With an increased intake of refugees from countries in Africa, the Middle East and south-east Asia, more women with genital mutilation are living in Australia, with most in NSW. It has prompted the state Health Department to develop the first guidelines for clinicians treating women affected by the barbaric procedure, which involves partial or total removal of the genitalia.
We didn’t want to be in that situation ever again.
An obstetrician specialising in the care of women with genital mutilation, Greg Jenkins, said it was often not identified by doctors until women were admitted to hospital in labour.
”That’s really too late and it needs to be recognised earlier in their pregnancy so the opportunity for counselling and management is there,” Dr Jenkins said. ”The difficulty is, in the country where they come from, genital mutilation is common so midwives there assume women have had it done and know what to do.”
Dr Jenkins works at Auburn Hospital, the only hospital with dedicated guidelines on how to care for mutilation victims. His program requires at least one senior midwife experienced in female genital mutilation and childbirth to be on hand at every shift. Women are assigned a midwife who they see exclusively throughout their pregnancy, with an interpreter available for those with little English.
”What prompted our guidelines was a 16-year-old girl who came into hospital in labour in 1993,” Dr Jenkins said.
”She had quite a severe form of genital mutilation and the staff, who had never seen a case before, didn’t know how to deal with it. She ended up with a nasty tear, and when the operating theatre consultant came in they didn’t know what to do about it. We didn’t want to be in that situation ever again.”
Dr Jenkins said he had not been consulted about the development of the clinical guidelines but said he supported anything that would help improve treatment. While they will not be mandatory, a NSW Health spokeswoman said hospitals would require ”very sound reasons” for not implementing them.
Without specialised care, women with genital mutilation are at higher risk of birth complications, including foetal distress, hemorrhage and tearing.
One woman, who did not want to be identified, said hospital staff were uncertain of what to do when she was in labour with her second child and they saw her vagina had been almost closed through mutilation.
”[So] they cut [me],” she said.
”But they didn’t stitch the incision. After [I went home], I felt some of my genital tissue was sticking out and that the area was still opened wide.”
She went to see a doctor, who did nothing. ”So I lived with that condition until I had my third child,” she said.
”The baby was big and during that labour the incision was enlarged more and I had complications. I was bleeding for 15 minutes and the midwife was anxious; she didn’t realise what was happening to me.”
The draft guidelines will be released next month, when they will be considered by Local Health Districts before being implemented in early to mid-2013.