Care for pregnant women who have experienced genital cutting

Female genital cutting (FGC) also known as female genital mutilation (FGM) or female circumcision is when some or all of a woman's or girl's external genital organs are cut or damaged for cultural beliefs, or reasons not connected with medical treatments. It is often performed by traditional practitioners such as traditional birth attendants without any form of anaesthesia or analgesia using non-sterile instruments. There are no known medical benefits to FGC, and it can be dangerous for the health and psychological well-being of these women and girls, resulting in both short- and long-term problems. Long-term complications include chronic pelvic infection, formation of cysts, vaginal obstruction and infertility. Some of the greatest health problems associated with FGC and faced by most women arise during pregnancy and when giving birth. In some cases, complications from FGC can result in death.

Care offered to these women may include 1) surgery to widen the vaginal opening (deinfibulation), 2) cutting the perineum during birth to widen the outlet to help the baby to be born (episiotomy), 3) removal of cysts and 4) treatment of infections.  Women and their partners may also benefit from counselling to enable them to explore and understand the problems caused by FGC. This may also help them make informed decisions about the care they might receive.

We looked for randomised controlled trials to find out what might work best for women. However, we did not find any studies for inclusion in this review. So, there remains the problem of how best to care for pregnant women and women planning a pregnancy in these circumstances. Trials are urgently needed, although conducting such studies might be difficult. In the meantime, caregivers will do their best to look after these women during pregnancy and childbirth.

Authors' conclusions: 

FGC research has focused mainly on observational studies to describe the social and cultural context of the practice, and we found no intervention trials conducted to improve outcomes for pregnant women presenting with complications of FGC. While RCTs will provide the most reliable evidence on the effectiveness of interventions, there remains the issue of what is considered ethically appropriate and the willingness of women to undergo randomisation on an issue that is enmeshed in cultural traditions and beliefs. Consequently, conducting such a study might be difficult.

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Background: 

Female genital cutting (FGC) refers to all procedures that involve the partial or total removal of the external female genitalia, or other injury to the female genital organs for cultural or other non-therapeutic reasons. There are no known medical benefits to FGC, and it can be potentially dangerous for the health and psychological well-being of women and girls who are subjected to the practice resulting in short- and long-term complications. Health problems of significance associated with FGC faced by most women are maternal and neonatal mortality and morbidity, the need for assisted delivery and psychological distress. Under good clinical guidelines for caring for women who have undergone genital cutting, interventions could provide holistic care that is culturally sensitive and non-judgemental to improve outcomes and overall quality of life of women. This review focuses on key interventions carried out to improve outcome and overall quality of life in pregnant women who have undergone FGC.

Objectives: 

To evaluate the impact of interventions to improve all outcomes in pregnant women or women planning a pregnancy who have undergone genital cutting. The comparison group consisted of those who have undergone FGC but have not received any intervention.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2012) and organisations engaged in projects regarding FGC.

Selection criteria: 

Randomised controlled trials (RCTs), cluster-randomised trials or quasi-RCTs with reported data comparing intervention outcomes among pregnant women or women planning a pregnancy who have undergone genital cutting compared with those who did not receive any intervention.

Data collection and analysis: 

We did not identify any RCTs, cluster-randomised trials or quasi-RCTs.

Main results: 

There are no included studies.

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