We are UHB: Alison Byrne, Midwife - FGM Service

University Hospitals Birmingham NHS Foundation Trust runs Good Hope, Heartlands, Queen Elizabeth and Solihull hospitals, the Birmingham Chest Clinic, and Solihull community services.

I am a FGM specialist midwife at University Hospitals Birmingham. FGM stands for female genital mutilation, which is a deep-rooted cultural practise that has gone on for thousands of years and still happens in many countries, including the UK. 

Somebody asked me last week, how long I had been running this service and I had to stop and think: it has been running since 2002 and began at Heartlands Hospital.

It all started when I worked on the delivery suite at Heartlands and women who had FGM would attend to have their babies. At the time, it was around one woman every six months. I had done two lots of training, as a nurse and then as a midwife, and I had never seen, or heard of it. No one knew what it was, and because we didn’t know how to care for these ladies appropriately, women sometimes had to have caesarean sections to deliver their baby due to complications from FGM. A colleague and I started to look into it more, because we both wanted to give these women the best care. We improved our education on the practise and spent time in a London clinic where FGM was more common. Soon after, we started the service and this enabled us to be able to give the appropriate care to women, both physically and emotionally.

FGM involves removing parts of the genitalia and there are four different types. Depending on what type a woman has, there are implications on the physical and emotional implications they may experience. 

There is often a common theme to why FGM happens because all sorts of traditions and beliefs are passed down through families over generations.

FGM is a very individualised practise, and its implications can last a lifetime. It happens predominantly to children, at different ages. It can range from birth, up to adolescence as a rite of passage or before a wedding day. This is why women may have different issues or needs that they bring to my clinic.

Some women don't even know that they have had it. Every pregnant woman should be asked; "have you had female circumcision?" We don't use the term FGM with women unless they use it first, because they can find the term ‘mutilation’ offensive.

Some women will come into my clinic, and they know that they've had it, because they remember every single second of it happening. In my role, I may be telling them at the age of 25, halfway through a pregnancy that they have had this performed and they have had no knowledge of it. You can imagine the kind of issues that opens, so my clinic is full of women with very different attitudes, responses, issues, and experiences. For those who come to my pregnant woman clinic, my job is to assess and identify the type of FGM and then plan their care accordingly.

For the ladies who are not pregnant, I run another clinic. Here, I will see ladies who have very different issues. They might have issues with intercourse, issues with sensitivity, or flashbacks. These women can be physically and emotionally scarred, when their clitoris is removed without their consent. It can make women feel like less of a woman and can lead to all sorts of problems for the woman and her own body image and confidence.

FGM is has no health benefits and unfortunately, it may be the women in the community who lead and organise it. It can be the child's mother, auntie, or grandmother who arrange FGM. They might be the women that are holding the child down whilst the procedure takes place. It is often due to a lack of education and because of longstanding cultural traditions. It is also often done in non-sterile conditions with non-sterile equipment and often without anaesthetic. I'm still shocked every day. It is unreal that we're still living in a society where this still happens.

The service has grown and grown, because Birmingham has changed so much since 2002, and the numbers of women who are now coming through the service are immense. It's not because FGM is on the increase, it's because of the diversity of Birmingham and through migration families who are from FGM- practising countries, such as Africa, Asia, Europe and North and South America. Things are starting to get better. The education and awareness are getting through, and women generally would never allow anything like this to happen to their daughters.

What I have seen and heard over the years makes me very sad, but it also makes me feel very passionate about giving women who have suffered from the horrific effects of FGM, the best care. Having a baby should be a positive experience and I try my best, with the wider maternity teams, to ensure that these women get the best experience possible.

I feel very privileged to have spent all these 22 years working with the communities of ladies who are so amazingly strong and courageous

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