how we care for women with fgm in leeds maternity service sarah bennett specialist midwife bme women...
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How we care for women with FGM in Leeds Maternity Service
Sarah BennettSpecialist Midwife BME Women
November 6 2014
Aims & ObjectivesDefine FGM
Reveal the global and local prevalence of FGM
Share the Leeds FGM service as an example of good
practice
FGM: Definition “All procedures which involve, partial or total
removal of the female external genitalia, or any other injury to the female genital organs, for non-therapeutic reasons”
FGM Act 2003 “A person is guilty of an offence if s/he excises, infibulates or
otherwise mutilates the whole or any part of a girl's labia majora, labia minora or clitoris. It is an offence for a UK national or permanent UK resident to aid, abet, counsel or procure this procedure for another person”
Prevalence / Distribution: GlobalTraditional Practicing Communities Africa, Asia/M East - Iraq, Iran, India, Pakistan, Indonesia, Malaysia
Migrant CommunitiesEurope, USA, Canada, Australia, New Zealand
England & Wales
An estimated 137,000 women and girls
living England and Wales have, or are at
risk of FGM. FGM makes up 1.5% of all maternities each year 3
Prevalence / Distribution: Leeds
FGM Clinic Data 2013
154 women reviewed
81% live in the most disadvantaged areas
Ethiopia, Eritrea, Somalia, Sudan, Gambia, Guinea, Nigeria, South Africa,
Kenya… 80% from Eritrea, Somalia, Sudan
New Estimates Using the 2011 Census
1,003-2,667 women and girls in Leeds have undergone or are at risk of FGM
Rationale for FGM service Physical, Psychological, Sexual Health Consequences:Short Term
Pain, severe bleeding, urine retention, infection, broken bones, death 10%
Long TermChronic pain, cysts, abscesses, ulcers, scarring, recurrent infections, sexual
dysfunction, subfertility, chronic anxiety, phobias, depression, PTSD
Pregnancy/Childbirth Mother Increased risk of: recurrent urine infections, LSCS, severe
perineal/vaginal trauma, severe bleeding, extended
hospital stay
Baby Increased risk of: poor condition at birth, low birth weight, Still Birth,
Neonatal Death
Protecting girlsWhere risk of FGM is identified, midwives have a legal and professional duty to share information between key agencies and to document responses 1, 4, 5
The Intercollegiate guidance recommends;1. The NHS develop information sharing protocols and pathways about women and girls at-risk or who have undergone FGM with other health and social care agencies, the Department for Education and Police 1 2. All adult women presenting within the NHS must be considered potential victims of crime 1. They therefore must be referred to the FGM clinic where a through assessment of risk will be made and a decision to refer to police, Children Social Work Services (CSWS) and support services will be taken. 3. Risk of FGM must be assessed for any female child born to a woman with FGM1. All girls (under 18) presenting with FGM or considered at risk of FGM must be referred to CSWS and the police 1, 4, 6.
Rationale for FGM service
Leeds Midwife led FGM ServiceAims Reduce FGM morbidity & mortality
Improve women’s maternity care experience
Prevent FGM/Protect children
Meet midwives/obstetricians training need
ElementsTraining
FGM Clinic
LTHT FGM Clinical Guidelines/Care Pathway
Training
Pre-registration training at University of Leeds undergraduate midwives
Mandatory training for postgraduate midwivesShadowing/observation in FGM clinicLeeds Safeguarding Children Board training
calendar
Leeds Maternity Care Pathway
Identification: Good Practice Points
Always use an interpreter (if required)
Confidentiality
Self Awareness/CommunicationCreate Respectful & Non-judgmental Environment
Listen!
Alert to social context
Do not examine without good cause
Sensitive Identification Begin meeting with a general discussion
Acknowledge you're aware of a traditional practice in her
country of birth where girls genitals are cut
Ask, is this practiced in your community? What do you call
this practice? Explain, we call it circumcision in the UK.
Explain this practice can cause severe health complications
Use value neutral terms “Were you circumcised/cut as a child”
Or use the word she uses to describe FGM “Did you have....?”
Be direct, indirect questioning is confusing
What does a good FGM service consist of?
Comprehensive, accessible guidelineTimely referral processDedicated clinic, with access to interpretersDocumentationInternal communication Referral pathways to Social Care/Children’s Services/Police Postnatal communication – to GP and HV
What do the women say?Is very nice
service, I really love it, thank you very much. God
bless youIt was good to see you today, we learned a lot. We can now share the knowledge we have with our community to help
protect girls and stop circumcision from happening
Everything is now good
Friendly service, very informative
References1. RCM 2013 Tackling FGM in the UK – Intercollegiate recommendations for identifying, recording and reporting RCM London https://www.rcm.org.uk/sites/default/files/FGM_Report.pdf2. HM Government 2011 Multi-Agency Practice Guidelines: Female Genital Mutilation https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216669/dh_124588.pdf 3. Macfarlane A, Dorkenoo E, (2014) FGM in England and Wales: Updated statistical estimates of the numbers of affected women living in England and Wales and girls at risk Interim report on provisional estimates. City University, London.4. HM Government (2013) Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children, London, Stationery Office5. NMC 2008 The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf6. West Yorkshire Consortium Procedures Manual April 2014 http://westyorkscb.proceduresonline.com/chapters/contents.html