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Does the timing of deinfibulation for women with type 3 female genital mutilation affect labour outcomes?

02 June 2015
Volume 23 · Issue 6



To determine whether timing of deinfibulation influences obstetric outcomes for women with type 3 female genital mutilation (FGM).


A retrospective observational study comprising 94 women with type 3 FGM who gave birth from 2008–2012.


Outcomes described in maternity notes of women with deinfibulation performed prior to labour (n=62) compared with ‘not deinfibulated before labour’ (n=32). Secondary analysis was then performed excluding women who had caesarean sections.


Women who were ‘not deinfibulated before labour’ had a significantly greater risk of episiotomy (RR 1.67, P<0.05) and prolonged hospital stay of >2 days (RR 1.33, P<0.05). They also had non-significant increased risk of a postpartum haemorrhage (RR 1.15, P=0.58); prolonged second stage (RR 1.77, P=0.16); and required vaginal packing in theatre (RR 2.6, P =0.17). Apgar scores were no different, and both groups had higher than the national average rates for emergency caesarean section and instrumental birth.


Type 3 FGM is associated with morbidity in childbirth. When deinfibulation is deferred until labour the risk of morbidity increases.

Female genital mutilation (FGM) is a deeply-rooted practice, with culture and tradition given as the main reasons for its continuation (Momoh, 2003). FGM affects approximately 140 million women worldwide and is practised in 28 African countries, the Middle East and South East Asia (WHO, 2014). It is also found in Europe, Canada, USA, Russia and Australia because of migrating populations. In 2014, a new report estimated that 137 000 women and girls affected by FGM (or born in countries where FGM is practised), were permanently residing in England and Wales in 2011; and about 60 000 girls aged 0–14 were born in England and Wales to mothers who had undergone FGM. It was further estimated that, since 2008, women with FGM make up about 1.5% of all maternity episodes in England and Wales each year. About three fifths of these women were born in the group of countries in the Horn of Africa where FGM is almost universal, and type 3 is commonly practised (Dorkenoo and Macfarlane, 2014).

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