These childbirth injuries are most common in parts of Africa and the Middle East. The problem is common in these areas because women marry very young. They become pregnant before their bodies have had a chance to fully develop. When the time comes to deliver, the birth canal is just too small to fit the baby. The result is obstructed labor, and the best management is c-section--if the woman lives in a place where c-sections are available. Unfortunately many of them don't. These woman may labor for days and days. Eventually the baby dies; the skull collapses allowing it to deliver.
Loss of a baby is only the beginning of the tragedy. The days of labor with the fetal head squeezing the vagina, bladder, and rectum against the bones of mom's pelvis cause a loss of blood supply to the compressed tissue. The tissue becomes necrotic, forming a hole between the bladder or rectum and the vagina. This hole is called a fistula. Women with fistulas become incontinent of stool and/or urine. Their husbands leave them and they become outcasts in their community.
There is hope for a small number of these women. Once upon a time I read the inspiring story of Drs. Reg and Catherine Hamlin, missionary physicians who founded the Addis Ababa Fistula Hospital in Ethiopia. The hospital cares for women who have childbirth injuries. They also train surgeons from other parts of the world to repair fistulas.
A few years ago, PBS aired a documentary called "A Walk to Beautiful." The film follows the lives of five Ethiopian women who suffered from OB fistulas, and their journey to healing. You can also find it posted on YouTube.
We don't see OB fistulas very often here at Kudjip (thank goodness). Women in PNG tend to get married in their mid to late teens, or even early twenties, so their bodies are more ready to have babies by the time they do. Those who do have obstructed labor can usually make it to a hospital for delivery and/or c-section.
Madlina's story could have come out of Ethiopia. She is from the Jimi, a poor and remote valley here in PNG. She was pregnant with her second child and began to feel contractions at about nine months. The pains came stronger and stronger, lasting for five days. She was finally able to make her way to a rural health center. The nurse attempted to do a vacuum delivery, but there just wasn't enough room for the baby to come out. By the time she arrived at Kudjip, the on-duty nurse was unable to find fetal heart tones. Madlina delivered a dead baby with a fractured skull.
When I saw Madlina and reviewed her chart the morning following her delivery, I knew that she was very high risk for developing a fistula. I ordered a foley catheter. She was started on broad spectrum antibiotics and the nurses washed her every shift. Despite our diligent care, things were looking pretty bad for the first few days.
One day when I was doing an ultrasound, I noticed that there were tears in Madlina's eyes. I asked her why she was crying and her watchmeri replied that she thought that God was punishing her. My heart broke for Madlina again. I explained to her how much that He loved her, that He sent His very own son to bear the punishment for our sins. Because of Jesus's death, the Lord knows what it is to loose a child. His heart breaks for Madlina, too. I prayed that He would give her comfort.
Well, slowly our patient began to get better. Her pain resolved. The vaginal tissue turned from necrotic to pink. Dr. Jim took over her care and was able to sew up her laceration. About two weeks after her admission, Madlina was able to go home. You should have seen the lovely smile on her face! It was something like this...
There is still a chance that Madlina could develop a fistula. If she does, we will likely refer her to a hospital in the neighboring province. There is an OB/Gyn doc from Egypt who has some experience in repairing OB fistulas.
Please pray for this beautiful young woman, that Papa God would heal her physical wounds and those of her heart.
"He has made everything beautiful in its time. He has also set eternity in the human heart, yet no one can fathom what God has done from beginning to end."
~ Ecclesiastes 3:11