Women who have undergone female genital mutilation (FGM) can and do give birth vaginally, but the process often requires additional medical preparation and carries higher risks than it does for women without FGM. The specific challenges depend heavily on the type of FGM involved. Types I and II, which involve partial or complete removal of external tissue, can reduce the elasticity of the perineum and lead to tearing. Type III, known as infibulation, involves the narrowing or sealing of the vaginal opening and typically requires a surgical procedure to reopen it before or during labor.
Why FGM Affects Labor and Delivery
The tissue changes caused by FGM create physical barriers during childbirth. Scar tissue is less flexible than the soft tissue it replaces, and the perineum needs to stretch significantly to allow a baby’s head through. When that tissue can’t stretch enough, the second stage of labor, the pushing phase, takes longer and is more likely to result in tearing or obstruction.
A prospective study comparing 134 women with FGM to 134 without found that the pushing stage averaged about 74 minutes in the FGM group compared to roughly 46 minutes in the control group. Outlet obstruction, where the baby’s passage through the vaginal opening is physically blocked, occurred in 31% of women with FGM versus 13% without. The risk of perineal tearing was about 2.5 times higher, and the need for emergency cesarean delivery roughly doubled.
These risks are most pronounced with Types II and III, where more tissue has been removed or sealed. But even with Type I, the loss of tissue elasticity in the perineal area can increase tearing risk by at least 50%.
How De-infibulation Works
For women with Type III FGM, the sealed vaginal opening must be surgically reopened in a procedure called de-infibulation. This is the single most important medical intervention for enabling vaginal birth in women who have been infibulated. A healthcare provider carefully cuts through the scar tissue covering the vaginal opening to restore access for both delivery and prenatal examinations.
De-infibulation can happen at two different points. Ideally, it’s performed during pregnancy, often in the second trimester, which gives the tissue time to heal before labor. This also allows for proper prenatal care, since vaginal examinations may be impossible while the opening remains sealed. When it’s done during pregnancy, it’s typically performed under local anesthesia in an outpatient setting.
If a woman arrives in labor without having had the procedure, de-infibulation can also be performed during the first or second stage of labor. In that case, an epidural is usually offered for pain relief. The provider examines the undersurface of the scar, determines how much tissue needs to be divided, and makes a careful incision to open the vaginal passage enough for delivery.
What Delivery Looks Like
After de-infibulation, or for women with Types I and II, vaginal delivery proceeds similarly to any birth, though with closer monitoring. Healthcare providers watch for signs of obstruction and are prepared to intervene quickly if needed. Episiotomy, a small cut to widen the vaginal opening during delivery, is more commonly performed in women with FGM to prevent uncontrolled tearing.
Cesarean delivery is not automatic. Most women with FGM deliver vaginally, but the threshold for moving to a cesarean is lower because of the higher obstruction risk. In the Somalia-based study, about 14% of women with FGM needed an emergency cesarean compared to 7% without. The decision typically comes down to whether labor is progressing and whether the baby is tolerating the longer pushing phase.
Postpartum hemorrhage is another concern. A meta-analysis found that across African settings, women with FGM had roughly 2.6 times the risk of significant bleeding after delivery. Interestingly, studies conducted in European settings did not find the same elevated risk, which likely reflects differences in the quality and availability of obstetric care.
Risks to the Baby
The prolonged labor and potential for obstruction don’t just affect the mother. Babies born to women with FGM are about twice as likely to have low Apgar scores at five minutes after birth, a standard measure of how well a newborn is doing. The need for neonatal intensive care was also nearly double in one study: 11% versus 6%. These risks stem primarily from the longer, more difficult labor rather than from FGM itself directly harming the baby. When labor is well monitored and obstruction is caught early, outcomes improve substantially.
The Role of Prenatal Planning
The single biggest factor in a safe delivery for women with FGM is early prenatal care. When the type of FGM is identified early in pregnancy, the care team can plan accordingly. For infibulated women, this means scheduling de-infibulation with enough time to heal. For all types, it means having experienced providers, appropriate monitoring during labor, and a clear plan for intervention if complications arise.
The World Health Organization’s 2025 guidelines emphasize that survivors of FGM may need specialized care at different life stages, including pregnancy, and that this care should be both clinically sound and empathetic. In practice, that means providers should be trained to recognize the different types of FGM, understand the obstetric implications, and approach examinations with sensitivity.
Why Sensitive Care Matters
Childbirth can be psychologically difficult for women with FGM in ways that go beyond the physical. Vaginal examinations, the loss of bodily control during labor, and the vulnerability of delivery can trigger trauma responses related to the original procedure, which was often performed in childhood without consent. Some women avoid prenatal appointments altogether out of fear or distress.
Providers trained in caring for FGM survivors ask permission before each examination, allow patients to postpone non-urgent procedures until they feel comfortable, and recognize that missed appointments may signal fear rather than indifference. This approach matters not just for emotional wellbeing but for medical outcomes: women who feel safe with their care team are more likely to attend prenatal visits, agree to de-infibulation before labor, and arrive at the hospital early enough for proper monitoring during delivery.