–about Obstetric Fistula

OBSTETRIC fistula is the most devastating and serious of all childbirth injuries. It happens because most mothers in poor countries give birth without any medical help; and so, many are young girls. Complications from pregnancy and childbirth are among the leading causes of death and disability for women of reproductive age in these places.

Obstetric fistula was largely eliminated in the United States in the latter part of the 19th and early 20th centuries with improved obstetric care in general and the use of C-sections in particular to relieve obstructed labour.
After enduring days of agonizing, obstructed labour, a woman’s body is literally broken by childbirth. During labour contractions, the baby’s head is constantly pushing against the mother’s pelvic bone, causing tissue to die from lack of blood flow to that area. All of that pushing creates a hole, or in medical terms a “fistula”, between the birth passage and an internal organ such as the bladder or rectum. This makes a woman unable to hold her urine, and sometimes bowel content as well; and her baby is unlikely to survive.
If she survives, a woman with fistula is likely to be rejected by her husband because of her inability to bear more children and her foul smell. She will be shunned by her community, and forced to live an isolated existence. Such women suffer profound psychological trauma resulting from their utter loss of status and dignity, in addition to suffering constantly from their physical internal injury.
The numbers are staggering. Right now, hundreds of thousands of women are suffering from this heartbreaking, treatable childbirth injury because they are too poor to afford surgery, which costs about US$450.
This number keeps growing. It is estimated that each year, between 30,000 and 50,000 women develop this childbirth injury. The international capacity to treat fistula patients has been estimated at just over 14,000 a year, less than half the amount of new women who develop a fistula each year.
Surgeons would describe this as an enormous backlog of untreated patients. There is clearly an overwhelming need for treating far more women.

Ana’s Story

Today, Ana is 18 years old, with an enthusiastic outlook and bubbly smile. That wasn’t always the case. Ana was just shy of 16 years old when she became pregnant. Everything went well, until it was time to deliver. Her labour was excruciating, and lasted for days.
On the fourth day of labour, nurses pushed and pulled, and pulled, and pulled so hard that eventually the baby’s arm was detached. After this, the baby no longer moved.
Ana survived this horrific delivery, only to discover that she had begun to leak urine.
Her incontinence prevented Ana from leaving her home; she never went out, until one day after her aunt told her about a program she had heard about, provided by Fistula Foundation grantee partner Centro Evangélico de Medicina do Lubango (CEML). Here, women could access fistula repair surgery.
Full of new hope, Ana showed up at CEML for surgery. It went very well, and staff at CEML describe her recovery as nearly instant, noting that she nearly bounced out of her hospital bed to announce that she was dry!
While she was recovering, Ana had the opportunity to practice her letters, and began to recognize some words. Today, she has hope for the future — as well as that enthusiastic outlook and bubbly smile.

Hamida’s story
Hamida is a young woman of twenty-five from Teknaf in the Cox’s Bazar District, a town remotely located at the southernmost point of mainland Bangladesh, at the Myanmar border. When Hamida was only thirteen years old, she was married. She became pregnant and gave birth at home with no medical help, preferring home as a safe place for delivery, as more than 95 percent of women do in her region, for fear of hospital costs.

The population of the region is made up of farmers who are unable to afford regular medical care, except in emergency situations. Most women here never see a doctor once during their entire pregnancy.
Hamida’s labour became obstructed, and she endured three days of excruciating pain. Her baby did not survive. Teknaf’s remote location makes emergency obstetric intervention nearly impossible. There are no hospitals in the area capable of performing a Caesarian section, and the population relies on Cox’s Bazaar for emergency medical treatment – which requires a three-hour drive to reach.
This difficult labour left Hamida with a fistula, leaking urine from her incontinence. Her husband divorced her because he could not stand the continuous odour. She suffered a life of misery and isolation, occasioned by her fistula and other complications that made her life unbearable. She lived with her parents but was supposed to have a family of her own.
Eventually, Hamida was able to seek treatment for her fistula. After a failed surgery at another institution, in 2012, Hamida was introduced to Hope Hospital. The hospital is a network of medical facilities that provide care to underserved rural areas of Bangladesh. Hope Hospital has been a partner of The Fistula Foundation for more than two years, receiving support for patient identification and fistula education, funding for fistula repair surgeries, and advanced surgical training to allow the hospital’s fistula surgeon to deepen his skills and perform more complicated fistula surgeries.
Here at Hope Hospital, Hamida received a successful operation that would allow her to start a new life of her own, one filled with hope and opportunity. She no longer needs to suffer a life of misery and isolation simply for trying to bring a child into the world.

