Female Genital Cutting raises childbirth risks

By Amy Norton August 13, 2009 NEW YORK (Reuters Health) - Pregnant women who underwent female genital cutting as girls are at increased risk of needing an emergency Cesarean section or suffering serious tears during childbirth, a new study finds. It is estimated that more than 130 million women worldwide have undergone female genital mutilation, also known as female "circumcision." The centuries-old practice, which involves removing part or all of a girl's clitoris and labia, and sometimes narrowing the vaginal opening, remains a common practice in some countries, mainly in sub-Saharan Africa. With increased immigration, more and more healthcare workers in developed countries are seeing women who have undergone female genital mutilation. In the new study, doctors at the University of Berne, in Switzerland, followed 122 pregnant women with a history of genital mutilation who received prenatal care at their medical center. They compared their childbirth outcomes with 110 other women the same age who delivered at the hospital. Overall, women with genital mutilation had a higher risk of emergency C-section; 18 needed the procedure, compared with three women in the comparison group. They were also more likely to suffer severe vaginal tears during delivery -- with nine having the complication, versus one woman in the comparison group. The findings, which appear in the medical journal BJOG, show that healthcare workers in developed countries need to be prepared to care for women who've undergone genital cutting. That includes prenatal discussions about how delivery should proceed, Dr. Annette Kuhn, the senior researcher on the study, told Reuters Health in an email. All of the women with genital cutting in this study had been asked about how they wanted to manage delivery. Six percent wanted to have defibulation -- surgical widening of the vaginal opening -- before giving birth. Another 43 percent wanted it during labor, while one-third requested that it be done only if medically necessary. A small number of women wanted to have the vaginal opening re-stitched after giving birth -- a request they were denied because it is medically inadvisable, as well as illegal in Switzerland, the researchers note. It is important, Kuhn said, for health professionals in developed countries to be able to sensitively discuss the issue of female genital cutting, and inform women of their potential treatment options.