vanish. "If you're waiting to be completely free of anxiety before trying to conceive, that's probably unrealistic. And that's OK."

"It's much more reasonable and achievable to build skills like tolerance for discomfort and uncertainty and grounding yourself in the present than it is to make all your fears go away and feel 'ready,'" she said. "You can be afraid and still takes steps towards having the life you want."

Senior health reporter Anna Medaris Miller is here to answer all of your questions about pregnancy- especially the ones you don't want to bring to your doctor or even friends. As a journalist covering women's health for more than a decade, she'll mine the research, consult a range of experts, and give you the key takeaways. Submit your question anonymously to Anna here.