Pregnancy is something that many women look forward to, even pray and hope for. In fact, motherhood is so special, that many couples go through assisted conception techniques to realise their dreams of becoming parents. Having children is easily one of the best feelings in the world and what better news for a couple than the two lines on the home pregnancy kit?

With this news, the couple’s lives are on the cusp of some significant changes that they can’t wait for. However, as exciting as this is, a mother-to-be can experience a lot of things that she wouldn’t be too happy about.

The long nine months of pregnancy are just the beginning of an even longer phase of a woman’s life that will turn her world upside down for the rest of her life! In the nine months of pregnancy and postpartum, a woman’s body goes through countless hormonal changes to accommodate the fetus in the body, nurture it and allow it to leave the body safely. Obviously, this is no small feat. Growing a baby inside the womb presents women with several challenges that include mood swings and physical changes. But hey, it isn’t limited to that.

Along with physical changes, hormonal changes cause the to-be-mothers and new mothers the likeliness to develop certain health conditions like gestational diabetes, varicose veins etc. One very painful and embarrassing condition is the development of obstetric fistula.

Giving birth is like a second birth for a woman. All along the nine months, she has selflessly carried a baby in a womb, changing her entire life to ensure that she protects, nurtures, loves and safeguards her baby from any harm. Through these nine months, she puts all of her needs aside to ensure that she can bring this baby into the world safely. Even before the delivery, she is a mother who is fierce enough to wade through fire for the well-being of her baby.

As the date for the birth inches closer, she knows she will be in pain; pain that can rip her to shreds and leave her gasping for breath. But, she prepares for it like a warrior, believing in the power she has and the sheer love for her unborn baby pushes her to deliver her baby, either vaginally or through a major operation like cesarean. She knows the risks, but she is very strong to go through with it.

Now, even though she is prepared for labour, she might be in for a completely different kind of a pain and health hazard – obstetric fistula. An obstetric fistula is a hole or a canal that develops between the vagina and rectum or bladder due to prolonged obstructed labour, leaving the woman incontinent of urine or feces or both.

Labour is an orchestrated harmony of several things. One, the baby should be in the best position – which is head down towards the birth canal. The factors inside the woman’s uterus or womb also contribute to the challenges in birth. Sometimes, a woman may experience something called obstructed labour. Also known as labour dystocia, obstructed labour is when even though the uterus is contracting normally, the baby does not exit the pelvis due to being physically blocked.

For women whose labour goes unattended, the labour can last up to six or seven days. The labour produces contractions that push the baby’s head against the mother’s pelvic bone. The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow.

This lack of blood flow causes the delicate tissue to die, and where the tissue dies, holes are created between the labouring mother’s bladder and vagina and/or between the rectum and vagina. This is what causes incontinence in a fistula patient. This could also prove fatal for the baby due to not receiving adequate oxygen.

• Flatulence
• Urinary incontinence (continual or only at night)
• Fecal incontinence (continual or only at night)
• Foul-smelling vaginal discharge or pus
• Abdominal or pelvic pain
• Fever
• Tenderness
• Itching
• Repeated vaginal infections
• Urinary tract infections (UTIs)
• Irritation or pain in the vagina or surrounding areas.
• Pain during sexual activity
• Nausea/vomiting
• Diarrhea
• Amenorrhea (Abnormal menstruation)

According to WHO, between 50, 000 to 1,00, 000 women worldwide are affected by obstetric fistula every year, and for every woman that receives treatment, at least 50 go without it. Sometimes the fistula may heal on its own. If it’s a small bladder fistula, the doctor will put a small tube called a catheter into your bladder to drain the urine and give the fistula time to heal by itself. They might also consider using a special glue or plug made of natural proteins to seal or fill the fistula.

In most cases, people require surgery to stitch the fistula together. The surgery depends on the type of fistula and where it is located. It could be laparoscopic, which is minimally invasive and where your doctor makes small cuts (incisions) and uses cameras and tools to fix the fistula. It could also require abdominal surgery.

The surgeon will sew a special patch over the fistula by taking tissue from your body to close it. They will fold a flap of healthy tissue over the fistula, fix the muscles of your anus if they are damaged, and prescribe medication and antibiotics to treat infection caused by the fistula.

Women who conceived early and/ or are deprived of proper obstetric care, generally suffer from obstetric fistula. This happens because they were not attended to on time when they started feeling the contractions.

It is very important for mothers-to-be, new mothers to have a healthy pregnancy and delivery so that they don’t face challenges in their future. It is advised to visit your obstetrician regularly and prepare yourself for the due date, well in advance, to avoid complications related to delivery.

At SMILES, we understand that postpartum is the time for new mothers to bond with their newborn babies and any health condition that threatens to eclipse this phase can cause a lot of stress to the mothers. We also understand that giving birth is physically and mentally draining, which is why, if a mother presents with a fistula, we ensure that we are sensitive towards her needs and give her the maximum comfort possible.