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Fistula FAQs from Worldwide Fistual Fund

Here’s the more about fistulas from Worldwide Fistula Fund, which performs fistula surgeries on women in southern Niger:

1. WHAT IS OBSTETRIC FISTULA?

Fistula is a medical condition caused by prolonged or obstructed labor. The most common childbirth injuries that occur after obstructed labor are vesicovaginal fistula (VVF) and rectovaginal fistula (RVF). The word “fistula” is a medical term for an abnormal connection between two body organs or cavities. In VVF, the pressure of the fetal head in the pelvis during obstructed labor interrupts the blood flow to the tissues that are being compressed and causes those tissues to die. When the tissues between the bladder and vagina die, a hole opens up between them which allows urine to leak out as soon as it reaches the bladder. In RVF, the same process occurs, but in this case the tissues between the vagina and rectum are destroyed and feces pour out through the vagina.

2. WHO SUFFERS FROM OBSTETRIC FISTULA?

While it is impossible to know exactly how many women suffer from fistulas caused by obstructed labor, it is estimated that between two million to 3.5 million women in the developing world currently suffer from the condition and between 50,000 to 130,000 new cases develop each year. Fistula was common in western countries more than a century ago, but advances in medical care and universal access to emergency obstetric services have eliminated this condition in the industrialized world. Most of the women who have fistula today live in developing countries, where access to obstetric care is limited or nonexistent.

3. WHAT HAPPENS TO WOMEN WHO HAVE THIS CONDITION?

Once a woman sustains a childbirth injury of this kind, there are really very few places where she can go for help. In many parts of the world, women who do find help have waited five years between injury and treatment. By opening up a fistula hospital in Danja, Niger, the Worldwide Fistula Fund is committed to increasing access to care for women with childbirth injuries of this kind.

4. WHAT HAPPENS TO BABIES IN CASES OF OBSTRUCTED LABOR?

Among women who survive obstructed labor and developed an obstetric fistula, fewer than 7-percent have a live baby at the end of their ordeal. Since childbirth injury typically occurs during the mother’s first pregnancy, almost 70-percent of fistula victims end up with no living children. In the developing world, where family is usually one’s only source of security, the lack of children is devastating.

5. HOW DOES THE WORLDWIDE FISTULA FUND HELP?

The Worldwide Fistula Fund helps by performing fistula surgeries on women in southern Niger. Although fistula surgery is very challenging, it can still be performed with a high degree of success in low-technology settings throughout Africa.

6. HOW SUCCESSFUL ARE OBSTETRIC FISTULA SURGERIES?

The surgery to close a VVF is successful in the vast majority of cases but “closure” of the fistula does not necessarily mean that the woman is “cured.” About 15-percent of women whose fistula is closed continue to lose urine due to other problems with the bladder and urethra. Many women who have been through obstructed labor also have other injuries (including nerve damage, partial paralysis and/or traumatic pelvic conditions) that cause tremendous suffering and require ongoing physical therapy to address.

Simple Checklist to Prevent Maternal/Infant Deaths

Acording to this article from Impact, http://www.psi.org/impact-magazine/2012/05/can-simple-checklist-make-child-birth-safer, checklists have cut surgical deaths in half.  Makes alot of sense for birth.

PSI/India has joined a team led by the World Health Organization, Harvard School of Public Health, Bill & Melinda Gates Foundation and many others who are asking whether checklists can significantly reduce the nearly 5 million maternal and infant deaths a year associated with childbirth.

PSI/India and partners have assembled a 31-item list of reminders, from the simple – asking the mother’s companion to be present at the birth – to precise clinical signs of infection and hemorrhage. Their aim over the next three years is to test it in India to see whether childbirth-related harm, including death, in institutional deliveries can be significantly reduced through adherence to essential childbirth-related clinical care standards.

Helping Babies Breathe Initiative

The more I learn about clean birth kits and their usage, the more I understand how trained attendants are critical to the survival of moms and babies.

One amazing program that I have learned of is Helping Babies Breath.  This program trains midwifes, doctors,  nurses, and “in certain circumstances” traditional birth attendants in  neonatal resuscitation.  Here’s more:

The Curriculum

Helping Babies Breathe is a neonatal resuscitation curriculum for resource-limited circumstances. It was developed on the premise that assessment at birth and simple newborn care are things that every baby deserves. The initial steps taught in HBB can save lives and give a much better start to many babies who struggle to breathe at birth. The focus is to meet the needs of every baby born.

