1. Leila CG Frodsham Consultant Obstetrician & Gynaecologist Maidstone and Tunbridge Wells NHS Trust Sex, Drugs and Normal Childbirth

2. Introduction Normalising Childbirth Project Govt drive to reduce LSCS Steady rise in tocophobia cases Patient drive to deliver by LSCS Private sector Botox for non consummators Vaginismus cases pregnant

3. Normalising childbirth South East Coastal Region Collaboration of maternity units Drive to reduce LSCS rates <23% Maternal request LSCS down Tocophobia request LSCS up

4. Tocophobia ‘An abnormal or persistent fear of childbirth’ Primary-in nullips Secondary-following delivery Most common>50% after NVD

5. Tocophobia Tocophobia LSCS requests increased by 40% Withdrawal of midwifery counsellors Less debrief Less antenatal support for tocophobics Tocophobia as a calling card or a real increase?

6. Normal childbirth? No evidence to support benefit of encouraging vaginal delivery Many similarities with vaginismus A new area to utilise our skills.

7. Sex, Drugs and Normal Childbirth