To provide effective care for women affected by FGM, it is essential that service pathways ensure a smooth passage for women through their maternity care. Throughout their care key issues include accurate, appropriate and timely assessment, referral, and planning and thorough documentation.
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Please see the flow charts in the Clinical Practice Guideline on this website Female Genital Mutilation Maternity for a visual depiction of the pathways of care for women affected by FGM.
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Attention should be given to the following key points:
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- A Social Assessment should be made at the first antenatal visit, and referral made to the Family and Reproductive Rights Education Program (FARREP) workers for support, advocacy and referral, with all actions clearly documented. Please note, it is the woman's choice to take up the referral option.
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| - At the initial clinical assessment (first antenatal visit), a woman's FGM status should be physically assessed, diagnosed, and documented clearly and accurately in the antenatal notes, with the aid of diagrams.
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| - Women should be supplied with appropriate information about the reasons for deinfibulation, if required, and counselled about the health consequences of deinfibulation, to enable them to give informed consent as to resuturing and postnatal care. This may be done with the FGM medical officer for the Unit or clinical area.
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| - A referral should be made to the FGM liaison Officer for the Antenatal Unit for follow up.
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| - Women affected by FGM will require a detailed birth plan, which should be developed in partnership with the woman and her family (bearing in mind that the women's wishes are central and may change over the course of the pregnancy). The birth plan will include details of the timing of deinfibulation (antenatal or intrapartum). This should be clearly recorded in the notes. This will be reviewed at the Pre Admission Clinic assessment and at 36 weeks gestation. Women should be offered a hand held copy, using dot points, which they can take with them to the Birth Rooms.
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| - Women attending for planned C/S will require counselling regarding deinfibulation and appropriate planning for elective deinfibulation. (See the page Caesarean section issues for women affected by FGM in this section).
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| - If women present late in pregnancy, they still require full clinical and social assessment, and appropriate management
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| - Before postnatal discharge, planning should include referral to a community-based FARREP worker, and to appropriate community supports.
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