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Frequently Asked Questions about VVF Table of Contents
What childbirth injuries are most common ?The most common childbirth injuries that occur after obstructed labor are vesicovaginal fistula (VVF) and rectovaginal fistula (RVF). The word "fistula" is a medical term for an abnormal connection between two body organs or cavities. In VVF, the pressure of the fetal head in the pelvis during obstructed labor interrupts the blood flow to the tissues that are being compressed, causing those tissues to die. When the tissues between the bladder and vagina die, a hole opens up between them, causing urine to leak out as soon as it reaches the bladder. In RVF, the same process occurs, but in this case the tissues between the vagina and rectum are destroyed, leading and feces pour out through the vagina as soon as they enter the rectum. Back to TopHow long does "obstructed" labor last?In most large published series describing fistula victims, the average time in labor is nearly 4 days. Labor as long as 14 days has been reported; however, once labor becomes obstructed, the fetal head can exert enough pressure on the affected vaginal tissues to create a fistula in less than a single day. This is why prompt obstetric care is so important in preventing this complication of childbirth. Back to TopHow many women have these injuries?Everyone working in this area is frustrated by the lack of accurate information. In an effort to get to the bottom of this question, Dr. Cindy Stanton, an epidemiologist at the Johns Hopkins School of Public Health and a world authority on the demographics of maternal morbidity and mortality, recently traced each and every mention of the size of the VVF epidemic back to source documents. In the end, she found that all were based on estimates or guesses. Projects are currently being designed to do scientific survey studies on VVF. Getting accurate answers to these questions will take years of research. Back to TopCan these injuries be treated successfully ?The surgery to close a VVF can be successful in the vast majority of cases, but “closure” of the fistula does not necessarily mean that the woman is "cured". About 15% of women whose fistula is closed successfully continued to lose urine due to other problems with the bladder and urethra and many women who have been through obstructed labor have other injuries that also cause tremendous suffering. Although fistula surgery is very challenging, it can still be performed with a high degree of success in low-technology settings throughout Africa. Back to TopCan these women get help ?Once she sustains q childbirth injury of this kind, there are really very few places where a woman can go for help . Patients coming to the Fistula Hospital in Ethiopia waited, on average, 5 years between injury and treatment. The Nigerian government once estimated (another guess) that there were at least 800,000 VVF victims awaiting repair in that country alone. Think of the number of others who have no where to go! Women with childbirth injuries have just as much of a human right to healthcare as do women in wealthy countries. The Worldwide Fistula Fund is committed to increasing access to care for women with childbirth injuries. Back to TopWhat happens to the baby during obstructed labor?Obstructed labor can be deadly for the mother (it is one of the top five causes of maternal death worldwide), but the consequences for the baby are even worse! Among women who survive obstructed labor and develop a fistula, fewer than 7% have a live baby at the end of their ordeal. Since childbirth injury typically occurs during the mother's first pregnancy, almost 70% of fistula victims end up with no living children. In the developing world, where family is usually one's only source of security, the lack of children is devastating and has serious consequences for a woman’s old age. Back to TopWhy haven't I ever heard of this terrible problem before?A large part of the problem is that women in the developing world have almost no voice in the "world community". Can you imagine the media attention that would be given to a problem that left millions of American men dead or handicapped? Yet, the epidemic of developing-world maternal morbidity and mortality has gone largely unnoticed by the rest of the world. One of the major goals of The Worldwide Fistula Fund is to bring this "hidden epidemic" out into the open and to speak up for those who have no voice. Fortunately, awareness of this issues has finally started to grow. FGM, or female genital mutilation (also called “female getting cutting” or “female circumcision”), is a destructive cultural practice in which all or part of the external female genitalia are cut away for ritual reasons. In its most severe forms, these practices can cause fistulas themselves or result in scarring that in turn produces obstructed labor and VVF. Worldwide, however, most fistulas are not the result of FGM. FGM and childbirth injuries from obstructed labor tend to be problems in the same geographic areas, among the same cultural and ethnic groups. However, there are many parts of Africa where FGM is not practiced where fistulas are commonplace and many women who have undergone FGM deliver their children without developing a fistula. Both FGM and the presence of obstetric fistulas are linked to the low status of women in these societies, which results in a general lack of access to emergency obstetric services, high maternal mortality, and widespread problems with childbirth injuries. We think of FGM and fistulas as being different symptoms of the same problem: a refusal to acknowledge women’s inherent worth and to provide them with their “fair share” of nutrition, health care, education, and other social goods. For more information on related topics, please see the Other Causes page.
This is a complicated question. It is discussed in more detail on our Prevention page. |
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