to CELEBRATE the first FGM prosecutions!

[Sallyingforth]

Breaking news on BBC. Hope they send them down for a long sentence as an example to others.

If you have given birth, did a HCP have a "peek down there" to see if you had an exit route? It is perfectly normal for women to have no examinations prior to labour and I imagine most women would be rather perturbed at being subjected to such scrutiny.

But they do check to see how far along you are... I don't understand why they aren't automatically given c-sections as soon as fgm is discovered? Seems the safest thing to do to me?

Many thanks for your detailed explanations, traffic

Firsttimeemummy Glad to be of some use!

Incidentally, you can decline examination to see how far along you are and some women do. So it's possible to be completely caught unawares. Any forced examination could be considered assault.

As for automatic CS - well sometimes it is offered, it depends on the clinical findings and the woman's wishes. Bear in mind that cultures which practice FGM also revere large families and the women prefer to have a vaginal birth rather than risk repeated CS.

But they do check to see how far along you are... I don't understand why they aren't automatically given c-sections as soon as fgm is discovered?

You could automatically offer a section, but obviously you can't do one without consent.

Some women do not present in hospital until quite late, especially if they are worried about the reaction of staff to FGM.

Can't really equate my experiences to today as it was so long ago and I have my suspicions that the internal examination my GP insisted on doing when he confirmed my pregnancy may actually have been an assault.
However, yes, I do think it should be standard practise to ensure there are no unnatural obstructions prior to birth. It's for the safety of the patient. I don't see that as intrusive. Only those who have a very misplaced polite correctness would see that as intrusive.
Some of the women affected by this have little to no English. How, even if they wanted to, could they find the words to describe what they had been subjected to. Much better to make this risk assessment a standard ante-natal practice.

I do think it should be standard practise to ensure there are no unnatural obstructions prior to birth

Standard practice can't happen without consent.

Unless there is a court order, no HP can look or touch anything with agreement. Are you suggesting that this should be overturned in the case of pregnant women? I do hope not.

Healthcare practice is evidence based. The rules and regulations of our professional bodies and the law expect this. In order to introduce a "standard practice" it would have to be proven to be of benefit to the majority - the principle of justice applies. The number of women for whom an antenatal vaginal examination would be of benefit in these circumstances is small and as creamteas points out would have to be done with consent. Many women who have had FGM are in the group of vulnerable adults who do not (or are not permitted to) attend for antenatal care. The areas where there are large communities of immigrants usually have interpreters in clinics and they are always available by phone. Again not ideal having to discuss such private information with a stranger.

It would be interesting to hear the thoughts of women on here.

have been pregnant 4 times and only on the last one did a HCP offer to give me 'a good sweep' as I was 2 weeks over date.

I declined. it's certainly not routine practise to check pregnant women's vaginas or indeed primary aged school girls to see if they have had fgm.

however we deal with this dreadful awful thing it can't be like that.

traffic your posts are so interesting and informative.

Gill that would be sexually assaulting pregnant women then! that's your answer? sorry that's ridiculous.

The basic requirement that children are kept safe is universal and
cuts across cultural boundaries.Every child living in this country is
entitled to be given the protection of the law,regardless of his or her
background.Cultural heritage is important to many people, but it
cannot take precedence over standards of care embodied in law.

Taking into account that quote from Lord Lamy, what amazes me is that women who have had infibulation and who want it reinstated rather than repaired and who have husbands/partners who are clearly in favour of it, are actually allowed to remain in custody of their girl babies. Surely if the babies were removed at birth due to the risk they would face later, that would be the perfect deterrent.

I am also amazed at the knowledge of some of the midwives on here and the sensitivity they claim to use. My children were born nearly 20 years ago now and I can't even recall the midwives being able to record information correctly in my notes.

Near I can't agree on your last point. I had my first babies 24 and 23 years ago and the vast majority of my midwives and doctors were fantastic.

obviously there are always exceptions in any profession in any time frame

NearTheWinymill I'm not sure how to interpret your last point. Are you incredulous at our knowledge base and skeptical of our sensitivity or is it a case of damning with faint praise?!

Are you suggesting that this should be overturned in the case of pregnant women? I do hope not.

There was really no need for that Creamteas. I may not be a midwife but I am not stupid.

What dismays me is the way that all the risk fall to the NHS. The woman may know she cannot deliver naturally but she may decide not to reveal this until labour comences. We all know that an emergency C sections is not an ideal situation and more risky than one that has been planned - so the NHS bears that risk. There may be no surgeons available or the theatre may already be in use. The woman's life and that of her baby could be put needlessly in danger.

According to here the rate of death in childbirth in London has doubled in the last 5 years.

Surely we should be doing everything possible to ensure these numbers fall?

We need to put aside our misplaced political correctness, start being sensible about this and start asking mothers some very probing questions. The very minimum required for a safe delivery is an unobstructed passage. Checking to ensure there is one should not be thought of as an assault. It's part of the risk assessment - or should be.

TheBody - The circumstances I related upthread were very different when the GP insisted in doing an unnecessary smear test and told me that it was essential before I could be referred to midwifery services - which I now know was total rot. He left the practice shortly after.

