Obstetric fistula--an epidemic in Ethiopia

[stevierae]

I came across this link today while reading a letter in the New York Times. I do know about femal genital mutilation, but I did not know about this tragic complication of unattended childbirth, particularly in Ethiopia and, in fact, all over Africa.

I was dumbfounded. These poor women----young girls, actually. We take so much about safe childbirth for granted. In fact, for a long time (particularly in the '60s and '70s) there was a movement aspousing "natural" childbirth done in the squatting position---"you know, the way women in Africa do it---then they go right back to work in the fields, baby strapped to their back." Little did they know the complications that often developed, whether or not the baby was even born alive.

This is a must read.

http://www.fistulafoundation.org/aboutfistula/ows.html

More womens' stories appear here:

http://www.fistulafoundation.org/press/profiles.html

[chicagrl72]

I came across this link today while reading a letter in the New York Times. I do know about femal genital mutilation, but I did not know about this tragic complication of unattended childbirth, particularly in Ethiopia and, in fact, all over Africa.

I was dumbfounded. These poor women----young girls, actually. We take so much about safe childbirth for granted. In fact, for a long time (particularly in the '60s and '70s) there was a movement aspousing "natural" childbirth done in the squatting position---"you know, the way women in Africa do it---then they go right back to work in the fields, baby strapped to their back." Little did they know the complications that often developed, whether or not the baby was even born alive.

This is a must read.

http://www.fistulafoundation.org/aboutfistula/ows.html

More womens' stories appear here:

http://www.fistulafoundation.org/press/profiles.html

i am a bit confused ..why did the fistula happen b/c of unattended childbirth or the trauma of genital mutilation

sorry for being ignorant

TIA

les

[sirI, MSN, APRN, NP]

I came across this link today while reading a letter in the New York Times. I do know about femal genital mutilation, but I did not know about this tragic complication of unattended childbirth, particularly in Ethiopia and, in fact, all over Africa.

I was dumbfounded. These poor women----young girls, actually. We take so much about safe childbirth for granted. In fact, for a long time (particularly in the '60s and '70s) there was a movement aspousing "natural" childbirth done in the squatting position---"you know, the way women in Africa do it---then they go right back to work in the fields, baby strapped to their back." Little did they know the complications that often developed, whether or not the baby was even born alive.

This is a must read.

http://www.fistulafoundation.org/aboutfistula/ows.html

More womens' stories appear here:

http://www.fistulafoundation.org/press/profiles.html

I have seen 7 cases of fistula after delivery. However, these women had Crohn's disease. A horrible eixistence for any woman.

[kellyo, LPN]

Saw a show on Oprah about it. Very interesting and sad. Apparently, there used to be fistula hospitals in the US long ago...

[CEG]

Is squatting or having an unattended birth really related to fistulas? I was hoping if my upcoming babe was as ginormous as the last to try squatting if I needed to...

I came across this link today while reading a letter in the New York Times. I do know about femal genital mutilation, but I did not know about this tragic complication of unattended childbirth, particularly in Ethiopia and, in fact, all over Africa.

I was dumbfounded. These poor women----young girls, actually. We take so much about safe childbirth for granted. In fact, for a long time (particularly in the '60s and '70s) there was a movement aspousing "natural" childbirth done in the squatting position---"you know, the way women in Africa do it---then they go right back to work in the fields, baby strapped to their back." Little did they know the complications that often developed, whether or not the baby was even born alive.

This is a must read.

http://www.fistulafoundation.org/aboutfistula/ows.html

More womens' stories appear here:

http://www.fistulafoundation.org/press/profiles.html

[fergus51]

Squatting doesn't cause fistulas. This is from the website above:

Q: What is an obstetric fistula?

A: A fistula is a hole. An obstetric fistula of the kind that occurs in Ethiopia (and many other developing countries) is a hole between a woman's birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby's head against the mother's pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her lady parts and her bladder (called a vesicolady partsl fistula or VVF) and sometimes between her lady parts and rectum (rectolady partsl fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell.

