Reply #17: Obstetrical care saves women from horrible injuries and death. [View All]

Sure, healthy women often can deliver healthy infants without medical help. But many healthy women need medical intervention to deliver safely and when it's not available, women suffer horribly. Read up on what happens to women in Africa and other regions where medical care is not readily available:  


The Hidden Epidemic

Maternal Morbidity and Mortality

"A tremendous disparity exists between risks associated with pregnancy and labor faced by women in the developing world compared to women from wealthier nations. Over the course of a lifetime, 1 in 30,0000 Scandinavian women will die in pregnancy or labor. For a woman from Africa, the risk is 1 in 12. 

To think of it from another perspective, the annual number of maternal deaths estimated in the West African nation of Nigeria roughly equals the number of American men that died in the Korean Conflict of the 1950's.  The developed world seems to be unaware of the carnage, largely because women in the developing world have no voice in the international community.


But, for every woman that dies in labor in the developing world, many more find their lives destroyed by terrible injuries.   For most women, the problem is untreated obstructed labor.   Access to modern obstetrical care is only a dream for much of the world, and availability of a timely cesarean section is an impossibility.  The grinding pressure of the fetal head throughout days of obstructed labor causes interruption of blood-flow to pelvic organs, and a whole spectrum of injuries ensue.  Just a partial list of resulting problems would include:

Vesicovaginal Fistula (VVF):  The tissue lying between the bladder and vagina dies from lack of blood supply, and a large opening results.  This renders the patient totally and permanently incontinent of urine.

Rectovaginal Fistula (RVF):  The same process results in a hole between the rectum and vagina, and total fecal incontinence ensues.

Amenorrhea:   For nearly two thirds of VVF victims, menstrual cycles never resume, and the pregnancy resulting in this obstetrical catastrophe is the woman's first and last.

Vaginal Destruction:   Loss of blood flow to the pelvis results, for some women, in the total loss of vaginal tissue, and sexual activity becomes impossible.

Foot-drop:   About 1 in 5 VVF victims suffer damage to nerves supplying muscles in the lower leg, resulting in foot-drop.  This severely limits the woman's mobility and ability to perform the tasks associated with daily  living.
 

In many developing-world cultural contexts, the role of the woman is to provide sexual satisfaction for her husband, to produce children, and to do much of the hard labor associated with life in agricultural societies.  This spectrum of injuries is cruelly effective in destroying the woman's ability to perform any of these roles, and social melt-down results.   These women become social outcasts, isolated from family,  friends, village society, and religious life  by a scenario in which they had no active role. "

http://www.wfmic.org/hidden_epidemic.htm


from another source:

"Vesico Vaginal Fistula (VVF). . . is generally caused by prolonged, obstructed labour which, in some cases, can last up to 10 days. During labour, the infant's skull presses against the soft tissues of the mother's pelvis, interrupting the blood supply.

If the condition lasts for more than three hours, the tissues die, leaving an opening between the bladder and the vagina. As a result, the mother leaks urine continuously. The prolonged labour can also create a hole between the bladder and the rectum – a recto vaginal fistula - causing faeces to leak into the woman's vagina. In 95% of the cases, the infant dies inside the mother.

. . .Fistulas occur in 2 to 5 out of every 1000 deliveries and were quite common in Europe and North America until the middle of the 20th century."

(Fistulas were the reason for many women spending their days on a "fainting couch" in the "good old days." Apparently, there was less leakage of urine and/or feces as long as they stayed in a reclining position so they were carried around rather than walking. Obviously, only the well-off women got this treatment , God only knows what happened to the poor ones because they certainly don't fare well today in the countries where this is still a major problem.)


and yet another source:

"An obstetric fistula is a hole that develops between a woman's vagina and her bladder or rectum, or both, usually as a result of trauma during childbirth. If a woman's baby will not fit through her birth canal because her pelvis is too small or the baby is too big or badly positioned, the labor is said to be obstructed.

The baby's head becomes wedged in the mother's pelvis, cutting off the blood supply to the soft tissues of her bladder, rectum and vagina.Where there is inadequate obstetric care, a woman may be in obstructed labor for three or four days without relief. The baby usually dies. If the mother survives, her injured pelvic tissue soon rots away, creating a fistula.

Fistulas may also result from ritual genital cutting, unsafe abortion attempts, pelvic fractures or other injury.

Consequences of obstetric fistulas:

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Women with bladder (vesico-vaginal) fistulas have no control over their urine, and those with rectal (recto-vaginal) fistulas have no control over their bowel movements.
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The women suffer from discomfort and humiliation of constant wetness that leaves them with genital ulcerations, frequent infections and a terrible odor.
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Rupture or scarring of their uteruses may have left them infertile.
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Affected women are often blamed for their condition, which may be confused with venereal disease. They are shamed, ostracized, divorced, abandoned, isolated and left without support. Many women are forced to become beggars.
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Women who formerly prepared or sold food for a living usually can no longer do so, as they and their possessions are regarded as unclean. They may be excluded from religious practices and barred from public transportation.
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As most of these women's babies died from the obstructed labor, and many suffer infertility afterward, they may be further isolated in societies where childlessness is unacceptable and social support systems require kinship groups."



Read the story of Hawa Musa, a Nigerian victim of injuries from childbirth to get a better picture of what the numbers and clinical descriptions mean for a woman's life. (More numbers: It's estimated that there are at least 200, 000 Nigerian women living with these injuries.)

http://www.wfmic.org/profile2.htm