What is obstetric fistula?
A fistula is an opening in an internal organ to the outside of the body.
An obstetric fistula is a hole in the bladder or rectum caused during labour. It leaves the woman permanently incontinent of urine and in 20% of cases incontinent of bowel contents as well. The human body does not repair the hole naturally.
The woman’s foul smell means that she is incapable of leading a normal life with her husband, family and the others in her village.
Social ostracism often causes these women to hide away, hoping that by lying still they will stop leaking. Lack of movement together with nerve damage, often caused during their prolonged labour, leads to atrophy of the leg muscles so that they become partially or totally crippled.
As well as being incontinent and sometimes crippled, the tragic isolated condition of these women leads to severe depression. Unless they can receive help they will stay like this for the rest of their lives.
What causes obstetric fistula?
Prolonged unrelieved obstructed labour is the main direct cause of obstetric fistula.
The continuous pressure of the baby’s head against the pelvic bone cuts off the blood supply to the tissue of the bladder and sometimes the bowel. As a result the tissue dies and falls out leaving a hole. The woman’s bodily wastes then continuously pass through this hole down the birth passage. The woman is unable to control this. She will remain incontinent for the rest of her life. A lack of access to proper sanitation and health care products mean that she will smell and become an outcast from her community, unless she can receive skilled medical care to repair the hole.
What causes obstructed labour?
Obstructed labour is caused by:
- the baby being in the wrong position (eg lying across the uterus) so it cannot be born head first in the normal way; or
- the women’s pelvis is too narrow for the baby to pass through the birth passage in the normal way.
A lack of adequate nutrition, hard manual work from an early age and early marriage can lead to a young girl of teenage years becoming pregnant before she is fully developed. In such cases the baby is likely to be too big for a normal delivery to be possible.
Sometimes a woman will experience obstructed labour because the baby is in the wrong position. This can happen to any pregnant mother. A woman who may have had multiple normal deliveries in the past, can experience obstructed labour and be left suffering with an obstetric fistula.
Is obstetric fistula preventable?
At least 5% of all women in the world experience obstructed labour irrespective of the country in which they live.
Ready access to skilled medical diagnosis and care during pregnancy and labour in the developed world has eradicated obstetric fistula from these countries.
New York once had a fistula hospital. But it closed in the 1890’s because of improvements in medical care and the development of safe procedures for conducting Caesarean sections. The world famous Waldorf Astoria Hotel on Park Avenue is now situated where New York’s fistula hospital once stood.
In developing countries where access to skilled medical help is much more limited, rural women have very limited or no access to medical care. They are at a high risk of suffering obstetric fistula or maternal morbidity during pregnancy and labour.
The Addis Ababa Fistula Hospital has established the Hamlin College of Midwives and is training young Ethiopian women to be skilled midwives who will work in their local communities to help pregnant women and identify women at risk of experiencing obstructed labour.
Is female circumcision a cause of obstructed labour or obstetric fistula?
Whilst female circumcision is a custom practised in areas where obstetric fistula also occurs, it is not a cause of obstetric fistula. Occasionally the cutting associated with circumcision can damage the bladder and cause incontinence. However, obstetric fistula is the result of damage to the bladder tissue or rectal wall caused by prolonged pressure of the baby’s head against the mother’s pelvic bone. The tissue dies and drops out leaving a fistula or hole.
How does the woman who experiences obstructed labour eventually give birth?
Women who experience obstructed labour and who do not receive medical help will often die of exhaustion, dehydration or haemorrhaging from a ruptured uterus.
Women who survive the ordeal usually give birth to a still born child. Once the child dies inside the mother the foetus shrinks and the bones soften. This allows the baby to pass out or be pulled from the mother. Occasionally a live baby will be born despite a period of obstructed labour.
What age are the women being treated at the Hospital?
The Hospital treats teenage girls who are not fully grown and have suffered obstructed labour causing an obstetric fistula during their first pregnancy. It also treats older women who have had multiple normal deliveries, but for whom the mal-positioning of their latest baby has resulted in obstructed labour and an obstetric fistula.
How long can a woman survive in obstructed labour?
