{"id":70325,"date":"2016-05-22T14:48:37","date_gmt":"2016-05-22T12:48:37","guid":{"rendered":"http:\/\/www.myza.co.za\/better-maternal-care-in-africa-can-save-women-from-suffering-in-childbirth-the-conversation\/"},"modified":"2016-05-22T14:48:37","modified_gmt":"2016-05-22T12:48:37","slug":"better-maternal-care-in-africa-can-save-women-from-suffering-in-childbirth-the-conversation","status":"publish","type":"post","link":"https:\/\/www.myza.co.za\/press\/better-maternal-care-in-africa-can-save-women-from-suffering-in-childbirth-the-conversation\/","title":{"rendered":"Better maternal care in Africa can save women from suffering in childbirth | The Conversation"},"content":{"rendered":"
Women in Africa have poor access to emergency obstetric care during childbirth. <\/span> David Mooring\/flickr<\/span><\/span><\/figcaption><\/figure>\n

Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable \u2013 including obstructed and protracted labour and one of its side-effects, obstetric fistula.<\/p>\n

An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother\u2019s pelvis is too small or the baby is too large.<\/p>\n

In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.<\/p>\n

Although skilled attendants are necessary, it is the emergency obstetric surgeon who is needed to successfully remove the foetus and save both the baby and mother\u2019s life.<\/p>\n

A developing world problem<\/h2>\n

Obstetric fistulas are more commonly reported in developing countries, including South Africa. But it is predominantly localised to the \u201cfistula belt\u201d \u2013 an area spanning the northern half of sub-Saharan Africa from Mauritania to Eritrea, and the Middle East and Asia\u2019s developing countries.<\/p>\n

About two million women suffer obstetric fistulas worldwide. But most are concentrated in the fistula belt, where more than 6,000 new cases are reported each year.<\/p>\n

For example, in Ethiopia it is estimated that 9,000 women develop a fistula each year, of which only 1,200 are treated.<\/p>\n

A fistula forms when, during prolonged labour contractions, the foetus constantly pushes against the mother\u2019s unyielding pelvic bones. The effect leads to the compression of the blood vessels, which decreases blood flow to this area and deprives the tissue of nutrients.<\/p>\n

As a result it weakens the tissue and a hole forms. The baby is unlikely to survive \u2013 and if the mother survives and the fistula is not repaired, she is left with both psychological and physiological scarring.<\/p>\n

In some cases a woman may experience labour for up to a week. Globally, more than 75% of women with fistulas have endured labour that lasted three days or more.<\/p>\n

For most women who live in the developed world, obstetric fistulas are uncommon and are usually promptly repaired. This is primarily due to emergency obstetric care that is readily available.<\/p>\n

But women who survive the excruciating ordeal of obstructed labour and develop an obstetric fistula in impoverished countries are often doomed to a life of absolute misery.<\/p>\n

From a physiological perspective, they suffer from uncontrollable leaking of urine and faeces and are unlikely to bear more children.<\/p>\n

The psychological suffering stems from often being rejected by their husbands, shamed and socially segregated and ultimately divorced, demoralised and excluded from their family and religious activities. They also face a high risk of worsening poverty and malnutrition.<\/p>\n

Obstructed labour is preventable<\/h2>\n

In principle, obstetric fistula can be avoided by:<\/p>\n