Had an obstretician wanted to examine me as part of ante-natal preparations I would not have an issue with that.

Having thought about why nothing is being done to monitor children of mothers who have suffered FGM, could it be that the problem is so widespread that the money and services simply aren't there to cope with the volume of possible cases.
I'm in no way saying that this is a good enough excuse as to why nothing is being done, but I can't see this government forking out millions to tackle this huge, but largely hidden problem.

Gill FGM/Infibulation does not prevent a vaginal birth, it impedes it. Without an anterior episiotomy/deinfibulation then the risks to the baby and of extreme tissue damage are increased. But as I mentioned before, the women are aware they will need to be cut and accept it as it is the norm in their culture and it will be part of a normal labour story in their family. I've never actually seen a woman refuse it in labour. So an emergency CS purely to bypass the infibulation would be uncommon. There are probably cases where they have been seen antenatally and a CS is advised but I am not aware of them.

The best available evidence for route of delivery is to aim for a vaginal birth with deinfibulation and subsequent reversal, preferably done antenatally but otherwise done carefully in the second stage of labour.

The difficulty in the UK is that although they may know they will need to be cut, they may not know they will not be able to have it reinstated. And if their antenatal care is limited the opportunities to discuss it are obviously reduced or absent.

I think traffic you should ignore jane

You have been massively informative, thank you.

On 94.9 Vanessa Feltz did a phone in on this subject. I listened today on catch up and it was really sad.

Ruth Rendell is campaigning to bring this to our attention as it is such a taboo subject and several women did ring retelling their awful experiences.

it is well worth a listen.

I think I was trying to say I wish I'd had a midwife like you traffic. Mine missed the fact that DS1 was being strangled by the cord!! Although what I would say as someone who had babies at a major London teaching hospital is that I felt every group was catered extremely well for and very sensitively; gay women, blended families, refugees, teenagers, etc, but I did feel very much that the "ordinary" people who wanted their babies and who had no problems were a bit forgotten and that our care was a bit dismissive. Perhaps we got the less experienced midwives - I don't know - but I felt overall it could have been more caring and a bit more sensitive.

Apologies for major derail but I do wonder if there is an impact of some of these sorts of problems on the care that the majority receive and who should also be at the heart of the service.

Traffic thank you so much for posting the links. The RCM one in particular is very informative (extremely depressing, but informative). It's particularly good on the social and cultural factors. BTW, for all those saying "just take all the children into care" - google the outcomes for children in care (and watch Rabbit Proof Fence). Sadly, there is not a good history of white majority populations taking ethnic minorities into care en masse. The more effective strategy has got to be persuading the communities in question not to do this in the first place. (And this is not me being super PC, this is me thinking how the hell do we stop this in a way that actually works? My knee jerk reaction is "lock the parents up and throw away the key", but sadly, though it might make me feel better, it wouldn't work in terms of protecting vulnerable children).

I'd love to see some transcripts of classroom discussions (either trainee midwives or experienced midwives doing CPD) on the case studies though - I read them and thought "Fuck, I'd freeze like a rabbit in the headlights, which is not very helpful."

"LazyJaney do you think any other form of GBH should be allowed on the NHS as well, to save some poor thug a criminal record? Some forms of violence are illegal for a really good reason"

Abortion is a better analogy for a similar issue, ie if the Right To Life zealots win and it can't be performed in hospitals, do you really think it will all go away and no one will have abortions anymore?

Ditto here. I predict if this case puts the wind up doctors, we will have Panorama and Newsnight et al reporting on backstreet disasters within the year.

Lazey - almost all cases are already carried out abroad or in backstreet arrangements. I suggest you read the RCM report Traffic linked to. The RCM make it quite clear that any of these procedures are illegal and that even where the patient requests it they must be told that it is illegal. I presume the other professional bodies issue similar and equally unequivocal guidelines. Barring a few very atypical cases the practice already is underground.

NearTheWindymill Thank you!

And to everyone else I'm pleased the information has been useful.

The reason it continues, is because no one has bothered to enforce the law. The perpetrators think we are happy to turn a blind eye when the reality is that most of us can hardly believe such a barbaric practice even exists

I agree, but I also believe that we've spent so long insisting on political correctness that it's become difficult to comment on any issue which might conceivably upset a member of a minority, however well intentioned the commenter may be

I'd imagine that no decent person wants to cause deliberate offence to anyone, but you only have to read some MN threads to see folk leapt upon like a hunted animal, remarks twisted out of all recognition and a general "competitive liberalism" taking hold

For me, this can easily lead to a situation where many are simply too frightened to speak out and a "blind eye" is turned in cases where public attention really is needed - FGM being an excellent example

I absolutely agree Puzzled. Remember the fuss about forced marriages ? Now just about everyone is happy with laws which try to prevent it.
I see a similar argument waiting in the wings about Sharia law.
Our democracy has evolved over centuries until the point we are now at where most people are equal before the law and yet some seem to think it should not apply to some sections of our community, thus depriving them of what we take to be our basic human rights. There's some very muddled thinking going on here.

Puzzled - I totally agree. Well put.