The Addis Ababa Fistula Hospital

Over the last few years I’ve periodically received letters from the Addis Ababa Fistula Hospital, detailing the incredible healing work they do for the women of Ethiopia. This is a brief explanation of fistula and the wonderful people caring for the young women of Ethiopia.

It is estimated that throughout the world, one woman in every twenty will have difficulty in childbirth. In the 19th Century, the death of both mother and child was not uncommon.
Modern medical care and treatment, with easy access to Hospitals and doctors, has eliminated this threat in our western civilisation.
But this is not so in developing countries. The joy of parenthood is frequently marred in the aftermath of obstructed labour. Days in obstructed labour can cause a hole or fistula to the birth passage, the bladder and sometimes the rectum. As a result, the woman leaks urine constantly. She then has an offensive odour. Her husband will leave her and her family and friends will avoid her.
Many a young girl with fistula injuries has suffered a fate worse than death, experiencing a life of rejection, separation, loneliness and "shame".
In 1959, two Australian doctors Reg and Catherine Hamlin, went to Ethiopia to train midwives. Seeing the plight of these poor women, they became determined to help them.
They developed a delicate surgical technique that, in most cases, will result in a complete cure. Then they built the Addis Ababa Fistula Hospital. Since then more than 30,000 women have been treated and cured. The Hospital now trains doctors from other developing countries. The effect of their work is spreading world-wide, restoring new life and dignity of thousands of young women.

Every time I read one of the stories of the young women that are cared for at the Hospital, I end up crying all over myself. We are so lucky to live in a country where we have immediate access to medical care when we need it, and particularly for those women who do have genuine difficulty in childbirth.
I will be donating a percentage of all my Doula earnings to the Fistula Hospital, in that way all my clients will be a part of supporting these young women (most of them teenagers) and helping them to regain a life of dignity.
For more information on the Addis Ababa Fistula Hospital, and to read some of the stories, go to www.fistulatrust.org . I hope it impacts you as much as it has me.

(Fistula is really only an issue in third world countries, where healthy diet, good sanitation and education are not available for everyone. Most of the people affected are not women, but young teens and girls, far too young to be birthing, but in a culture and society where early marriage and therefore motherhood is common.)

Choosing an Obstetrician

If you are thinking of choosing an Obstetrician as your care provider for pregnancy and birth, it is essential that you choose someone who is the right fit for you. Just because your sister or friend had a particular OB and was happy with them, doesn't mean that you will be. After all, you wouldn't choose their husband/partner for yourself, so why would you automatically go with their OB?

The movie Knocked Up was less than impressive on the birthing side, but they did get a couple of things right. Interviewing at least 3 OB's is vital in discovering whether that person will respect your wishes for the birth you want. I wouldn't accept the "intimacy" of the interview process in Knocked Up (totally un-necessary!), but at least they didn't settle for the first OB they met. You might form a really good opinion of OB #1, but when you interview #2 you may discover that the first was really not on the ball with current evidence-based care.

Be informed of what is acceptable and safe obstetric practice before you begin interviewing, otherwise you won't know if what you're hearing is myth or reality. Unfortunately there are many OB's who would rather do a caesarean for their own convenience than wait and give you time to birth your baby naturally. However there are also some fantastic OB's who will not rush in to perform un-necessary surgery, and will give the birthing mother the respect, time and support to birth the way she wants to. But how do you work out who is good and who should be avoided?

Firstly, work out what you want your birth to be and why you want that. Do you want a completely natural, drug free birth? Do you want a natural birth, but are open to the idea of drugs if you decide to use them? Do you want every drug under the sun? Do you want a caesarean? Are you basing these decisions on what is best for you and your baby, or are you making decisions based on fear? Have you considered and researched all the options for maternity care? Don’t forget that although some women may need obstetric care, for the vast majority of women the very best maternity care you can receive is from a midwife.

Secondly, take responsibility for your birth. It is not the OB's responsibility to make the decisions and tell you what to do. It is your responsibility to accept this birth as yours, and make wise well thought through decisions about what you want, and then tell your OB what will be done. If they try and push you to do things a certain way that is against what you want, then they are not the right one for you, and you should take your business elsewhere. Do not forget that you are the client, you have the business they want, and they need to be respectful.

Thirdly, inform and prepare yourself well. Read the good books, not the ones written just for a laugh, (see recommended reading list below) remember that knowledge is power, and if you are well informed you will make wise decisions. Speak to people who can help you find answers to your questions, not just your mum or girlfriends, as helpful as they may be. Talk to midwives and Doula's. Even if you would never consider homebirth, talk to the independent midwives, they are highly trained, experienced and a wealth of knowledge, they will offer a different perspective which can only ever be helpful in giving you a more well rounded understanding of birth.

Fourthly, hire a Doula to support you and your partner throughout your entire labour and birth. Doula’s, unlike hospital based midwives and obstetricians, will stay with you throughout your entire labour and birth. Having that continuity of care makes an enormous difference to your ability to cope with labour and both mother and baby’s well-being.

Write down all your questions, so that you won’t forget them at your appointments. It’s all too easy to get distracted by listening to baby’s heartbeat and the myriad of other checks, and forget the questions you’ve been waiting all week to ask.

Here are some Interview questions for Obstetricians.

Under what circumstances do you consider Induction necessary?

If my waters break but I do not go into labour immediately, how long would I have before you would want to intervene?

What is your policy on breaking the waters, epidurals, episiotomies?

What is your episiotomy rate?

What is your policy regarding monitoring of the baby?

What is your policy on eating and drinking during labour?

What is your policy on Vaginal Breech Birth and Water Birth?

What is your caesarean rate for first time mothers?

What is your VBAC (Vaginal Birth after Caesarean) rate?

Under what circumstances would you consider doing a caesarean?

How do you try to avoid the need for a caesarean?

If an Obstetrician is very vague and dismissive of your questions, or if they patronise, ridicule or try to use scare tactics to convince you of their reasons, go somewhere else. It is better to choose a new care provider than to try to fight for what you want while giving birth. It is never too late to change care-providers. I know of women who felt unsupported by their Obstetricians, so at 8 and 14 days past their respective due dates, they changed care-provider and had the wonderful births they wanted.

Remember this is your birth and your baby, and you deserve to be supported and cared for in the way YOU require.