Obstetric fistulas

An MSF nurse leads a group physiotherapy session with patients.
NIGERIA 2017 © Maro Verli/MSF
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Obstetric fistula is a preventable but devastating injury that can affect women living in poor, remote areas without access to skilled maternal care. It can lead to stigmatization and exclusion from family and community life.

1
million
girls and women live with fistula worldwide
100,000
new cases
each year
90%
of women
who develop fistula lose their baby to stillbirth

An obstetric fistula is a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously. It usually arises from prolonged, complicated, and unattended labor. Doctors Without Borders/Médecins Sans Frontières' (MSF) health care projects for pregnant women help prevent the occurrence of fistula, and provide treatment and psychological support for those affected.

What causes fistulas?

Almost all fistulas are caused by prolonged, obstructed labor where the infant’s head is too big for the mother’s pelvis. Delivery stops when the uterus is not contracting properly. As the baby’s head continues to press against the birth canal, the surrounding tissue eventually dies and creates a hole or fistula.

Fistulas do not heal naturally. Often the baby will be stillborn, adding even more suffering for the mother.
 
While rare, our surgeons have also seen a small number of fistula cases resulting from extreme sexual violence.

How MSF responds

Our response to fistulas begins with working to prevent complications during pregnancy and birth, by providing comprehensive antenatal and maternal care, and by training local midwives to help mothers give birth safely.

We also perform fistula repair through either permanent programs or “fistula camps,” focusing on some of the world’s poorest regions with little access to obstetrical care. Because of the stigma attached to fistulas, our teams also provide psychological and psychosocial care to help fistula sufferers re-integrate into their communities.

Permanent centers: Today, MSF treats obstetric fistulas at a permanent center in Nigeria, which uses visiting surgeons to repair fistulas and provide post-operative care. After recovering, patients learn physical therapy exercises to strengthen their muscles and regain control over incontinence.

Fistula camps: In 2007, our teams began running periodic “fistula camps” to provide specialized fistula repair surgery in places with the greatest needs. The camps last around six weeks. The first phase is informing communities—especially women with fistulas—that the camp is happening and what it involves. For example, in Galkayo, a remote, undeveloped part of the long-troubled country, Somalia, we worked with community health educators and medical staff at small health centers to spread a very basic message: “if you leak urine, you can be cured; come to the MSF fistula camp.”

An advance team then sets up tents, typically with 40 to 80 beds, near a functioning hospital and hires staff. Next, a fistula surgeon arrives and spends the next few weeks operating on several women each day. Once recovered, these women are led through exercises designed to help them regain control over pelvic muscles that had been rendered all but useless by the fistula.

More recently we have conducted camps in Central African Republic, Democratic Republic of Congo, and South Sudan.

Training: We also conduct training for both midwives and local surgeons. Training local midwives is vital because they can identify when a mother is having difficulty giving birth and can arrange help before it is too late. For surgeons, although the operation does not require sophisticated equipment, it is technically difficult to carry out and takes some time to master.

Psychological and psychosocial care: Fistula sufferers often face severe stigma and even exclusion from work and/or community life. Our teams, therefore, provide psychological and psychosocial care aimed at helping patients see they are not alone, encouraging them to bond with one another and find the courage to heal, and then to re-enter the society that had shunned them.