FGM and Giving Birth

What FGM is, and the four types

The NHS defines it as "a procedure where the female genitals are deliberately cut, injured or changed, but there's no medical reason for this to be done". The RCOG uses the same framing and adds that it "is recognised as a human rights violation, has no health benefits, and harms girls and women in many ways".

Four types are recognised. The RCOG describes them as: type 1, removal of all or part of the clitoris, sometimes with the hood; type 2, removal of the clitoris with part or all of the inner labia, with or without cutting the outer labia; type 3, "making a covering seal to narrow the vaginal opening by cutting and sewing together the inner and outer labia with or without removal of the clitoris"; and type 4, all other harmful procedures including stretching, pricking, piercing, cutting, scraping and burning.

Type 3, also called infibulation, is the one that most changes what happens at a birth. The World Health Organization publishes the same classification in its fact sheet on the practice.

What NICE asks your team to tell you

NICE's intrapartum guideline contains a specific recommendation, and it is one you are entitled to have had before labour: "Inform any woman with infibulated genital mutilation of the risks of difficulty with vaginal examination, catheterisation and application of fetal scalp electrodes. Inform her of the risks of delay in the second stage and spontaneous laceration together with the possible need for defibulation in labour."

Deinfibulation and defibulation are the same procedure; different bodies use different spellings. Reading that recommendation in advance is useful because it names, in one sentence, every part of a labour that may be harder — and each of them can be planned for rather than discovered.

Antenatally, NICE asks teams to "assess the woman's risk of and, if appropriate, discuss female genital mutilation (FGM) in a kind, sensitive manner", following UK government safeguarding guidance. NICE's postnatal guideline lists FGM in mother or previous child among the information that should be shared when care is transferred between professionals.

Deinfibulation

The RCOG's definition: "Deinfibulation is a minor operation to divide the scar tissue which is narrowing the vaginal opening in type 3 FGM." It is recommended if the opening is not open enough for you to pass urine normally, have sex comfortably, have an internal examination, have a cervical smear test, have vaginal surgery, or "have a safe vaginal delivery".

On anaesthetic, the RCOG says it "can usually be performed under a local anaesthetic although you may choose to have a spinal or general anaesthetic". You should be given more information and the chance to ask questions before it is done.

Timing is the decision most worth making early. It can be done before pregnancy, during pregnancy, or during labour itself. Doing it antenatally means it happens calmly, with the anaesthetic you chose, and with time to heal and to see how things feel. Doing it in labour means it happens quickly, in the second stage, sometimes alongside other decisions.

Neither is wrong, and it is your decision. It is simply much easier to make in the second trimester than in transition.

Re-closing after birth is illegal

Re-infibulation — closing the opening again after a birth — is not lawful in the UK. Both the RCOG and the NHS state that FGM is illegal in the UK, and the NHS adds that it is also illegal to arrange for someone to be taken abroad for it. A UK maternity team cannot re-close you after a birth, whoever asks.

If you are under pressure from family or community about this, the NHS names sources of help including a GP, your midwife, other healthcare professionals, and the NSPCC's FGM helpline.

What care should look like

The NHS points women who have had FGM to "a specialist NHS gynaecologist or FGM service", and asks you to speak to a GP, midwife or other professional about services in your area. National FGM support clinics exist and can be found through the NHS.

Practically, a good plan written into your notes might cover: whether deinfibulation is planned and when; who will do vaginal examinations and how many people will be in the room; whether a catheter is likely and how that will be managed; whether a fetal scalp electrode is likely to be difficult, and what monitoring will be used instead; and how pain relief will be discussed.

NICE's general expectations about consent apply with particular force here: every procedure explained before it happens, consent sought, and a woman told she can decline an examination before it starts or ask for it to stop at any stage.

Safeguarding, explained honestly

Healthcare professionals in the UK have legal duties around FGM, and it is better to know what they are than to be surprised.

The RCOG: "FGM is a form of child abuse. If you are under the age of 18 years your healthcare professional is obliged under the law to report FGM to the local safeguarding team and the police, who will deal with the matter sensitively."

For adult women, disclosing that you have had FGM is not itself a reason for your baby to be taken from you. Services assess risk to children, and a conversation about a daughter's future is likely; that conversation is not the same as an allegation against you. The NHS's material is directed at supporting women who have had FGM, not at prosecuting them.

What may be harder, and what helps

The RCOG lists physical problems that can follow FGM, including painful periods, pain passing urine, urinary tract infections, "inability or difficulty in having a vaginal examination and cervical smear", pain during sex, genital scarring, vaginal narrowing, problems with childbirth, increased risk of caesarean section, increased risk of bleeding after delivery and a higher risk of stillbirth.

It also lists the psychological effects — low self-esteem, depression, anxiety, flashbacks, post-traumatic stress disorder — and these matter as much as the physical ones for how a birth is planned. Support for them should be offered alongside the surgical conversation, not instead of it.

Where to start

Tell your midwife at booking, or at any point afterwards. The RCOG's advice is exactly that: "Tell your healthcare professional so that you can be offered the care you may need and be referred to the right place for help and support." Ask for an interpreter if you want one, and ask for one who is independent of your family — NICE asks teams to use interpreters who are independent of the woman rather than a relative or friend.