This is a practical guide intended for health-care professionals and planners, policy-makers and community leaders. It strives to draw attention to the urgent issue of obstetric fistula and advocates for change.
Obstetric Fistula
[UPDATED February 2016] Each year, more than a quarter million women die in pregnancy and childbirth. Of those that do not die, an unknown number suffer long-term health problems. The maternal injury with perhaps the most devastating aftermath is obstetric fistula. A fistula is a hole, or abnormal opening, in the birth canal, that results in chronic leakage of urine and/or feces.
Obstetric fistula due to obstructed labor is by far the most common form of genital fistula in the countries where we work, constituting an estimated 80-90% of all genital fistula cases. Obstetric fistula is usually caused by several days of obstructed labor, without timely medical intervention or cesarean section. During this time, the soft tissues of the pelvis are compressed between the baby's head and the mother's pelvic bones.
The lack of blood flow causes tissue to die, creating a hole between the mother's vagina and bladder or between the vagina and rectum, or both, and resulting in leakage. Left with chronic leaking, women with obstetric fistula are often abandoned or neglected by their husbands and families, unable to work, and ostracized by their communities. Women who develop obstetric fistula usually have had a stillbirth, so they must also deal with the loss of a baby. Women with fistula are often among the most impoverished and vulnerable members of society.
In this Trending Topic the Health COMpass presents several tools, training materials, and client materials that have proven successful in preparing both service providers and clients to understand and manage fistula repair surgery and obstetric fistula after-effects.
You are most welcome to add your own program materials to the Health COMpass on this, or any other topic. Just register as a user and contribute the materials online.
Banner photo: A young woman with fistula leans on her mother for support at the fistula hospital in Niamey, Niger. © 2013 Alison Heller/ Washington University in Saint Louis, Courtesy of Photoshare
Resources
This pamphlet is aimed at community health workers and volunteers. It explains how to prevent fistula and the devastating social, economic and health problems caused by it are explained in this pamphlet. It includes information on the surgery to repair fistula and where to get it.
This poster illustrates the major causes of obstetric fistula and many ways of repairing them.
Also illustrated is a woman suffering and a woman hopeful for her future after repair has been accomplished.
This poster provides guidance on how to advise women following fistula repair, depending on whether they wish to become pregnant or are willing to wait up to one year before becoming pregnant.
The goal of this curriculum is to prepare service providers at all levels to provide information and counseling to fistula clients, including referral for treatment and recovery services and counseling for related issues outside their usual scope of work.
This supplement complements the counseling curriculum to address the physical, social, and psychological impacts specific to traumatic fistula.
This booklet provides clients with information about family planning methods for couples following a woman's fistula repair. The booklet provides a list of questions to be answered by the client in making her decision about which FP method to use, depending on whether she wishes to become pregnant again:
This is a template for an informed consent form for obstetric fistula repair.
This training package contains materials to train health workers on obstetric fistula prevention, identification, and pre-repair care. The course contains a participant handbook, a facilitator manual, ten modules, a variety of visual aids, and supplementary handouts.
This brochure was created by a Fistula Care center in Sierra Leone. It explains how fistula happens, and what happens at the care center, including surgery and physical therapy.
This is a job aid for diagnosis of obstetric fistula when women present with a leakage of urine at a primary health care center. It offers a yes/no checklist for description of the women's symptoms, and a list of "to dos" to prepare the woman for repair surgery. There is also a list of references for further reading.
This brochure is a guide to informed consent for administrators, supervisors, and staff responsible for service delivery and for personnel providing direct care to clients.
It provides the following information as well as a sample of an informed consent form:
This checklist facilitates the supervision and monitoring of fistula repair service delivery. Forms include: Facility Information; Fistula Service Delivery at Facility; Monitoring of Counseling Services; Notes from Client Interviews; and Summary Notes and Recommendations from the Supervision and Monitoring Visit.
This poster offers five ways of preventing fistula:
This poster lists seven steps for providers to take when dealing with patients with obstetric fistula:
This postcard lists the harmful practices which need to be avoided so as to to avoid obstetric fistula:
This poster explains that obstetric fistula is reparable. It encourages women to go to the hospital in Kissidougou for treatment.
This checklist asks three questions:
Between 2005 and September 2013, 33,402 fistula repair surgeries were supported with funding from USAID, over 23,000 of which were supported by Fistula Care.
This guide serves as a companion to the "Learn From My Story" series.
This picture book is designed to support health service providers and field-level workers in raising awareness among local leaders and the general population about obstetric fistula and engaging these audiences in the effort to prevent obstetric fistula and improve maternal health in their communities.
This booklet provides clients with information about family planning methods for couples following a woman's fistula repair. The booklet provides a list of questions to be answered by the client in making her decision about which FP method to use, depending on whether she wishes to become pregnant again:
