Antenatal Care

Referral pathway for the care of women with FGM

referral pathway for FGM47

Midwives should aim to provide non-judgemental and sensitive care, even when lacking experience of caring for women with FGM, as a failure to do so can leave women feeling isolated and abnormal.

“Sometimes when circumcised women go to the hospital, the nurses call each other to see the circumcised woman. This is an unhappy experience for many women. The nurses ask a lot of questions and they stare” 10o

“There is this woman who has pharaonic type circumcision. When she went to the hospital, the trainee doctor who was treating her was very surprised when he saw her. He asked her if she had an accident and what happened to her. She told him she was circumcised and explained everything to him. He started to cry and she ended up feeling sorry for herself. It was the first time she felt she had a problem.” 10o

Antenatal Care Guide

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Deinfibulation in Hospital

Can be performed by a registered midwife or obstetrician during the preconception, antenatal or intrapartum periods.

Leeds Teaching Hospital (2006) Female Genital Mutilation Clinical Guideline 47

Adequate anaesthesia is essential to minimise further psychological harm.  Infiltrate the midline area along the original scar line with local anaesthesia prior to the incision. Group and Save bloods should be taken and sent due to risk of haemorrhage. 15

Leeds Teaching Hospital (2006) Female Genital Mutilation Clinical Guideline 47

Insert 1-2 fingers under the anterior scar tissue. Use your fingers to feel how far up to cut as you divide the old scar tissue. Aim for the anterior episiotomy to extend just above the urethral meatus to allow for unobstructed voiding.

Leeds Teaching Hospital (2006) Female Genital Mutilation Clinical Guideline 47

Once deinfibulation is complete it is possible to identify the extent of the remaining genital tissue.

Leeds Teaching Hospital (2006) Female Genital Mutilation Clinical Guideline 47

Suture using continuous sutures to minimise bleeding and prevent adhesion of the edges of the wound, which could result in reinfibulation. 49

Next Topic: Intrapartum care