Understanding Obstetric Fistula

Many people understand that obstetric fistula is a childbirth injury caused by prolonged and unrelieved obstructed labor, that when left untreated leaves women incontinent. But, there is often confusion about what exactly produces an obstetric fistula. Contrary to a common misconception, the injury is not due to ripping and tearing of tissue, rather it is due to pressure of the baby’s head being pushed against the mother’s pelvic bone by uterine contractions during labor. This pressure can cut off the supply of oxygenated blood, and the tissue, deprived of oxygen becomes “necrotic” or dead. It is the dead tissue that when it falls away creates the holes in the vagina, bladder and sometimes the rectum, which allow bodily waste to leak uncontrollably. Those holes are literally called “fistulas”; in layman’s terms a hole between an internal organ and the outside world that should not exist.

The World Health Organization has labeled obstetric fistula the most devastating and serious of all childbirth injuries. It was eradicated in the United States more than 100 years ago. In fact, the site of the Waldorf Astoria Hotel in New York City is the location of a fistula hospital that closed in the 1890s.

Unfortunately, in the world’s poorest countries and most rural areas, a majority of mothers are delivering babies at home without medical help. That sad truth is one of the reasons that complications from pregnancy and childbirth are among the leading causes of death and disability for women of reproductive age in the developing world. The good news is, in the hands of a trained surgeon, most women with obstetric fistula can be cured through surgery.

This article originally appeared in Fistula Foundation’s Spring 2014 newsletter. Click here to view a PDF of the entire newsletter.