When I hear Of Fistula, The Next Thing That Comes to Mind Is Pregnancy And Childbirth (Part III)

This is the third and final part on the series on Fistula:


A fistula:

A fistula is a hole, or abnormal opening, in the birth canal, that results in chronic leakage of urine and/or feaces.

Obstetric Fistula:

 An abnormal opening between a woman’s genital tract and her urinary tract or rectum.

According to fistulacare.org, each year, more than a quarter million women die in pregnancy and childbirth. Of those that do not perish, an unknown number suffer long-term health problems. The maternal injury with perhaps the most devastating aftermath is obstetric fistula. 

Obstetric fistula due to obstructed labour is by far the most common form of genital fistula, constituting an estimated 80-90% of all genital fistula cases. 

Obstetric fistula is usually caused by several days of obstructed labor, without timely medical intervention or cesarean section. During this time, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones. The lack of blood flow causes tissue to die, creating a hole between the mother’s vagina and bladder or between the vagina and rectum, or both, and resulting in leakage.

Left with chronic leaking, women with obstetric fistula are often abandoned or neglected by their husbands and families, unable to work, and ostracized by their communities. Women who develop obstetric fistula usually have had a stillbirth, so they must also deal with the loss of a baby. Women with fistula are often among the most impoverished and vulnerable members of society.

Iatrogenic Fistula:

Sometimes genital fistula can be caused unintentionally by a health care provider. This type of injury is called iatrogenic fistula. For instance, during a cesarean section, it is possible that the bladder is accidentally cut, resulting in a hole or abnormal opening through which urine leaks.

Iatrogenic fistula can also occur by accident during surgeries unrelated to childbirth. In many of the countries where we work, approximately 10-15% of the overall patient caseload is due to iatrogenic causes. Training surgeons and other health care staff in emergency obstetric care and other surgical skills is essential to preventing new cases of iatrogenic fistula.

Traumatic Fistula

Traumatic fistula is a condition that can occur as the result of sexual violence, often in conflict and post-conflict settings. There are no solid estimates of its prevalence, but traumatic gynecologic fistula can make up a significant part of the overall genital fistula caseload in places where sexual violence has been used as a weapon of war.

Rape, often aggravated by the thrusting of objects into the vagina or anus, can result in a hole between a woman’s vagina and bladder or rectum, or both, resulting in the leaking of urine and/or feces. 

Survivors of sexual assault may have additional, severe physical injuries and are at an increased risk for unwanted pregnancy and sexually transmitted infections, including HIV. 

Survivors live not only with chronic incontinence, but also with the psychological trauma and stigma of rape.

Fistula is life-shattering: Women contend with chronic incontinence and often are ostracized by their husbands, families, and communities. The good news is that fistula can be completely repaired up to 90% of the time if fistula survivors have access to a trained surgeon at a hospital providing fistula repair.

Beyond surgical repair, other needed support includes comprehensive counseling and physiotherapy, as needed, as well as treatment of concurrent disabilities. When repaired women leave a health facility, there is need to link them to community-based organizations that support their reintegration back into their community.

Human Rights Defenders Can Contribute to Prevention of Fistula

Prevention

Many of the approaches that prevent obstetric fistula are the same ones that make motherhood safer in general.  Engage with your community or advocate for improved Health facility services. Improving maternal health, strengthening obstetric care and facility-based prevention work focuses on:

Family Planning

Family Planning allows couples to delay early births, space desired births, and limit family size. Up to one-third of all maternal deaths and injuries could have been prevented if women had access to contraception. Family planning can also help women with a repaired fistula achieve a successful pregnancy, if that is their desire, by helping them delay a future pregnancy until they are fully healed. Women who have experienced repair are generally advised to abstain from sexual relations for a period of time to allow them to heal. In some situations, for some women find it difficult to comply with this recommendation. Other women may need a longer time before they are able to successfully sustain a pregnancy, and family planning methods can help couples determine when is the best time to get pregnant.

Promotion of the Partograph

The partograph is a low-tech tool for preventing and managing prolonged or obstructed labor, a significant cause of reproductive morbidity and mortality. It is a preprinted one-page form on which observations of the progress of labor and information about maternal and foetal condition are recorded. 

The partograph is designed to act as an “early warning system,” alerting doctors, midwives, and nurses to the need for action—e.g., referral to a higher level facility, labor augmentation, or cesarean section. Correct and consistent use of the partograph has the potential to reduce obstructed labor and its adverse consequences, including fistula.

Immediate Catheterization

If a woman with obstructed labour arrives at a hospital and is believed to be at risk for obstetric fistula, immediate catheterization can help to prevent the fistula from developing. The catheter should remain in place until well after the end of labour.

Cesarean Section

Timely Cesarean Section is critical for women with obstructed labor. Doctors performing a cesarean delivery must be competent so that they do not inadvertently create an iatrogenic fistula. Fistula Care Plus works with hospitals to ensure that quality cesarean sections are available from trained health professionals.

Community-Based Prevention

Be part o the effort preventing fistula at the community level. Activities include social mobilization and awareness-raising campaigns, dramas and broadcasts about the importance of antenatal care and assisted delivery, and support for transportation and referrals.

Remember, you too can contribute to preventing Fistula


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