FGM guidlines urge mandatory training and social services referral

By The Press Association9th July 2015News EnglandFemale Genital Mutilation, Guidance, News England

Midwives, obstetricians and gynaecologists should receive mandatory training about female genital mutilation (FGM), according to new guidelines on treating pregnant women who have undergone the procedure.

The Royal College of Obstetricians and Gynaecologists (Rcog) said pregnancy presents an ideal opportunity for healthcare professionals to identify women with FGM and it may be the first time they have ever sought medical services.

Women who have had the procedure, which is illegal in the UK, are more likely to suffer problems in childbirth, which is why it is so important that they get the right care.

Rcog has published updated guidelines aimed at midwives, obstetricians and gynaecologists, which say they should also receive mandatory training on deinfibulation, the surgical procedure to open up the closed vagina.

Clinicians who deal with expectant mothers who have undergone the procedure should also carry out an assessment of the risk of the unborn child, or any other children the women may have, having it done themselves.

The guidelines say all women and girls who have had recent FGM, or severe complications because of it, should be referred to police and social services.

They follow new laws announced by the Government earlier this year which make it mandatory for all professionals, including doctors, nurses and teachers, to report FGM in under-18s.

Lead author Dr Naomi Low-Beer (pictured) said it is “absolutely critical” that doctors understand the laws themselves so they are able to communicate them to their patients.

Under the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland, and the Prohibition of Female Genital Mutilation Act 2005 in Scotland, it is illegal to arrange or assist in arranging for a UK national or UK resident to be taken overseas for FGM, while it is also an offence for those with parental responsibility to fail to protect a girl from the risk.

The new guidelines stipulate that health professionals must explain the UK law to their patients and explain why they must record the fact they have had the procedure, also known as female circumcision.

It is estimated that around 137,000 women and girls in England and Wales have had FGM, but experts said there is a lack of real data on it.

Dr Low-Beer, a consultant gynaecologist at Chelsea and Westminster Hospital, said because of the risk of complications such as severe bleeding, perineal tears and increased likelihood of emergency caesarian, women with FGM will need consultant-led maternity care.

The guidelines say pregnant women should be asked whether they have undergone FGM when they have their first midwife appointment and the impact of the procedure on labour and delivery should be discussed sensitively with a plan of care agreed.

Co-chair of the Rcog guidelines committee, Dr Manish Gupta, said: “This guideline, drawing on the latest scientific evidence and expert opinion, provides further clarity on how healthcare professionals should manage FGM, as well as the organisation of services for women with FGM.

“The guideline is intended for use alongside established training programmes and we urge all healthcare professionals caring for women and girls to undertake Health Education England’s FGM e-learning programme.

“Trusts have a responsibility to ensure that all women with FGM can access specialist FGM services, and that their staff have received appropriate training.”

Dr Low-Beer added: “FGM is a violation of human rights and a form of child abuse for which there can be no justification.

“Thousands of vulnerable women in the UK are living with the long-term physical and psychological consequences of FGM, and these women must receive high quality care by obstetricians, gynaecologists and other healthcare professionals.

“We must be aware of our pivotal responsibility to provide accessible advice, treatment and support whilst ensuring that children are protected.”

Janet Fyle, professional policy advisor at the Royal College of Midwives, said: “These updated guidelines are welcome and provide good information for health professionals working in maternity services.

“Midwives have a pivotal role to play in identifying and supporting women who have undergone FGM. Meeting a midwife is often the first time that many of these women will engage with health services.

“Consequently we must ensure that midwives have the training, time and knowledge of the services needed to support women through what can be a difficult and distressing time.

“Trusts and other employers need to ensure that their staff have the appropriate training on FGM with clear national guidelines and pathways in place, and mechanisms for monitoring their effectiveness. This training should be mandatory and employers must ensure that their staff are given the time for training on FGM issues.”