One slip in a vaginal delivery can lead to lifelong problems

Childbirth, one of the most beautiful moments in a woman’s life, turned into a nightmare for 30-year-old Ritika Saxena. A resident of Dwarka, a Delhi suburb, Ritika delivered a baby boy, six months ago, at a plush private hospital in South Delhi. Having heard about it’s reputation, she was assured of a smooth delivery. However, the experience turned out to be rather harrowing.

She was wheeled into the labour room after pain was induced. The gynaecologist was desperately trying to pull the baby out with forceps, as the baby’s heart rate kept dropping. In the process, Ritika’s insides were damaged severely. The tissue that separates the anus and the vagina was severed, and a fistula or a canal developed. “The gynaecologist just stitched me up from the outside. I went home in pain,” she said. 

Every time she went to the washroom she could see saw yellow deposits around her vagina. To Ritika’s ignorance, she was passing stool through her vagina. “Let alone make sure that I am properly cured, my gynaecologist refused to acknowledge that there was a problem,” said Saxena. She was examined again by a family doctor who suspected the formation of a fistula after the delivery.

In Saxena’s case,  the blood supply to tissues had been hampered leading to the formation of a fistula, a small connection between the anal canal and the vagina through which she was leaking stools.

Saxena later approached Dr Aparna Hegde, one of the very few urogynaecologists in India, who has specialised in anal sphincter injuries. “They are missed clinically at the time of delivery and  can eventually lead to stool and gas leakage. They need to be repaired at the time of delivery,” said Dr Hegde, Director, Centre for Urogynaecology and Pelvic Health. 

It is also important to undergo 3D endoanal ultrasound and anorectal manometry six months following the repair, to ensure that the operation was successful.

“To improve blood supply, a muscle flap from the thigh was inserted in the reconstructive surgery,” said Dr Hegde. 

Saxena underwent the surgery in November; the recovery process however will be long. “I cannot sit properly. I will have to undergo physiotherapy for three months to regain muscle strength, ” she said. From the time she was pregnant until now, she has spent close to Rs 8 lakh rupees within a year. 

In the case of 32-year-old Deepa (named changed), the situation was embarrassing. “Every time she would move, even a little, she would pass wind. Persistent incontinence of stools, or urgency of defecation are emotionally and socially debilitating,” Dr Hegde said. 

Hegde believes that there is a conspiracy of silence around issues women face post-pregnancy due to the damage of the pelvic floor. It is important to counsel women correctly about these problems. 

When Ludhiana-based Monical Agarwal (26) (name changed) had a fistula last year after pregnancy, she was debilitated. “I would end up spending entire nights in the washroom passing watery stool.

Doctors, during vaginal delivery, place a cut to ease the pulling of the baby. When the cut is deep, it can cause a fistula. “Till date, my doctor does not admit that it was his fault,” said Agarwal. 

She underwent a reconstructive surgery under Dr Hegde to get the condition corrected. “Total control over my urgency to pass stools will come back after the physiotherapy sessions which I need to undergo weekly for three months, she said. 

Dr Duru Shah, a Mumbai - based gynaecologist believes that more awareness needs to be created around this issue. “It is an error on the part of the gynaecologist and they should take every measure possible to correct the condition,” she said.