Modern Day Midwife Katie Moriarty recounts how she, like so many other health care professionals, was ill prepared for her first encounter with FGM.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 6 Episode 6

“No one knows where the soul resides. Does it inhabit the heart? The brain? Where in the body does it hide? How is it clothed? And how might we protect it? Exposed to the light the soul seems a fragile thing…. too vulnerable for scrutiny …too delicate to live.”

This episode really hit home as a Modern Day Midwife living outside of Detroit, Michigan—near the city of Livonia, Michigan! The story line regarding female genital mutilation (FGM), also known as female genital cutting and female circumcision, was very relevant due to the fact that this area is entrenched in the nation's first federal prosecution of genital cutting. A local physician—along with his wife—and another local ER physician were recently arrested and charged with conspiring to perform FGM procedures on girls from ages 6 to 8.

I remember the very first time that I was at a birth with a woman that had FGM. The woman was from Somalia and I was her Labor and Delivery Nurse in Toronto. It was 1989 and I remember the physicians and staff really not being knowledgeable regarding her care. Munanie and colleagues (2001) explored knowledge, attitudes and responses of health professionals that cared for women that had experienced FMG and report harmful comments being made by caregivers along with women feeling that they were regarded with disgust along with a lack of respect for their cultural practices.

Women felt they were handled roughly during prenatal examinations and at birth/ delivery and reported they did not receive any special care for the postpartum period. Often their preference for having females to support them during their births was ignored. This research did indicate that health professionals are often not well prepared to meet the challenges of FMG and the potential complications that can occur. I know that I was not well prepared and had never received any professional education or training on this topic area during my nursing training.

I have put a few links to read more on FMG (types, the procedure, prevalence, history and culture, human rights) along with health risks linked with FMG. What we do know is that women need respect, kindness, non-judgmental support and care that will encompass their minds and their bodies. They need providers that evaluate them from their first antepartum appointment and discuss the options and their care and are involved with true shared decision making that includes both the woman and her partner. Women need us to travel the path towards their birth and postpartum right alongside them—as there is often anxiety and fear.

“Deka was escorted back to her homeland where her family were waiting and she was cut like generations of women before her. There are so many secret wounds – so many types of hidden scars. Natifa in time decided that her own little girl would not be circumcised. It was a bold step and it took courage like every new journey. The soul being stronger than we think can survive all mutilations and the marks upon it make it perfect and complete”.

Katie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
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REFERENCES & RESOURCES

About FMG (2011). Providing information on the practice of female genital mutilation. Retrieved from http://about-fgm.co.uk/

American College of Nurse Midwives (2012). Position statement by the American College of Nurse-Midwives: Female circumcision. Retrieved from: http://www.acnm.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000068/Female%20Circumcision%20Sept%202012.pdf

FIGO (2015). Health bodies demand zero tolerance on FGM by all health personnel, and pledge to be at the forefront of the generation where FGM ends Retrieved from: http://www.figo.org/news/health-bodies-demand-zero-tolerance-fgm-all-health-personnel-and-pledge-be-forefront-generation

Munanie E (2001). Female genital mutilation: Knowledge, attitudes & responses amongst communities & health professionals. London: Forward Press.

UNFPA, UNICEP, IC, FIGO (2015). Joint Statement on International Day of Zero Tolerance for Female Genital Mutilation (FGM): A call to action for health workers around the world to mobilise against FGM. Retrieved from: http://www.unfpa.org/press/joint-statement-international-day-zero-tolerance-female-genital-mutilation-fgm

World Health Organization (2017). Female genital mutilation: Factsheet. Retrieved from http://www.who.int/mediacentre/factsheets/fs241/en/

World Health Organization (2017). Health risks of female genital mutilation. Retrieved from http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en/