Health, Maternal and Newborn Health
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Midwives: At the Center of Preventing Obstetric Fistula

This week, midwives from around the globe are convening in Prague at the International Confederation of Midwives (ICM) Congress to share best practices, new innovations, learn more about the current status of mothers and newborns, and inspire each other (and others) to action.

As midwives are at the center of caring for women, ensuring they have safe pregnancies and childbirths, they play a crucial role in preventing maternal mortality, as well as, maternal morbidities. The statistics of maternal mortality are devestating – nearly 300,000 deaths every year, and for every woman who dies, up to 20 women experience serious, at times life-altering, complications.

Obstetric fistula is a devestating childbirth injury due to prolonged obstructed labour, leading to the leakage of urine and/or feaces. “It is a double tragedy, as in most cases the woman has a stillborn baby,” said Dr. Hamid Rushwan, Chief Executive, FIGO, at a session on the subject. As the moderator of the session, Dr. Mulu Muleta, an Ethiopian surgeon who has dedicated her career to treating women with fistula, highlighted the challenges that women face when suffering from fistula – ranging from social exclusion and stigmatization to becoming unable to perform daily tasks. She stated, “it is such a devastating injury, some women believe they have been cursed by an evil spirit”.

There is not enough research on the amount of women living with fistula. Women who live in remote areas may not be counted and the prevalence of fistula is hard to estimate. Some estimates report that as many as 2-3 million women are living with the condition. Dr. Rushwan called them “guesstimates”.

Midwives at the center of caring for women’s health

Prior to and during women’s reproductive age, midwives are essential to empowering women to take infomed decisions about their health – whether it is providing adolescent health services, supporting access to family planning for delaying first age of pregnancy and spacing births, or advocating for safe pregnancies and childbirth. Midwives also play an essential role to prevent obstetric fistula.

Sister Marit Legesse speaking at the ICM Congress.  Photo Credit: Johnson & Johnson

Sister Marit Legesse speaking at the ICM Congress.
Photo Credit: Johnson & Johnson

As many of the indirect causes of fistula are related to socio-demographic factors such as child marriage, early pregnancies and lack of education, midwives have an essential role in educating, raising awareness and changing social norms.  “Midwives need to be trained to care for women with sensitivity to these social factors” highlighted Sister Marit Legesse, Ethiopian midwife and Vice Dean of Hamlin College of Midwives.

These are some key things midwives can do to prevent fistula:

  • Educate adolescent girls, parents and community members on the risks of early pregnancy and unattended deliveries
  • Ensure women have adequate nutrition and support the immunization of girls early in childhood
  • Improve access to reproductive health services and information, including family planning
  • Ensure pregnant women have access to maternal health services and information, and learn to seek care when experiencing complications
  • Provide competent care during delivery
  • Use of a partograph during labour, to identify prolonged obstructed labour
  • Advocate for emergency obstetric care facilities and skills
  • Promote women’s empowerment, including girls’ education

Midwives can also:

  • Dispell myths about obstetric fistula and inform that it is entirely preventable
  • Provide a safe space for women who have experienced fistula and listen to them
  • Help women with experience of fistula plan pregnancies and give birth at hospital

Obstetric fistula is a preventable and treatable condition. Educated midwives have the capability to perform nearly 90 percent of the essential care for women and newborns before, during and after delivery. When we invest in midwives, we invest in saving lives and preventing disabilities. When we invest in midwives, we invest in healthy women and children, enabling our communities to thrive.

A lot is being done to prevent and treat women with fistula. Here is a snapshot of some amazing work done in Ethiopia and Tanzania, captured by Johnson & Johnson. 

Featured image: An Ethiopian woman recovers from life-changing fistula surgery at the Hamlin Fistula Hospital in Addis Ababa, Ethiopia. Photo Credit: Lucy Perry/Hamlin Fistula Relief and Aid Fund Australia

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