An obstetric fistula is one of the worst injuries that can happen to a woman during childbirth.
A fistula is any abnormal connection or opening between two organs in the body. With obstetric fistulas, the opening can be between the vagina and the urinary tract or between the vagina and the rectum, or in the worst cases, both types.
What Causes a Fistula?
This kind of injury can happen when labor is obstructed, which means that the baby’s head is stuck in the birth canal and with each contraction is pressed hard against the mother’s pelvic bone. After many hours or days of obstructed labor, the blood supply to these tissues is cut off because of this compression. The vaginal, bladder, or rectal tissues start to die. Several days after these tissues die, a hole develops either between the urethra or bladder and the vagina or between the rectum and the vagina.
In most cases of obstructed labor this severe, the baby dies. But in addition to that tragedy, the mother is left leaking urine or feces from her vagina.
Where Does This Happen?
Fistulas due to obstructed labor happen very, very rarely in developed countries like the United States, where there is good medical care and rapid access to surgery for a cesarean section if obstructed labor occurs. However, fistulas between the bladder or rectum and the vagina can also be caused by pelvic surgery or de due to cancers, radiation treatments infection, and trauma. In the United States and the United Kingdom, 70% of fistulas are the result of pelvic surgery.
However, obstetric fistulas caused by obstructed labor happen all too frequently in underdeveloped countries that are plagued by poverty and which do not have widespread access to good medical care. Ninety percent of fistulas in developing countries are due to obstructed labor.
One of the main causes of obstructed labor is a baby that is too large for the birth canal. In underdeveloped and poor countries, the birth canal may be too small because of malnutrition in the mother that stunted her bone growth or because she is simply too young to be giving birth.
When we say that labor is prolonged due to obstruction, we are talking about days and days of labor. Women in Africa who developed fistulas and who went for treatment had been through labor that averaged 3.9 days in length.
Not only did these women or girls suffer through days of excruciatingly painful labor, with a stillborn child in the end, the fistulas they develop then devastate their lives. They become socially ostracized because they are leaking urine and feces continuously. They are often cut off even by their families.
What Can Be Done?
Obstetrical fistulas can be corrected surgically, although it may take more than one surgery to fix the problem in serious cases. In Africa, women who need to have fistulas corrected often must travel for days to get to hospitals where the surgery can be done, but their poverty prevents them from being able to afford either the travel or the costs of the procedure. For every woman who is treated for a fistula, an estimated 50 women go without treatment.
Several international organizations have been set up to help this situation. Some have the goal of preventing obstetric fistulas by improving childbirth conditions in developing countries. Others, such as the Fistula Foundation, help fund surgical clinics where fistulas can be corrected. Some organizations, such as the Addis Ababa Fistula Hospital and Hamlin College of Midwives, do both.
You can read the World Health Organization’s 10 facts about obstetric fistulas on their website.