By Chioma Obinna

It’s been over a year since 25 -year- old Chinyere Simeon lost her baby at birth due to what health experts told her was  obstructed labour that lasted  several days. In addition to losing her baby, she started leaking urine uncontrollably from her vagina. The condition is what is known as obstetric fistula- an abnormal hole in-between the bladder and the vagina or the rectum. The condition left her permanently incontinent.

It was hard to comprehend as she sat on her hospital bed with her two hands buried in-between her thighs. Meanwhile, she kept hope alive.

For victims of fistula like Chinyere, health experts say regular ante-natal visit and hospital delivery would have saved her baby as well as guarantee her optimal health.

Health surveys in the country show that while health facilities are available with specialised health services, many pregnant women boycott them for various reasons. According to health officials, many pregnant women still patronise unskilled medical personnel including traditional birth attendants. They say even those who manage to attend ante-natal in hospital do not deliver in those facilities.

Chinyere and 35- year -old Agbowo Lebechi admit they had been patronising unqualified birth attendants throughout their pregnancies. Agbowo said she did so with her five pregnancies.

According to the Federal Ministry of Health, one of the dangers of patronising  unskilled birth attendants is  avoidable loss of babies. Another is fistula. When it occurs it leads to  rejection by other members of the family. Sometimes, victims are abandoned by the community.  Chinyere said she lost her second baby to prolonged obstructed labour.

“I was in labour for several days in the house. When nothing could be done by the nurse at home, I was transferred to a private hospital. Getting to the hospital, my bladder burst, and that was the beginning of my problem,” she said, adding that she never knew there was danger in patronising quacks.  Her first child was delivered in the house without  complications.  Just like the saying that no two pregnancies are the same, Chinyere thought her second delivery was going to be easy like the first.  Unfortunately, the reverse was the case.

“In the hospital, the labour continued from 7am to 6pm and nothing happened. I was then transferred to a General Hospital where I was operated upon.

“My baby could not make it.”

Chinyere said she was devastated and regretted not going to hospital for ante-natal.   “If I had known, I would have gone to  hospital earlier.  I never knew the importance of ante-natal visit.  I did not attend anyone.”

Teary eyed, Chinyere described the situation as one of one trouble after another. “I started leaking urine at the hospital but I was discharged.  They only told me about it without offering solution”, she explained.

The Okposi in Ohaozara LGA, Ebonyi State born tailor added: “Everyday I changed pads four times. I spent N800 daily on pads alone”.

Now that she no longer leaks urine after a successfully surgery at the Abakaliki National Obstetric Fistula Centre, she says she will become an ambassador for fistula.

“Once I am discharged, I am going to use my story to spread the message on importance of hospital delivery and antenatal” Chinyere stated. “It has been hell for me. I told myself I should die but, today, the story is different.”

Chinyere said she owes her life to the woman who directed her to the centre for repair.

“I am fine and no longer leaking. From now on, I will be advising other women to always go to hospital once labour starts because it was the delay I had that led me to this problem.  I can’t wish this for my enemy.

“I want God to bless everybody that has contributed to this National Fistula Centre where I was treated free of charge”.

Modupe Adekogba,  Family Planning Advisor with Fistula Care Plus, a fistula project in Nigeria funded by USAID and managed by Engenderhealth, Mrs. Olajumoke Adekogba, said that during ante-natal visit, pregnant women are handed first-hand information about how healthy the mother and baby is.

“Ante-natal clinic will expose danger signs during pregnancy. Women are also taught the  importance of hospital delivery. There are a lot of things you would have prevented during this period like malaria in pregnancy and anaemia, etc” Adekogba added.

She urged pregnant women to go early to hospital to prevent obstructed labour which eventually leads to fistula. “When a woman delivers in hospital, problems are identified early and taken care of.  Emergency Caesarean section to save mother and child are done easily. In addition, you have a lot of experts that can rally round and give expertise advice.”

She also advised women to take up family planning which helps in child spacing as a strategy to reduce fistula, adding that, if there is adequate spacing of children, the woman will have time to recover from previous delivery.

“If a family is well planned, there will be less frequent pregnancy.  A woman that has access to information, education on child spacing will know that the benefits are more.  There is need to let the community leaders know about the benefit of child spacing. If they are involved, they will encourage their women and dispel all the myths and misconceptions about family planning.”

Prevention key to ending fistula – Experts

Separately, Clinical Associate, FistulaCare Plus,  Dr. Suleiman Zakariya, said 12,000 new cases of fistula are recorded in Nigeria annually.   According to him, this is in addition to the backlog of about 150,000 cases waiting to be treated.

“The most vulnerable group is the young, poor, rural women who are economically disadvantaged,” he stated.

Zachariya described fistula as a devastating medical condition that affects women of reproductive age, adding that prevention is key to ending it

While tracing the commonest cause of fistula  to prolonged obstructed labour, he said records had shown that prolonged obstructed labour accounts for more than 90 percent of all cases globally.

He explained that pregnant women should attend regular ante-natal clinic to end fistula.

“Pregnant women must deliver in  hospital under the supervision of trained medical personnel and that is a major factor in ending fistula.  There is also the need for couples to plan their delivery by identifying a hospital and making advance financial plans.

“It is important for the hospital to  offer emergency obstetric care. Also community involvement is necessary in this fight because when the community is sensitised, they will do a lot to prevent fistula from happening”.

Zachariya added that nutrition can play a major role in preventing fistula even before a young girl becomes pregnant.

“Nutrition is a component of a good ante-natal care because ante-natal will encourage the pregnant women to eat well because the baby also requires good diet to develop and for the mother to boost her immunity”, the Clinical Associate said.

“But the link between nutrition and fistula usually happens during adolescent”

“The young mother is bound to have a lot of problems on how her bones, will develop in the body.   If the bones especially the pelvic bone, did not develop well there is no way it can support pregnancy. So such a person will have a lot of problems during pregnancy and labour”.

“Again, adequate nutrition cannot be ensured in our communities where we have social challenges. So eliminating social challenges will ensure a healthy outcome of pregnancy and child birth”.

He advised women to ensure they do not stay long in labour, adding that labour should not exceed 12 hours.

“When it goes beyond that, the woman needs to be checked and to determine the next line of action,” he stated.

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