Caring for Women Who Have Experienced Female Genital Cutting.

Female genital cutting/mutilation (FGC/M) is a procedure that involves physically altering a woman's/girl's genitals for no health benefits. This is a practice that is deeply rooted in culture, religion, and social tradition primarily in some African and Middle East countries. It is performed by a midwife, barber, traditional healer with no surgical training, or a physician. The practice of FGC/M has been gaining increased attention as women from those countries have been migrating to the United States and Western Europe. The World Health Organization (WHO) has estimated that 125 million women worldwide have undergone FGC/M. The practice has serious short-term and long-term physical, obstetric, and psychological complications. It has been proposed by some healthcare professionals that physicians or other healthcare providers should perform the cutting because it would be done under more sanitary conditions that would reduce complications. However, the WHO and other organizations have condemned the practice by any medical professional. The FGC/M procedure is a human rights violation and has been banned by WHO and other organizations and governments. This article provides an overview of the current issues related to FGC/M and addresses important cultural considerations for nurses caring for women with FGC/M. Nurses are in a unique position to provide holistic, culturally competent care in a respectful, nonjudgmental atmosphere. Nurses have a role in educating women with FGC/M about the complications and care, as education is necessary in the challenge to eradicate the practice of FGC/M.

One consequence of infertility treatment: multifetal pregnancy.

This article discusses the issue of multifetal pregnancy as a result of fertility treatments. Pregnancies with multiple gestations are associated with serious infant and maternal health risks as well as psychological distress and significant financial consequences, and are a far too common consequence of infertility treatments such as assisted reproductive technology (ART) and ovulation induction drugs. Women with multifetal pregnancies are at a higher risk for multiple pregnancy complications and maternal morbidity/mortality as well as stress, depression, and anxiety disorders, especially when there is the threat of a loss of one or more fetuses. The rise in rates of multifetal gestation and the accompanying increased risk to both mother and fetuses have led the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology to develop guidelines to limit the number of transferred embryos during in vitro fertilization. Nurses who work with infertile women are in a position to educate them about the risks, benefits, and alternatives associated with ARTs and multifetal pregnancies, and should endeavor to learn as much as possible about this topic.

Nursing considerations in the case of multifetal pregnancy reduction.

This article concerns the issue of multifetal reduction performed in some cases of higher order multiple gestation in order to decrease the possibility of adverse pregnancy outcomes and increase the chances of survival in the remaining fetuses. If multifetal pregnancy reduction is considered as a treatment option, it is usually performed in the first or early second trimester. The decision to reduce one or more fetuses is extremely complicated, and numerous factors must be considered, since the procedure has risks, such as loss of the entire pregnancy or preterm labor and birth of the remaining fetuses. In addition, there are also psychological risks for the mother. Typically women faced with this decision have struggled for years with infertility and now they are asked to consider terminating one or more of the fetuses to prevent morbidity and/or mortality in others. Nurses who work with infertile women may be able to assist in minimizing the need for multifetal pregnancy reduction by educating women about the risks associated with assisted reproductive technologies and higher order multifetal pregnancy before decisions are made about multiple embryo transfers or intrauterine insemination after ovulation induction.

Neonatal genetic testing is more than screening.

Newborn screening practices have changed since breakthroughs have occurred in genetics and mapping of the human genome. Although newborn screening has been in existence since the 1960s, today's newborn screening practices are subsumed primarily under the umbrella of genetic testing. Inclusion of the family history tool is another dimension of neonatal assessment. Technology allows many noninvasive tests to be run at a low cost but with this advance comes ethical and legal dilemmas. This article discusses neonatal genetic testing and some of the ethical dilemmas that arise.

Female genital circumcision: medical and cultural considerations.

Female circumcision (FC), also known as female genital mutilation (FGM), is a procedure that involves partial or complete removal of external female genitalia. The definition given by the World Health Organization (WHO) states that female circumcision "comprise all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons" (WHO, 1998, p.5). The United Nations Children's Fund, the United Nations Population Fund, and the WHO have jointly issued a statement that FC and FGM causes unacceptable harm and issued a call for the elimination of this practice worldwide. The WHO also contends that female circumcision is a "violation of internationally accepted rights" (WHO, p.1). Female circumcision is a widespread cultural practice and affects millions of young women. Issues related to female circumcision that are of special concern are health consequences, civil rights, cultural considerations, and legal and ethical aspects. The purpose of this paper is to address the incidence of FC and FGM, the historical background, the procedure, the medical complications and cultural considerations. Legal and ethical issues of FGM will also be discussed.