The Hospital has had women arrive who report that they were in obstructed labour for up to 10 days. Although it is rare for a woman to experience labour for this length of time and survive, most obstructed labours can continue for up to five days.
If a woman’s uterus ruptures during labour she will die very quickly because of the acute haemorrhaging which follows the rupture.
How long can a baby survive in obstructed labour?
A baby will usually die if it has not been delivered within two or three days after labour begins.
How does the woman know that she has an obstetric fistula?
The first time a woman will know that something is wrong will be when she feels urine or bowel contents leaking uncontrollably from her body and she smells the foul odour that her body is now emitting. Many women will not know the cause. Some think they are cursed.
How can she seek help?
Most women who suffer from obstetric fistula live in remote villages with little or no access to medical help.
The Addis Ababa Fistula Hospital has established five regional outreach centres and is working with local health workers to try to reach women who are suffering from obstetric fistulae or who are at risk of obstructed labour.
If a woman in a remote village happens to hear that another woman has been cured at the Addis Ababa Fistula Hospital or one of its regional outreach centres, then she will try to get to the Hospital or a centre by travelling long distances over rugged terrain. She will have to walk for several hours or maybe a day or so to the nearest road in the hope that she will be able to catch a bus to take her to one of the centres or Addis Ababa.
Often it will be necessary for the woman to beg for the bus fare or for her family to sell a farm animal to raise sufficient money for the fare.
If the woman has become crippled because of her condition then her family will need to carry her if she is to get help. If one of the Hamlin Fistula outreach centres becomes aware of a woman who is suffering from obstetric fistula out in the countryside then it will arrange to transport the woman into the centre for treatment.
What is the physical and emotional state of the women who suffer from obstetric fistula?
The women leak bodily wastes uncontrollably. They are also often depressed, malnourished and are sometimes partially or completely crippled.
The Hospital’s holistic care of the women who come to it, is directed towards giving each woman a new life so that she can become "a citizen of the world", once again.
What do their husbands and families do?
Sometimes the woman’s husband will send her back to her parents as he says he cannot live with her smelly condition in the house. This often happens after a first pregnancy. If there are already children from the marriage then the husband may well keep his wife as a mother to the children. However she will have to live separately from them.
If the woman returns to her own parents or family they too will not be able to have her living in the house with them. So they will build her a little shed away from the main house and there she will live alone.
What if a woman can’t be cured?
Sometimes a woman’s injuries are so severe that she cannot be completely cured. This occurs in about 7% of cases. This may mean that the need for regular medical help prevents the woman returning to her village permanently. The Hospital does as much as it can to enable these women to lead as normal a life as possible.
The Hospital has built Desta Mender, "Joy Village", for such women. There they receive training in life and work skills. The program is designed to assist these women to manage their health issues. It also trains them in small business initiatives. This helps them to build their confidence and competence to consider living independently.
In other instances, a woman might suffer from stress incontinence caused by the disruption of the nerves which control her bladder. In these cases the Hospital will work with the woman to improve her continence, teaching her techniques and the use of a small device to assist her in controlling her bodily functions.
Why don’t we have obstetric fistulas in Australia?
Ready access to skilled medical antenatal care during pregnancy and emergency obstetric care when needed (ie a C–section operation), mean that women in Australia are at very low risk of suffering obstetric fistula.
How can I help?
The Addis Ababa Fistula Hospital is the only hospital in the world which is solely dedicated to helping women who suffer from obstetric fistula. The women who come to it are destitute. So the Hospital treats every woman free of charge.
The Ethiopian Government does not have the resources to fund the Hospital so the Hospital relies entirely on donations from overseas to fund its vital work. The Hospital has established a number of Partner organisations around the world to raise money to enable the Hospital to continue its work.
The Hamlin Fistula® Relief and Aid Fund is the authorised Australian representative of the Hospital. It is a registered charity with Australian tax deductible status. Donations can be made to the Fund via the Fund’s website. The Fund seeks to minimise its administration costs and the interest earned on moneys held in transit to the Hospital means that every cent of every dollar donated to the Fund is available to support the work of the Addis Ababa Fistula Hospital.
Click here for more ways to help.
