Effects of female genital mutilation on birth outcomes in Switzerland

Abstract

Objective The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland. Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.Design A retrospective case-control study.Setting A teaching hospital.Population One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.Methods Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.Main outcome measures Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.Results Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.Conclusion An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.

Female genital mutilation: Knowledge, attitude and practices of Flemish midwives

“…Issues in service delivery that hamper an adequate care for women with FGM, have been documented in other studies. These barriers in care include a lack of knowledge, communication problems, personal emotions and feelings of health professionals and the lack of technical guidance on clinical management (Nienhuis and Haaijer, 1995;Chalmers and Hashi, 2000;Widmark et al, 2002;Powell et al, 2004;Thierfelder et al, 2005;Leye et al, 2006;Wuest et al, 2009;Paliwal et al, 2013;Zenner et al, 2013). Our study showed that the provision of care in Flanders, by midwives, is hampered by a lack of knowledge on FGM, language barriers and difficulties in discussing this sensitive and complex issue with the women and her environment.…”

The Obstetric Consequences of Female Genital Mutilation/Cutting: A Systematic Review and Meta-Analysis

“…After sorting eligible studies according to outcomes, we included 44 primary publications reporting on obstetric outcomes: 21 comparative studies [14–20, 28–47], 7 single group cross-sectional studies [48–54], 5 case series [6, 55–58], and 4 case reports [59–62]. …”

“…However, in the WHO report, it is concluded that “the serious obstetric consequences of FGM, when it is performed prior to the index pregnancy, are mainly due to the scarring resulting from FGM” [10, page 12]. In fact, a range of studies suggests that the most plausible pathway of effect between FGM/C and obstetric harm is inelastic scar tissue [14–20]. However, divergent results among such studies and statements by scholars, physicians, and policy experts claiming that “reproductive health and medical complications associated with female genital surgeries in Africa are infrequent events” [21, page 22] have called into question whether FGM/C is associated with obstetric consequences for women.…”

An Updated Systematic Review and Meta-Analysis of the Obstetric Consequences of Female Genital Mutilation/Cutting

“…Out of the 28 studies included in our original review [7–9, 18–41], we classified seven as prospective [7, 19, 22, 23, 28, 31, 40]. In these studies, exposure data were gathered from female study participants during an antepartum examination, followed by an assessment of outcome data during the delivery situation.…”