Every day, about 800 women die of pregnancy or childbirth-related complications around the world. During childbirth, a number of injuries may occur and some of them are serious enough to cause immediate death due to prolonged and uncontrolled bleeding. Other injuries may cause significant health complications leading to a reduction in the quality of life. Collectively, these injuries are called obstetric fistulas.
The 23rd of May is set aside by the World Health Organization as the day to raise awareness for the ending of obstetric fistula.
What is an obstetric fistula?
An obstetric fistula is a condition in which a hole or passageway develops between the birth canal and the bladder (storage for urine) or the rectum (storage for faeces) or both in some cases. It is due to prolonged obstructed labour without treatment. Obstetric fistulas are responsible for 6% of maternal deaths and in 90% of cases, the baby is born stillborn.
Obstetric fistulas lead to long-term problems with urine and faecal continence (the ability to hold urine and faeces). Affected women are faced with:
- Social isolation and stigma,
- Psychological and physical pain,
- Skin infections,
- Kidney diseases,
- Poverty, and
- Death if left untreated, due to the continual leaking of urine, faeces or both.
Due to the damage caused to the nerves by the leaking urine and faces, some women develop nerve damage causing problems with walking.
How does it develop?
In developing countries, only 58% of women deliver in the presence of a doctor or a midwife. During unassisted prolonged labour, the continuous pressure on the mother?s pelvic bones by the head of the baby causes a reduction to the blood supply of the tissues in the pelvic region.
This decrease in blood supply damages the walls of them in the process causing a hole to be formed between the vagina and the bladder or the rectum - nearby organs in the pelvic region. Subsequently, the unusual connection between the vagina and the rectum, bladder or both constantly leak urine and faces through the vagina.
Ideally, a caesarean section would be necessary to prevent the development of obstetric fistula in cases of prolonged labour. Obstetric fistulas may also develop after poorly performed abortions, pelvic fracture, cancer or sexual abuse.
What types of fistulas are there?
An abnormal passageway between two organs in the body is called a fistula. As regards obstetric fistulas, a connection between the bladder and the vagina is called a vesicovaginal fistula while a connection between the rectum and the vagina is called a rectovaginal fistula.
Who is affected?
About 2 million women globally mostly in low resource settings have an obstetric fistula with about 100,000 new cases developing yearly, especially in Africa and Asia. Many of the women affected live with the condition for years. Obstetric fistula is quite rare in the developed world due to advances in obstetric care and other factors such as better nutrition, better health services and health education.
Most women with obstetric fistulas live in poverty. This makes it immensely difficult for them to access proper care when they are in labour, often turning to traditional or cultural options for delivery peculiar to their realities.
Poverty, a risk factor in the development of a fistula and also a consequence of obstetric fistula makes it difficult for affected women to earn a living because they constantly leak urine and/or faeces and need to constantly clean up.
How is it treated?
Reconstructive surgery is done to repair the damage done by obstetric fistula. It is done by a specialist with experience in fistula repair. While surgery can repair up to 90% of all fistulas, only a few women know about reconstructive surgery and even fewer women can afford it. In some communities, the condition is attributed to punishment or a curse rather than a medical condition. So far, only one woman in 50 has access to fistula treatment.
How Can Obstetric Fistulas Be Prevented?
Obstetric fistulas are totally preventable if access to timely care is available. In addition, family planning services should be made available, and harmful traditional practices such as child marriages and adolescent pregnancy should be discouraged.