Effects of Female Genital Mutilation on Birth Outcomes in Switzerland

Abstract

Worldwide estimates of the prevalence of female genital mutilation (FGM) indicate that well over 100 million women in more than 26 countries have undergone this procedure. Illegal in most western countries, FGM is primarily practiced in sub-Saharan Africa. Many women with FGM have migrated to Western countries where they constitute a significant proportion of the population. These women have special medical and psychological problems during pregnancy, and do not readily volunteer that they have undergone the procedure. Most physicians and other health professionals in Western countries have little knowledge of FGM and its management. There has been concern over reports of increased maternal and fetal mortality during childbirth among women with FGM. Little data is available on maternal expectations and wishes concerning antenatal, intrapartum, and postpartum care. This retrospective case control study evaluated the desires and wishes of women with FGM regarding their external genitalia following delivery, and as a secondary aim investigated fetal and maternal outcomes among women with FGM compared to nonmutilated women. The study was conducted between 1999 and 2008 in a teaching hospital setting in Switzerland. The case subjects were 122 pregnant women volunteers with FGM. Controls were 110 women without FGM who were matched for maternal age and delivered at the same time. Most patients were from Africa. Defibulation, a corrective surgical procedure for infibulation, was performed in some patients before or during labor. The primary study outcome measures were patients' wishes concerning their FGM management before and during labor, their satisfaction with the postpartum outcome, and intrapartum and postpartum maternal outcome data including duration of labor and blood loss as well as fetal outcomes. When given choices for managing their FGM during pregnancy, 6.5% (8/122) wanted to have antenatal defibulation, 43% (52/122) requested defibulation during labor, 34.4% (42/122) requested defibulation during labor only if deemed necessary by the medical staff, and 16.5% (20/122) patients were unable to articulate their expectations. No statistical differences between FGM patients and controls were found for maternal blood loss or duration of labor and fetal outcomes. Women after FGM did not have a longer duration of labor than the controls. Compared to controls, women with FGM had significantly more emergency Cesarean sections and third-degree vaginal tears, and significantly fewer first-degree and second-degree tears. Overall, 76% of patients were very satisfied (53%) or satisfied (23%) with the management of their FGM. These findings suggest that appropriate management of women with FGM in pregnancy and its prevention requires an interdisciplinary team approach with special training in FGM issues.