Silent suffering of women with childbirth injury

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

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