Key considerations: female genital mutilation

Midwives need to be aware of the psychosocial issues for women affected by FGM and the implications for midwifery care, including (Denholm, 2004b):

• FGM is a very sensitive area of discussion. Indicating that you are familiar with the practice of FGM and can assist with FGM-related complications may help to establish trust and to reduce a woman’s anxiety and discomfort. A non-judgmental approach, willingness to listen and knowledge of complications will help put women at ease and facilitate open discussion.
• In addition to routine antenatal care, women affected by FGM may require extra support and care. Additional antenatal planning may be necessary in relation to labour and birth.
• Most women affected by FGM are refugees who, in addition to the trauma of refugee flight may have difficulties adjusting to New Zealand society. Women may have limited English language skills, housing and income support challenges and may face social isolation and discrimination in New Zealand society. Some of these issues may be heightened during pregnancy and birth, and women may need to be referred for specialised psycho-social support. Women may be distressed and confused by an excessive focus on FGM.
  • The vaginal examination should be undertaken after good rapport with the woman has been established. It is helpful to document findings in detail to minimize the need for repeat examinations and so that any potential birth difficulties can be anticipated.
  • The need for deinfibulation should be discussed in detail during the antenatal period.
  • An experienced practitioner familiar with the complications of FGM should always be involved in the birth of the woman, particularly in the case of primagravidas, as almost all primagravidas will need to be deinfibulated to allow for the birth of the fetal head.
  • The postpartum period is traditionally an important time for women from societies where FGM is practiced. For example, women in Somalia are nurtured and cared for during the first 40 days postpartum. In many families the mother or sister takes care of housework and cares for the woman. Somali women in New Zealand are particularly vulnerable at this time with the loss of traditional support.