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Obstetric Care Saves Lives
Avoid the three delays.
(1) Delay deciding to seek care.
(2) Delay reaching a health care facility.
(3) Delay receiving attention at the facility.
Improving access to good-quality obstetric care, including skilled attendance during labor and delivery, helps women avoid obstetric fistulas. A skilled birth attendant can recognize obstructed labor before it becomes prolonged and quickly refer cases to emergency obstetric care.
Avoid the three delays.
Avoiding the three stages of delay—in deciding to seek care, in reaching a health care facility, and in receiving care at the facility—can substantially reduce the risks of prolonged obstructed labor and thus of obstetric fistula (54, 63, 70):
(1) Delay deciding to seek care.
The first delay can occur if a woman or her family delays seeking care from a skilled birth attendant, or if the attendant delays making a referral to an emergency obstetric facility. Cultural taboos, low status of women, lack of knowledge and skills, limited options for transport, and lack of resources often contribute to such delays (54). For example, in the Jos, Nigeria, study 29% of the patients delayed seeking care during obstructed labor because they did not have permission from the family (70).
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| WHO recommends use of a partograph, a chart for recording information about the progress of labor, as a key to avoiding prolonged labor and its complications. The partograph can help providers assess the conditions of the mother and fetus and identify when immediate medical care is needed. This partograph indicates an obstructed labor. The provider promptly recognized that action was needed and performed a cesarean section (82). |
To avoid delays, the family during the antenatal period should develop a plan for the birth and be prepared to deal with complications, including arrangements for transportation to a health care facility. A health care provider can help families prepare their plans (34). Families, midwives, and other rural health providers can learn to recognize the warning signs of maternal complications during delivery. Raising awareness of women’s reproductive health among families and community members, including husbands, mothers-in-law, community elders, and religious leaders, can support efforts both to prevent and to treat fistula (71).
In particular, skilled birth attendants should monitor labor through the use of a partograph, or partogram—a simple chart for recording information about the progress of labor and the condition of a woman and her baby (see left). WHO recommends use of a partograph with every labor (76). This decision-making tool is a key to prevention and treatment of prolonged labor and its complications, but in many developing countries it is still not widely used (26, 76).
(2) Delay reaching a health care facility.
It has been said that obstetric fistula results from a combination of obstructed labor and obstructed transportation (66, 71). Even after a decision to seek care has been made, a woman may not reach a facility in time to receive emergency care.
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A pregnant woman rides in the back of a truck for an emergency visit to a clinic in Zambia. It has been said that obstetric fistula results from a combination of obstructed labor and obstructed transportation. To avoid a delay in seeking emergency care, the woman and her family should develop a plan for the birth and be prepared to get her to emergency care quickly. |
To help avoid delays in reaching care, health care systems can develop better referral processes. Better transportation and communication between rural areas and hospitals and other centers that offer emergency obstetric care are vital to a functioning referral process. Families and communities can improve obstetric emergency preparedness by setting aside funds for emergency transport and related needs (36).
(3) Delay receiving attention at the facility.
The third delay can occur at the treatment facility itself. Many hospitals and clinics do not have enough skilled personnel to offer prompt surgical treatment for emergency obstetric cases. Emergency care may be delayed because supplies are lacking, diagnoses are late or wrong, or actions are incorrect. To help avoid delays at the facility, doctors, nurses, and other medical personnel need better training, equipment, and supplies. Policies should promote prompt emergency obstetric care for all who need it (62).
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