By L Lewis Wall. John’s Hopkins University Press, 2018.
It is difficult to know where to begin in writing a review of this book, as it brings together information from many areas; although possibly on reflection, I did not know what to expect. The book is not an academic text discussing the causes and treatments for the devastating and debilitating condition of obstetric fistula. Instead, Professor Wall has drawn upon his anthropological and medical expertise gathered from over 20 years of experience to bring the history and tragedy of obstetric fistula to the forefront of our minds.
It is fascinating and equally distressing to discover that evidence of vesico-vaginal fistula was observed as far back in history as the Egyptians, as described in Chapter One. Queen Henhenit was of small stature and suffered an obstructed labour, ultimately causing her untimely death. This discovery was made when archaeologists discovered a tomb containing the mummified body of the queen.
Chapter Two explores in detail why humans may suffer difficult and obstructed labours. Wall discusses the female anatomy and evolution in an easy-to-read style, interspersed with historical examples of obstetric fistula and alongside his personal experiences of working in such situations. Furthermore, he explains other complications thatzare a result of difficult births and which can have equally devastating lifetime consequences for the woman.
Although today we consider obstetric fistula to be confined to women in less affluent countries, we must not forget the reason it is rarely seen, as some long-term sequelae of childbirth are due to the high level of care and facilities afforded more affluent countries.
The middle chapters of the book continue in this vein and discuss the lack of facilities, the delays in gaining help, and how early intervention could and should be achieved. If the same life-saving facilities were available worldwide then women would not have to endure such agonies and shame, and the lives of babies would also be saved.
Chapter Ten introduces the work of Catherine and Reg Hamlin, both obstetrician-gynaecologists who began the Hamlin Fistula hospital over 50 years ago to help women suffering from this tragic illness. As a result of the Hamlins’ dedication and success, further centres have been created in other areas.
This short review cannot begin to explain the content and value of such a book. It reaches out on so many levels, giving an understanding through history, anthropology, science and compassion. Amazing work is being undertaken to treat and heal the women affected; however, so much can and still needs to be done to prevent fistulas and associated problems occurring during birth. To achieve this goal Wall states ‘that every woman in the world delivers her children in the presence of a skilled birth attendant who can summon emergency care when complications arise’ (p276).
The book does not make for comfortable reading, but anyone with an interest in improving the lives of childbearing women will be informed by the content.
Featured in the September 2018 issue of MIDIRS Midwifery Digest.
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