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“They get a C-section…they gonna die”: Somali women’s fears of obstetrical interventions in the United States.

J Transcult Nurs. 2010 Jul;21(3):220-7. doi: 10.1177/1043659609358780.

“They get a C-section…they gonna die”: Somali women’s fears of obstetrical interventions in the United States.

Brown E, Carroll J, Fogarty C, Holt C.

University of Rochester Medical Center, Rochester, NY 14620, USA. elizabeth_brown@urmc.rochester.edu

ABSTRACT

The authors explore sources of resistance to common prenatal and obstetrical interventions among 34 Somali resettled adult women in Rochester, New York. Results of individual interviews and focus groups with these women revealed aversion to or outright fear of cesarean sections because of fear of death and substantial resistance regarding other obstetrical interventions. Because Somali women expressed resistance to many common U.S. prenatal/obstetrical care practices, educating health professionals about Somali women’s fears and educating Somali women about common obstetrical practices are both necessary to improve maternity care for non-Bantu and Bantu Somali women.

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[Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso)].

Sante Publique. 2010 Sep-Oct;22(5):563-70.

[Female genital mutilation and complications in childbirth in the province of Gourma (Burkina Faso)].

[Article in French]

Ndiaye P, Diongue M, Faye A, Ouedraogo D, Tal Dia A.

Mèdecine Preventive et Santé Publique, Université Cheikh Anta Diop, BP 16 390 Dakar, Sénégal.

ABSTRACT

In order strengthen activities against female genital mutilation (FGM), this study aimed to assess the prevalence of childbirth complications due to FGM in the province of Gourma, Burkina Faso. The cross-sectional study was both descriptive and analytical; it was conducted between June 15 and August 15, 2007. The sampling was comprehensive, incorporating all of the women who gave birth in  the four maternity wards in Fada Ngourma, the provincial capital. The survey included an interview, clinical examination and document analysis of archives and records. The 354 respondents were younger than 25 years-old in 58% of the cases, and 78% of all women participating were illiterate. FGM was Type I, II or III for 28%, 28% and 3% for them respectively. Obstructed labor occurred in 29% of the cases, and a caesarean section was preformed in 7% of the cases. Of all the
normal vaginal deliveries, 24% required episiotomies, 18% experienced obstetric Hemorrhaging, 20% had uterine retroversion and 3% needed blood transfusions. Among the newborns, 5% were resuscitated and 4% were stillbirths. The existence of FGM has statistically increased the proportion of dystocia (OR = 11.5), cesarean section (OR = 17.6), episiotomy (OR = 64), perineal tears (OR = 10, 2), postpartum hemorrhage (OR = 13.0), retroverted uterus (OR = 14.7), blood transfusions (OR = 8.0) and stillbirths (OR = 10.2). Women with FGM Type 2 and 3 were more prone to dystocia and obstructed labor (OR = 5.7) and cesarean delivery (OR = 5.2) than those with FGM Type 1. FGM constitutes an important risk factor for complications during childbirth. It should be eradicated for good health of the mother, newborn and child in Burkina Faso.

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Somali immigrant women’s perceptions of cesarean delivery and patient-provider communication surrounding female circumcision and childbirth in the USA.

Int J Gynaecol Obstet. 2011 Dec;115(3):227-30. Epub 2011 Sep 19.

Somali immigrant women’s perceptions of cesarean delivery and patient-provider communication surrounding female circumcision and childbirth in the USA.

Ameresekere M, Borg R, Frederick J, Vragovic O, Saia K, Raj A.

Department of Psychiatry, Massachusetts General Hospital, Boston, USA. maithri@post.harvard.edu

OBJECTIVE: To explore perceptions of cesarean delivery and patient-provider communication surrounding female circumcision and childbirth through interviews with Somali women residing in the USA. METHODS: Semistructured in-depth interviews were conducted with 23 Somali immigrant women living in Boston who had given birth in the USA and Africa. Interviews asked about birth experiences in the USA and Africa, as well as norms and attitudes surrounding childbirth practices. Interview transcripts were coded and themes identified through an iterative process. RESULTS: Participants were aged 25-52 years and had been living in the USA for an average of 7 years. All women had experienced circumcision. Five women had undergone a cesarean delivery. Women feared having a cesarean because of their perception that it could result in death or disability. Women also highlighted that providers in the USA rarely discussed female circumcision or how it could affect childbirth experiences. CONCLUSIONS: Previous experiences and cultural beliefs can affect how Somali immigrant women understand labor and delivery practices in the USA and can explain why some women are wary of cesarean delivery. Educating providers and encouraging patient-provider communication about cesarean delivery and female circumcision can ease fears, increase trust, and improve birth experiences for Somali immigrant women in the USA.

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Female circumcision: obstetrical and psychological sequelae continues unabated in the 21st century.

J Matern Fetal Neonatal Med. 2011 Jun;24(6):833-6. Epub 2010 Dec 1.

Female circumcision: obstetrical and psychological sequelae continues unabated in
the 21st century.

Chibber R, El-Saleh E, El Harmi J.

Department of Obstetrics and Gynaecology, College Of Medicine Kuwait
University/King Faisal University Dammam, Safat 13110, Kuwait.

OBJECTIVES: To assess the incidence of female circumcision/female genital cutting
(FGC) among pregnant women and describe the obstetrical and psychological
sequelae of female circumcision.
METHOD: Four thousand eight hundred pregnant women over a 4-year period were
assessed for female circumcision. Odd ration (OR) and 95% confidence interval
(CI) were calculated to measure association between female circumcision, maternal
morbidity, and birth outcome. Variables included prolonged maternal
hospitalization, low birth weight, prolonged labor, obstructed labor, cesarean
section, and fetal outcome. Assessment measures to determine cognitive and
emotional effects included the Mini international Neuro-psychiatric interview and
Rey memory test.
RESULTS: The prevalence of female circumcision was 38%; women who were
circumcised were more likely have extended hospital stay. There was a positive
association between such women and prolonged labor, cesarean section, post-partum
hemorrhage, early neonatal death, and hepatitis C infection. Psychiatric sequelae
included: 80% continued to have flashbacks to the FGC event; 58% had a
psychiatric disorder (affective disorder); 38% had other anxiety disorders, and
30% had post-traumatic stress disorder.
CONCLUSION: Female circumcision is associated with adverse materno-fetal outcome
and psychiatric sequelae. Many will need psychiatric as well as gynecological
care.

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Effects of female genital mutilation on birth outcomes in Switzerland.

BJOG. 2009 Aug;116(9):1204-9. Epub 2009 May 14.

Effects of female genital mutilation on birth outcomes in Switzerland.

Wuest S, Raio L, Wyssmueller D, Mueller MD, Stadlmayr W, Surbek DV, Kuhn A.

Department of Obstetrics and Gynaecology, University of Berne and Inselspital Berne, Berne, Switzerland.

OBJECTIVE: The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland. Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.

DESIGN: A retrospective case-control study.

SETTING: A teaching hospital.

POPULATION: One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.

METHODS: Data for patients’ wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.

MAIN OUTCOME MEASURES: Patients’ satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.

RESULTS: Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.

CONCLUSION: An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.

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Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

Lancet. 2006 Jun 3;367(9525):1835-41.

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M.

National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia. FGMStudyGroup@who.int

Comment in Lancet. 2006 Jun 3;367(9525):1799-800.

Lancet. 2006 Aug 12;368(9535):579.

BACKGROUND: Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome.

METHODS: 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital.

FINDINGS: Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.

INTERPRETATION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

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