1. What is obstetric fistula?
An obstetric fistula is a devastating childbirth injury due to obstructed, prolonged labor whereby tissue separating a mother’s vagina from her urinary tract or rectum is destroyed or damaged and she is left with a hole that uncontrollably leaks her urine or feces out through her vagina. An obstetric fistula can only be healed through surgery.
2. What causes an obstetric fistula?
There are two primary mechanisms by which an obstetric fistula can form during obstructed labor: a crush injury from prolonged, obstructed labor or a laceration (a tear) of otherwise healthy tissue(s). These two causes are very distinct in regards to the circumstances leading up to the injury, the clinical settings where the injury occurs and the implications for treatment of the resulting fistula.
In sub-Saharan Africa and other developing, resource-limited parts of the world, obstetric fistulas are commonly caused by prolonged, obstructed labor leading to a crush injury of vital tissue. Prolonged pressure from the fetus compresses the mother’s soft tissues against her pelvic bones, cutting off the blood supply. This tissue normally separating the urinary tract (most commonly the bladder) or rectum from the vagina is destroyed and a hole opens that uncontrollably leaks her urine or feces out through her vagina.
The Worldwide Fistula Fund is focused on addressing obstetric fistula caused by prolonged obstructed labor in developing nations due to lack of access to skilled obstetric care.
Contributing factors for developing obstetric fistula due to prolonged, obstructed labor include limited or non-existent access to skilled emergency obstetric care and early marriage followed by adolescent pregnancy. A young mother with a narrow, not fully developed pelvis may have difficulty delivering a baby through her birth canal. Also, in many developing countries, it is traditional to give birth at home with an attendant from the family or community who may lack medical training.
Obstetric fistulas from prolonged, obstructed labor are not common in affluent countries due to skilled medical supervision during labor and delivery with prompt intervention (usually Cesarean section) when problems arise.
Sometimes obstetric fistulas are caused by problems that arise during instrumental vaginal delivery or operative procedures such as episiotomy, hysterectomy or Cesarean section. These fistula injuries are due to laceration of otherwise healthy tissue and are fundamentally different from those due to the crush injuries of prolonged obstructed labor.
3. Who suffers from obstetric fistula?
The United Nations Population Fund (UNFPA) estimates that approximately two million women in the developing world currently suffer from obstetric fistula and between 50,000 to 100,000 new cases develop each year.
The Worldwide Fistula Fund is specifically focused on addressing obstetric fistula caused by prolonged, obstructed labor in sub-Saharan Africa. Women with fistula injuries in the US should seek help from a board-certified urogynecologist. A specialist in Female Pelvic Medicine and Reconstructive Surgery (“urogynecology”) can be found through the American Urogynecology Society or at www.voicesforpfd.org.
4. What happens to women who have this condition?
A woman with a fistula is typically rejected by her husband, shunned by her community and lives in isolation. In rural sub-Saharan Africa, lack of knowledge about causes and treatment for fistula often results in women suffering for years before seeking treatment. The only successful treatment to begin the healing for an obstetric fistula is surgery.
Surgery can heal a fistula, but it is just the first step in treatment. Labor that leads to a fistula often causes nerve damage that limits a woman’s mobility and range of motion plus weakens her abdominal and pelvic floor muscles making daily tasks difficult, if not impossible.
Rural women in Africa do heavy work such as transporting water and firewood over long distances for cooking and laundry. Should a woman return home too soon after surgery or without adequate post-surgical therapy, there is a risk of re-opening the fistula. Appropriate therapy helps a woman regain her range of motion and strengthen her abdominal and pelvic floor muscles by building up to and then mimicking daily chores. Worldwide Fistula Fund established a Rehabilitation Advisory Council to incorporate physical therapy best practices into our treatment programs.
A woman recovering from a fistula needs counseling and support to address the psychological impact of being rejected, shunned and living in isolation. Through literacy and vocational skills a woman can generate income producing her own handiwork once she returns to her community.
5. What happens to babies in cases of obstructed labor?
Among women who survive obstructed labor and develop an obstetric fistula, over 90% deliver a stillborn baby at the end of their ordeal. Since childbirth injury typically occurs during the mother’s first pregnancy, almost 70-percent of fistula victims end up with no living children. In the developing world, where family is usually one’s only source of security, the lack of children is devastating.
6. How does the Worldwide Fistula Fund help?
Worldwide Fistula Fund (WFF) is a nonprofit global health organization dedicated to the treatment and prevention of obstetric fistulas. Working with local partners in sub-Saharan Africa, WFF helps girls and women to heal, recover and rebuild their lives through surgical care, rehabilitation and literacy & vocational classes. WFF trains African doctors in fistula prevention & treatment to improve the safety of childbirth.
7. How successful are obstetric fistula surgeries?
The surgery to close a fistula is successful in the vast majority of cases but “closure” of the fistula does not necessarily mean that the woman is “cured.” About 15-percent of women whose fistula is closed continue to lose urine due to other problems with the bladder and urethra. Many women who have been through obstructed labor also have other injuries (including nerve damage, partial paralysis and/or traumatic pelvic conditions) that cause tremendous suffering and require ongoing physical therapy to address.