Effects of female genital mutilation on birth outcomes in Switzerland

Objective  The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland.
Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.
Design  A retrospective case–control study.
Setting  A teaching hospital.
Population  One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.
Methods  Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.
Main outcome measures  Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.
Results  Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.
Conclusion  An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.