History of Obstetric Fistula

Photo Credit: Jeff Wilkinson

Obstetric Fistula has Plagued Childbirth Since the Beginning

The history of obstetric fistula is a quizzical one. Due to human evolution to upright walking, the pelvis has also changed with time. Simultaneously, our baby’s heads have gradually enlarged. With increasingly narrowing pelvic bones and larger babies, we have come into direct clash with human development.

We have had to interfere with evolution in order to save women and babies in birth.

Today's Options

Skilled midwives and physicians monitor the course of childbirth and can catch the signs of a baby who is not going to fit through the pelvis “normally.” (For more scientific information on this click here.) In these cases, assistance is needed. Obstetricians are trained to use medical vacuums and forceps to assist the baby in coming out if she has descended into the birth canal low enough. But if not, a cesarean delivery is needed.

This does not mean that all women need cesareans! Approximately 5-15% of women will experience this “mis-fit” of the baby and the pelvis and need a surgical intervention through a cesarean. Often times, however, a woman who needs a cesarean for this reason in the first delivery, will need one again in a future delivery.


This means that basically for the last 4 million years of human history, there have been women needing help during labor like a cesarean section, right? And only in the last 200 years, women have been able to receive safe cesarean sections.

So, what happened to all of those women who needed assistance and did not get it?

Sadly, they likely either died in childbirth or survived, but lived with an obstetric fistula.


A Surgical Solution

Women have been suffering from obstetric fistulas for centuries and finally, the medical community began trying with gusto to find a surgical solution in the 1800’s. A “race” set off between Western Europe and the US to perfect the surgical technique. Some women were helped, and many women were not.

It was not until J. Marion Sims used specialized suture made of silver employing the surgical dissection and repair techniques similar to what is still used today, that women began consistently being cured surgically. He developed this technique on enslaved women with questionable practice patterns.

Some people try to justify Dr. Sims as “a man of his time,” and he did help many women. That does not mean that unequal treatment should be justified. Instead, I say we remember the women who went through the traumatic deliveries that resulted in fistulas and then subsequently went through numerous traumatic surgeries to fix them.

To the indomitable courage of these long-suffering women, more than to any other single circumstance, is the world indebted for the results of these persevering efforts.

- J. Marion Sims