Midwifery care of circumcised women during labour

Abstract

The increasing numbers of immigrant circumcised women to countries where female circumcision is unfamiliar, has challenged many midwives during labour. Since this challenge has not been investigated in the Maltese healthcare system, the study aimed to explore the midwifery care of circumcised women during labour. The study's objectives were to assess whether the midwives' knowledge on female circumcision has an impact on the care given to circumcised women during labour and to explore the experiences of midwives in caring for circumcised women during labour. A quantitative approach was adopted for this study. Questionnaires were self administered to 38 midwives from Delivery Suite and three Obstetrics wards. A response rate of 86.8% (n=33/38) was obtained. Descriptive statistics and content analysis were used to analyze data. Findings indicate that midwives lack the necessary knowledge needed for the care of circumcised women. Emotions and communicational challenges were involved during the care of circumcised women in labour. Difficulties for midwives were encountered especially during vaginal examinations and catheterization. Circumcised women experienced complications especially severe pain and perineal tearing. De-infibulation was found to be a necessity in women with type 3 female circumcision. There appeared to be no guidelines on how to provide adequate care for circumcised women. Results were critically discussed and compared with other studies on the topic. It can be concluded that care of circumcised women during labour seems to be an issue which is not given importance in the local healthcare system. Recommendations include the need for midwives to increase their awareness, knowledge and understanding on female circumcision. There is also the need to develop an interdisciplinary team approach, the need for guidelines, and for a clinic which addresses the needs of circumcised women. There is also a need for non-judgemental, sensitive and respectful care. Recommendations for research include the need for a qualitative study to explore the perceptions of the circumcised women's childbirth experience in Malta. The subject of female circumcision needs to be given more importance in midwifery undergraduate programmes and in Continuous Professional Development courses and seminars.