Nirmala’s story

Nirmala is 25. She lives in Doti, in the far western region of Nepal. For many years, she lived in India, where her husband had found work. While living in India, she gave birth to her first child, a stillborn baby that was delivered after 24 hours of difficult labour that left Nirmala with a double fistula, in her bowels and bladder.
Her husband took her to the best hospitals in India, where they spent all of the money they had on multiple complex operations, X-rays and doctors’ visits – none of which were able to heal Nirmala. Suffering through the misery of her double fistula, Nirmala and her husband learned of a fistula camp being run by Fistula Foundation’s grantee partner, International Nepal Fellowship (INL).
“They may have had doubts about what they could expect from a set-up in a tent after the grand hospitals in India had failed, but they didn’t say so, and they had no money left,” reported a representative from INL.
Surgeons involved with the camp were able to successfully repair both of Nirmala’s fistulas, and she is now dry. She returned home cured and thinking about her future, that perhaps in a few years, she and her husband might be able to bring a baby into their home. (INL is hopeful for her and inspired, having learned this year of their first “fistula baby,” born to a patient healed in a 2010 fistula camp, who delivered safely by C-section).

10 facts on obstetric fistula
Each year, between 50,000 and 100,000 women worldwide are affected by obstetric fistula, a hole in the birth canal. The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.
Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems.
It is estimated that more than two million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

Obstetric fistula is preventable; it can largely be avoided by:
* delaying the age of first pregnancy;
* the cessation of harmful traditional practices; and
* timely access to obstetric care.

Preventing and managing obstetric fistula contribute to the Millennium Development Goal 5 of improving maternal health.
Fact 1
Obstructed labour occurs in 5% of live births, and accounts for 8% of all maternal deaths. It is one of the four major causes of maternal mortality and morbidity.

Fact 2
Obstetric fistula is a hole in the birth canal caused by obstructed labour. It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.

Fact 3
Each year, between 50,000 and 100,000 women worldwide develop obstetric fistula.
Fact 4
Women who experience this preventable condition suffer constant urinary incontinence, which often leads to social isolation, skin infections, kidney disorders, and even death, if left untreated.

Fact 5
Obstetric fistulae can largely be avoided by delaying the age at which a woman’s first pregnancy occurs; by the cessation of harmful traditional practices, and by timely access to quality obstetric care.

Fact 6
Most fistulae occur among women living in poverty in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children.

Fact 7
Obstetric fistula still exists because health care systems fail to provide accessible, quality maternal health care, including family planning; skilled care at birth; basic and comprehensive emergency obstetric care; and affordable treatment of fistula.

Fact 8
In 2008, over 2000 health professionals were trained in preventing and managing obstetric fistula.

Fact 9
Patients with uncomplicated fistulae can undergo a simple surgery to repair the hole in their bladder or rectum. The treatment cures up to 90% of obstetric fistula patients. However, since 2003, only 12,000 women in over 45 countries have received obstetric fistula treatment in Africa, Asia and the Middle East.

Fact 10
Preventing and managing obstetric fistula will contribute to improved maternal health, the fifth Millennium Development Goal.

Sources: http://www.fistulafoundation.org/, http://www.who.int/