Mama sat at the bedside of her daughter looking dejected at the hospital. She prays hard that God will save her daughter from this affliction that left them all in open disgrace and embarrassment. Her daughter had just put to bed but her vagina was leaking with urine. The young lady had sustained an injury during a mismanaged childbirth and was later brought to the hospital. Mama is burdened with caring for her daughter and newborn as the girl’s husband had abandoned them. He couldn’t cope with the mess as he referred to it. Mama believed that somebody had bewitched her daughter but at the hospital, she finds out that there is hope for her daughter. She prays hard that the surgery to the injury will work but also worry about raising enough money to pay for it.
This young lady has what is known as Obstetrics Fistula which occurred during childbirth with unskilled birth attendants: A sad story but hopeful.
The international Fistula awareness day comes up every 23rd May and this year’s theme is tagged: Hope, Healing & Dignity to us All.
Obstetrics Fistula is an abnormal hole in the bladder or rectum as a result of a traumatic birth experience. Urine drains uncontrollably through that hole to the vagina. It can also be termed to mean injury sustained in difficult childbirth or a birth not properly attended to.
Fistula occurs mostly in younger people (under 18 years) not old enough to give birth.
Factors that makes someone susceptible to Obstetrics Fistula:
1. Children below age 18 getting pregnant are a risk as their birth canal is not big enough for a baby. The injury is usually sustained during childbirth.
2. Labor that is not managed properly especially when there is an obstruction. This is a situation a baby is too big to pass through the birth canal.
3. When a woman presents a breech baby she can sustain an injury during delivery or in the process of trying to assist her.
4. During the operation of a woman to remove her womb probably because of fibroid mistakes can occur and she sustains an injury.
5. Unskilled birth attendants in the rural or urban area can put a pregnant woman at risk of Fistula injury.
6. Quacks carrying out a caesarean section can injure the bladder or vagina of a woman.
7. Cancer of the neck of the womb can also erode into the bladder leading to Fistula.
8. Female Genital Mutilation (Female Circumcision) could cause injury to the bladder. Also, infections may occur in patients not given any antibiotic after FGM. This infection can erode into the bladder and vagina.
9. Women who in an attempt to treat Fibroid or abort through herbal means take caustic materials are at risk of sustaining an injury in their vagina and bladder leading to Fistula.
10. In some cultural or family practices where women are not allowed to go to the hospital to give birth but instead are required to give birth at home with spiritual chants, when there is an obstruction such women are at risk of Fistula injury.
11. Lack of funds/poverty prevents people from going to safe hospitals to give birth. Stillbirth may occur and in an attempt to deliver the mother of the baby an injury can occur.
12. In remote villages/places distance to the hospital denies women access to proper care and therefore are exposed to quacks to monitor their labor. This is dangerous.
Prevention of Fistula:
• Integration of family planning to reduce the number of abortion by quacks helps to reduce fistula cases.
• Training and updating midwives to be able to detect when there is going to be a problem with a pregnant woman’s delivery. Such women are referred on time to a hospital equipped to care for them.
• Provision of Maternity Health centers in remote areas will enable women to have access to proper maternal care.
• Preventing underage marriage
• Sex and health education of teenage girls to keep them from engaging the services of quacks to do abortion.
• Health education on the importance of pregnant women registering with hospitals for proper care.
• Government making maternal care cheaper or even free.
Why Fistula should be eradicated
A leak of urine or faeces through the vagina leaves the woman psychological traumatized and physically incapacitated. She cannot go to work or go about her business for fear of the smell and stigmatization. Therefore she is economically handicapped. This will also affect the income of her family and her wellbeing.
Some women have been abandoned by their husbands because he could not cope with the trouble of his wife wetting the bed and smell. This further affects her well-being and that of the family.
The Good news is that Fistula is repairable. Many do not know that this is possible. Share with a woman with a Fistula today that her case is treatable.
Right now the University Teaching College Hospital and Adeoyo in Ibadan are offering free Fistula treatment. It is from 22nd May – 26th May 2017.
Fistula is Preventable; It is treatable
Apart from the opening story and conclusion, this article was drawn from points on an interview with a team from the Engendered Health (NGO) and members from Ministry of Health in Oyo state on the radio station Premier F.M 93.5 in Ibadan on the 23rd May 2017.
The team includes:
Prof. Oladosu Ojengbede – Chief Surgeon Obstetrics & gynecologist UCH.
Dr. Doyin Bello (Gynaecologist)
Mrs. Olajumoke Adekogba (Rep. Engendered Health – Fistula Care Plus (USAID)
Mrs. Oluwakemi Olawoyin( Rep. Commissioner for Health)
Adebisi Adetunji (C)