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International Day to End Obstetric Fistula

Mendenhall Glacier – Juneau, Alaska

Happy Monday to you! I’m celebrating turning 36 years old as well – which oddly enough, seems to be the most uneventful and peaceful birthday I have ever had! Does that happen as you get older?

I even made my own birthday cake – more as an activity for the kids than anything else – but we all got our share of licking some frosting off the beaters. Hands down, my favorite cake is chocolate cake with white icing. Anyone else stick to the same cake each year? Costco has a close second for yumminess too.

Anyways, May 23rd is the International Day to End Obstetric Fistula. The United Nations has made it a goal to end obstetric fistula by 2030. I don’t think it’s a realistic goal – there are a lot of factors, nations, and a global pandemic involved. But the spotlight on this diagnosis is worth the attention.

Source

If you’re new to the blog, I have a fistula from the birth of my second child. You can read about it here and here, but the short version is the OB/GYN sewed through my sphincter while she was repairing my second degree (technically, it’s an iatrogenic fistula since it was caused by error and not a laceration). I attempted to have surgery to fix it in 2021, but the surgery failed.

After that, I decided to share my story on the great wide web because everything that I had questions about I couldn’t find any answers too. And since then, I have women email me every couple months about their situation or story. For me, it turns out, you can have an extra hole in your body and live a pretty normal life. But that’s not the case for everyone.

So I’ll keep honoring the day and sharing my story for awareness.

For mamas

The main cause of fistulas in the United States is from poor healing or repair from a 3rd or 4th degree tear. These tears are more common in women that have an operative birth (with a vacuum or a forceps) and this risk is often briefly described by the provider that is offering the intervention right before they do the intervention.

Source

Because of this risk and the lack of information about the procedure’s risks, I found this handout a while back and print it out for all my mamas that have a 3rd or 4th degree tear in the hospital. Even if you didn’t get this information while you were in the hospital, I still recommend reading through the education in case an issue develops in the future, or that it would change your birth desires or plans in the future.

Most women will not have any long term issues after their laceration has been repaired, but a few will; this information is for those women because you usually find out you have a fistula one of two ways:

For any of these symptoms, please reach out to a board certified surgeon and see my prior posts on questions to ask them as you navigate your journey.

For providers…

There are two ways to look at fistulas: prevention and diagnosis.

For prevention, you must have excellent suturing technique and when you do not have the right lighting, suture, stirrup positions, etc., you must ask for someone to help you get the right environment for a good repair. In the event of a significant laceration, The Royal Women’s Hospital has a great handout for beginning providers on what to do, how to repair, and what to document.

I like to think that midwives prevent a number of operative births, but that’s had to find in the data and is always going to have different data site to site. But preventing an operative birth is a great way to minimize a fistula risk.

Another way is to practice OASIS (obstetric anal sphincter injuries) prevention techniques is to practice the SAFE PASSAGES protocol on your unit. SAFE PASSAGES was born out of a military initiative and the study found that when these interventions were practiced, OASIS tears were reduced by 63%! In civilian institutions, rates dropped by 38%. You can read the whole article here if you have a Medscape account (if not, it’s free to sign up).

Consider bringing this up at an upcoming journal club and see if there is interest in trying to change the culture on your unit! Or, just print out the acronyms and post them everywhere on your unit.

And, if you are a labor and delivery nurse, consider implementing these into your second stage interventions!

Obstetrics & Gynecology has a great article about that details OASIS lacerations, prevention and counseling for women after an OASIS tear. I found this article helpful when I am looking for data to counsel women on the risks of recurrence for future births.

There are a lot of factors that contribute to 3rd or 4th degree tears. And in the next few decades, we may see an increase in the vaginal tears. Some sources cite that the tears have gone from 1% of vaginal births in the late 1990s, to nearly 5% of vaginal births in present day.

Obesity, gestational diabetes, macrosomia, first time pregnancy…these are all contributing factors.

What do you guys think? Does your unit practice SAFER PASSAGES? Is it time that they should??

And here’s a sneak peak, the 38 and 39-40 templates are almost done – my favorite feature is that they’ll have bishop score charts on them as a teaching tool and a quick bishop score calculation for induction scheduling.

I’m hoping they’ll go live on the blog in about 1-2 weeks! And there are big things planned for the templates once the prenatal series is completed too…stay tuned.

Thank you for honoring and acknowledging this day, my story and women with OASIS tears. Awareness and education are the first step.

Love you guys!

Jamie

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