Silent suffering of women with childbirth injury

LONDON - Gloria Esegbona was a 12-year-old in Nigeria when she first became aware of the problem. Young women who had lost their babies in childbirth and suffered injuries from prolonged labour would come to her father, a family doctor, seeking help.

But he was not a surgeon so all he could do was refer them to someone else.

Some of the women, many just in their early teens, had been ostracised in their villages, abandoned by their families and smelled badly because of the injuries suffered during childbirth that had left them incontinent.

“The most harrowing time was when the sister of a friend of mine lost her baby. She died after giving birth because of an infection that resulted from her leakage,” said Esegbona, now a 30-year-old obstetric gynaecologist based in London.

“From that point I’ve always been interested in it.”

Fistula

The young women she encountered suffered from obstetric fistula - a preventable and treatable childbirth injury that no longer exists in Western countries thanks to advances in childbirth procedures.

But in developing nations women marry young, often before they are fully developed, and endure a very long labour and childbirth without medical assistance that causes tissue damage and leads to chronic incontinence.

The World Health Organisation estimates 2 million women in poor nations are living with fistula. Another 50,000-100,000 new cases occur each year. Without treatment, the women are unable to work because of the leakage and stench. Often they are blamed for their condition.

“My interest in this has come from a young childhood dream which has stayed with me,” said Esegbona, who now works with the United Nations Population Fund (UNFPA) on its campaign to end the occurrence of fistulas.

She was one of a team of international surgeons who joined Nigerian physicians, nurses and social workers from the United States and Britain who treated 545 women with fistula during a two-week period in Nigeria.

Ignored and forgotten

“What really hit home to me was that after four days of operating our immediate post-op ward was full with about 50 women. Looking at all of them, not one had a baby with them.

“Ninety-five percent of these women lose their babies in childbirth. It is very rare to find a lady who will have a live baby at the end of it,” said Esegbona.

If women in developed countries have a long and difficult labour, a doctor will usually perform a caesarean section. But in Nigeria and other poor countries expectant mothers are too poor or live too far away to have their baby in a hospital.

Many give birth with little or no help.

“Some deliver themselves. Some will be delivered by relatives and some will have a traditional birth attendant,” said Esegbona.

“The women are very poor. They might not be nourished enough so they are quite small and their pelvis may not be developed. On top of that is the fact that they are marrying young, so therefore they are not able to deliver their babies safely,” she added.

Up to 800,000 women in Nigeria are living with fistula and its consequences. Another 20,000 new cases occur each year. But the condition is preventable and treatable.

Reconstructive surgery

Reconstructive surgery can correct the problem in up to 90 percent of uncomplicated cases. But the surgery is very specialised and requires trained staff. The average cost of treatment and two weeks of post-operative care is $300 - a fortune for most women in developing countries.

Women who suffer from fistula tend to be young, poor, illiterate and live in remote areas. They not only can’t afford the treatment, many do not know it is available and have no access to it.

“Sometimes women are given a catheter to give the bladder time to rest,” said Esegbona. “It is a simple and straightforward thing but obviously women have to be able to afford it and there should be somewhere where they can go to get it done.”

Girls under 15 are five times more likely to die in childbirth than women in their 20s. Many who do survive suffer from fistula.

“In some communities where the services are not there, you have some women who have leaked for 20 years. They tend to be divorced or ostracised by their family,” said Esegbona.

Although fistula is treatable, the key to eradicating the problem is prevention. The UNFPA has launched a global initiative and is working with governments in dozens of countries to address the problem.

Interventions, such as emergency obstetric care and family planning services, to prevent fistula could also save the lives of thousands of women who die each year from complications of pregnancy or childhood.

“Obstetric fistula is a double sorrow because women lose their babies and they lose their dignity,” said Thoraya Ahmed Obaid, executive director of UNFPA.  

Reuters

Photo copyright: WHO/P. Virot