Female genital mutilation — structured oral station (12 minutes)

Opening prompt — "Classify her finding and tell me what it means for the birth."

Model response — verbatim WHO classification then the intrapartum consequence: ^[5][7]

• "She has Type III FGM — WHO Type III, often called infibulation, is the narrowing of the vaginal opening with the creation of a covering seal, formed by cutting and repositioning the labia minora or majora, with or without removal of the clitoral glans and prepuce."
• "Type III is the form that narrows the introitus and drives the intrapartum decision: it carries the highest obstetric risk — caesarean, postpartum haemorrhage, prolonged labour, instrumental delivery and perinatal death — from the WHO Lancet 2006 study."^[2]
• "My plan is to deinfibulate, never reinfibulate, and to plan a vaginal birth after deinfibulation unless there is a standard obstetric indication for caesarean."^[5][8]

Probe 1 — "Walk me through your antenatal plan."

• "At booking I document the WHO Type III in the handheld record and the hospital system. I arrange a professional, non-family interpreter and a female clinician with a chaperone. I screen for urogenital and psychosexual complications — urinalysis, swabs, a mental-health and sexual-function assessment — and offer referral to a specialist FGM service."^[8][10]
• "I counsel her on deinfibulation: a midline vertical incision of the scar, with suture of the raw labial edges, to open the introitus; I explain that I will not reinfibulate. I offer elective antenatal deinfibulation around 20 weeks so she heals before birth, or deinfibulation at the onset of labour if she prefers."^[5]

Probe 2 — "She asks you to 're-stitch' her after the birth. What do you say?"

• "I decline, firmly and non-judgmentally. WHO recommends against reinfibulation because it increases health risks throughout the life-course, and reinfibulation is itself a form of FGM. I explain this, offer psychosocial and sexual-health support, and document the conversation."^[5][8]

Probe 3 — "Her mother-in-law offers to interpret. What is your response?"

• "I thank her but decline. I never use a family or community member as interpreter for an FGM consultation — it breaches confidentiality and may place the woman at risk. I use a trained professional interpreter, and I ask the woman whether she prefers one who is not from her own community."^[10][11]

Probe 4 — "She asks you to perform 'a small cutting' on her six-year-old daughter. What do you do?"

• "I refuse. FGM on a child is a criminal offence in every Australian state and territory and in New Zealand, and performing or facilitating it — including 'vacation cutting' abroad — is prohibited. This is a mandatory-reporting scenario: I make an immediate report to child protection, I document the conversation, and I offer the family culturally safe information and support."^[8][9]

Probe 5 — "She is frightened and embarrassed. How do you communicate?"

This is a scored communication domain — demonstrate it out loud: ^[10]

• Move to her eye level, use her name, acknowledge the fear: "Thank you for trusting me with this. Many women from your community have been through it, and you have done nothing wrong. My job is to plan a safe birth for you and your baby, and to support you."
• Explain the plan in plain language, with the interpreter; offer a female clinician and a named contact for between visits; offer referral to community-led support.^[8][11]

Probe 6 — "How would your plan differ for a woman with Type II?"

• "Type II is excision of the clitoral glans and labia minora, with or without the labia majora. Deinfibulation is not required unless she is symptomatic; the introitus is patent. I plan a vaginal birth with vigilant perineal care and PPH preparedness. The dose-response — the WHO Lancet study — shows lower obstetric risk than Type III but still elevated above uncut women."^[2][5]