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Identification of the woman at risk of FGM
It is
essential to identify women who have undergone FGM at the
booking visit. The antenatal period may be the first contact
that she and her partner will have with the health care
system and she may feel quite unsure and frightened about
what to expect.
Who is at risk?
Patients
attending UCH with a past history of FGM are most commonly
from Somalia and Sudan. In Somalia 95% of women will have
FGM and the majority will have had the most extensive Type
III FGM. All women from these countries must be asked about
FGM.
The other
countries of origin with high rates of FGM and who are
likely to come to the UK include Eritrea, Gambia, Ghana,
Kenya, Nigeria, Sierra Leone and Yemen. Rates of FGM in
these countries are variable and many will have a Type I or
II FGM which may not cause obstetric complications.
How to ask?
Women may not
volunteer this information and the booking midwife will need
to ask sensitively. A trained interpreter may be
necessary. Women will not understand the terminology female
genital mutilation although may use the word circumcision.
Other ways of phrasing this difficult question include
asking if the women is “cut” or “closed” or “open”.
What to do if the woman has had FGM?
Once
identified it is important to explain to her about how FGM
may affect labour and delivery. She may already be aware
that some kind of “opening/cutting” may be necessary and
have strong views on this. She may however have very little
information on what has happened to her and what needs to
happen next. The possible problems must be explained
sensitively. She must also be made aware that she does need
a vaginal assessment to see whether the vagina is adequate
for delivery. This assessment must be done by a midwife or
obstetrician experienced in FGM and able to make that
decision. |