[fergus51]

i am a bit confused ..why did the fistula happen b/c of unattended childbirth or the trauma of genital mutilation

sorry for being ignorant

TIA

les

Genital mutilation doesn't cause fistulas. It's the unobstructed labor that causes a fistula.

Again, from the above website:

Q: I heard that fistulas are a result of female genital mutilation. Is this true?

A: While harmful traditional practices such as female genital mutilation (FGM) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients at Addis Ababa Fistula Hospital have been victims of FGM, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGM does not "cause" a fistula

[SmilingBluEyes]

Genital mutilation doesn't cause fistulas. It's the unobstructed labor that causes a fistula.

Again, from the above website:

Q: I heard that fistulas are a result of female genital mutilation. Is this true?

A: While harmful traditional practices such as female genital mutilation (FGM) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients at Addis Ababa Fistula Hospital have been victims of FGM, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGM does not "cause" a fistula

Good post.

It is indeed horribly sad, and avoidable. The physical and social consequences of this, entirely preventable. :angryfire

[babyktchr, BSN, RN]

A doc that worked at our hospital now goes to africa and donates time in clinics repairing fistulas. It is an amazing thing to read his experiences.

[gypsyatheart]

Thanks for posting this, it is truly sad, I spent some time going through this site. How blessed we are to live in a country where this is virtually non-existent. It is crazy that here we worry about whether or not we should get an epidural and in these third world countries....labor and birth can/may devestate a woman's life. Sad, so sad.

I came across this link today while reading a letter in the New York Times. I do know about femal genital mutilation, but I did not know about this tragic complication of unattended childbirth, particularly in Ethiopia and, in fact, all over Africa.

I was dumbfounded. These poor women----young girls, actually. We take so much about safe childbirth for granted. In fact, for a long time (particularly in the '60s and '70s) there was a movement aspousing "natural" childbirth done in the squatting position---"you know, the way women in Africa do it---then they go right back to work in the fields, baby strapped to their back." Little did they know the complications that often developed, whether or not the baby was even born alive.

This is a must read.

http://www.fistulafoundation.org/aboutfistula/ows.html

More womens' stories appear here:

http://www.fistulafoundation.org/press/profiles.html

[stevierae]

Squatting doesn't cause fistulas. This is from the website above:

Q: What is an obstetric fistula?

A: A fistula is a hole. An obstetric fistula of the kind that occurs in Ethiopia (and many other developing countries) is a hole between a woman's birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby's head against the mother's pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her lady parts and her bladder (called a vesicolady partsl fistula or VVF) and sometimes between her lady parts and rectum (rectolady partsl fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell.

Right; I didn't mean to insinuate that squatting causes fistulas (that's just their traditional way of delivering there,) --the point I was trying to make is that these poor girls have unattended, obstructed labors that go on for 3 and four days (apparently in a squatting position.)

They must have a high proportion of cephalo-pelvic disproportion there and breech or other malpresentations, (I am guessing) that, here, would be picked up on routine ultrasound BEFORE labor and a plan for safe intervention--possibly even a scheduled C-section.

Here a doctor would make a decision much sooner in the game for a C-section, even if they labored for a while. There, they don't have that opportunity, and after 3 or 4 days of obstructed labor the babies are born dead---I guess because of fetal distress? Or are some of them already dead, due to complications in utero during development and zero prenatal care? You OB nurses would know more than I.

I am guessing that 3 or 4 days of obstructed labor in ANY position, and the resultant pressure on the pelvic floor, can cause obstetric fistulas. We are, indeed, fortunate that it's a non-existent worry here.

[caroladybelle, BSN, RN]

Genital mutilation doesn't cause fistulas. It's the unobstructed labor that causes a fistula.

Again, from the above website:

Q: I heard that fistulas are a result of female genital mutilation. Is this true?

A: While harmful traditional practices such as female genital mutilation (FGM) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients at Addis Ababa Fistula Hospital have been victims of FGM, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGM does not "cause" a fistula

The fact that girls are married off at very young ages is a contributing issue.