The Golden Minute®

Helping Babies Breathe emphasizes skilled attendance at birth, assessment of every baby, temperature support, stimulation to breathe, and assisted ventilation as needed, all within “The Golden Minute” after birth.

This article from USAID on The Golden Minute® is also worth a read.

 To reach five years, though, a child must take his or her first breath of life in the first minute following birth. The World Health Organization estimates approximately one million babies die each year from birth asphyxia, a condition in which babies who do not breathe on their own immediately following delivery.

Let’s not export our flawed social views on Maternal Health

Today I had a conversation with a friend who is in her 50s about breastfeeding her four children, who were born over approximately a 15 year period.  She said with her first, she didn’t breastfeed at all.  With her second, she breastfed for a month.  And with her third and fourth, born 22 months apart, she breastfed each for a year — and was sad to stop.

What made the difference with her last two?  She said that noone breastfed when she had her first, there was no support.  By the time the last two came, breastfeeding was acceptable if not embraced.  Breastfeeding in the US is increasingly embraced but breast milk substitutes are still being given to almost half of US babies by day 7, according to the CDC.

Thinking about this conversation about social context,  it is clear that society drives what is acceptable/good when it comes to breastfeeding and birth.

In the US C-sections (often scheduled) are de rigeur among celebrities, thus they are regarded by US Weekly fans everywhere as a preferred choice.  The role of midwives is misunderstood, thus they are not sought out.  Birth is seen as dangerous and excruciating and voices opposing this media-driven view are drowned out.  Breast milk and formula are both regarded by many as equally nutritious, with formula having advantages like “baby is more full and sleeps better.”

One of my fears is that our views of maternal health will be exported to the developing world.  It has already begun in the areas of c-section and breastfeeding.

C-section rates in the developing world are on the rise.  One study by Belizan et al comments:

Although the epidemic of caesarean section in Latin America is not new,6 little action is taking place to reduce its use. This is partly because caesarean section is now culturally accepted as a normal way of giving birth.23

Breast milk substitutes are being pushed on populations with neither the money nor the clean water nor the need for them.  Laos is one example where the population has historically had high levels of breastfeeding, but influxes of breast milk substitutes are changing the situation.  This 2010 study by Barennes et al finds:

In Laos, mothers with the highest socio-economic status are showing a tendency to give up breastfeeding. Successful educational strategies and advocacy measures should be urgently developed to promote and sustain breastfeeding in developing countries.

Women in the third world need many things: among them community health workers, midwives, medicine, emergency care and supplies.    However, importing our flawed views of breastfeeding and birthing will not save lives.  Instead, practical solutions need to be found on the ground, where C-sections and milk substitutes are reserved for medically necessary conditions.

“Midwives Matter for Maternal Health and More”

Great post from NotEnoughGood.com (http://notenoughgood.com/2012/04/midwives/).

Midwives are undervalued and overlooked throughout the world.  They could make a difference to maternal and infant health outcomes.  According to the article:

UNFPA outlines the many skills a professional midwife can offer in reducing maternal mortality and morbidity.  For example, before and during pregnancy, midwives can be a source of substantiated advice and information. They can be a source of family planning advice and materials. During pregnancy and labor, a trained midwife can recognize signs of problems in women and their newborns, and can refer a woman to the appropriate facility.  When adequately trained, midwives can also provide emergency care. Through these skills, UNFPA believes that midwives can play a key role in achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). In some countries, midwives can also provide vaccination services.

The article goes on to talk about success stories in countries that  “have harnessed the power of midwives as frontline maternal health workers”.  Malaysia was able to reduce maternal mortality in this way.

The article concludes:

Investment in midwives, who are part of their communities and able to provide culturally relevant but accurate information is an invaluable resource for many women who would otherwise go without such quality care.  Because qualified midwives are trained to understand infectious disease and issues in the scope of pre- and post-natal care, as well as delivery, they are important assets to countries seeking to improve the lives of women, children, and other vulnerable populations.

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