Obstetric Fistulas After Childbirth: Understanding the Injury, Medical Negligence, and the Path to Recovery
Obstetric fistulas are among the most devastating long-term injuries women can experience after childbirth. This article explains what causes a fistula, how it can sometimes arise from poor obstetric management, what medical negligence may look like, and how affected women can seek support, validation, and legal advice. Written by a lawyer specialising in medical negligence and women’s health law in NSW.
Obstetric Fistulas: A Preventable Injury After Childbirth
An obstetric fistula is an abnormal opening that forms between the vagina and either the bladder (vesicovaginal fistula) or the rectum (rectovaginal fistula). This often results in continuous leakage of urine or faeces, leading to infections, odour, pain, and profound social and emotional distress.
While obstetric fistulas are more common in developing countries with limited access to emergency obstetric care, they do still occur in Australia—usually as a rare but preventable complication of prolonged or obstructed labour, or after instrumental deliveries and surgical errors.
How Obstetric Fistulas Occur
A fistula can form when the baby’s head is pressed for too long against the mother’s pelvic tissues during labour, cutting off blood flow and causing tissue death. When that tissue breaks down, a hole forms between the vagina and the bladder or rectum.
In Australia, causes may include:
Prolonged obstructed labour without timely intervention (e.g. delayed caesarean section).
Misuse of forceps or vacuum extraction, leading to tissue trauma.
Surgical injury during a caesarean section or hysterectomy.
Infection or poor wound repair following birth trauma.
Most importantly, early recognition and intervention can prevent a fistula from developing. When care providers fail to act on warning signs—such as abnormal labour progress, maternal distress, or fetal compromise—serious injury can follow.
Sources:
World Health Organization (WHO): Obstetric fistula factsheet, 2024
RANZCOG Clinical Guideline: Intrapartum Fetal Surveillance (4th ed.)
NSW Health: Maternity—Management of Obstructed Labour (Policy Directive, 2023)
When a Fistula May Indicate Medical Negligence
Not every obstetric injury is due to negligence. Childbirth carries inherent risks, and even with appropriate care, complications can occur.
However, medical negligence may arise when the standard of care provided falls below what a competent practitioner would have done in the same situation. Examples might include:
Failing to monitor labour progress adequately or recognise obstructed labour.
Not escalating care in time for a caesarean section.
Using excessive traction or inappropriate technique with forceps or vacuum devices.
Failing to repair a perineal tear correctly or monitor postnatal healing.
Delayed diagnosis or dismissal of postpartum pain, incontinence, or signs of infection.
From a legal standpoint, a woman may have a claim if it can be shown that the negligent act or omission caused or materially contributed to the fistula. Expert medical evidence is typically required to establish this link.
How Women Can Recognise a Possible Claim
Women often feel uncertain about whether what happened to them was “just bad luck” or preventable. Signs that it may be worth seeking legal advice include:
A delay in being offered or receiving a caesarean section despite signs of distress or prolonged labour.
Ongoing leakage of urine or faeces after birth that was initially dismissed by healthcare staff.
Difficulty obtaining records or inconsistent explanations about what happened during delivery.
The need for multiple corrective surgeries or long recovery periods.
A medical negligence lawyer can help obtain medical records, review expert opinions, and explain whether the care fell below acceptable standards under the Civil Liability Act 2002 (NSW) and common law principles.
The Broader Systemic Implications for Patient Safety
Obstetric fistulas highlight systemic issues in maternity care—particularly in recognition of birth trauma, timely escalation of care, and postnatal follow-up.
From a patient-safety perspective, these cases reveal:
The need for consistent adherence to RANZCOG and NSW Health guidelines on labour management.
Improved continuity of care, especially in rural or regional settings where delayed access to operating theatres can increase risk.
The importance of training and supervision in the use of obstetric instruments.
The psychological consequences of under-recognised birth trauma, which can compound physical injury.
The broader effect of these injuries is often silence and self-blame among affected women. Ensuring early recognition, reporting, and appropriate redress—both medical and legal—helps improve safety across the system.
Recovery and Validation: The Way Forward
Recovery from an obstetric fistula can involve surgery, physiotherapy, and significant emotional healing. Many women describe feelings of shame or isolation, particularly where symptoms were initially minimised or dismissed.
Validation starts with recognising that these injuries are not the woman’s fault. Legal consultation can serve a dual purpose: clarifying rights and responsibilities, but also helping patients reclaim a sense of agency and acknowledgment that their suffering is real and preventable.
Support groups, pelvic floor specialists, trauma-informed counselling, and multidisciplinary follow-up all play key roles in recovery.
If a woman suspects her injury could have been avoided, speaking with a qualified medical negligence lawyer can clarify her options, including compensation for pain, suffering, medical costs, and loss of income.
Conclusion
Obstetric fistulas are deeply traumatic but, in most cases, preventable injuries. They highlight the intersection between medical safety, systemic accountability, and women’s rights. While not all fistulas result from negligence, understanding when care has fallen short empowers women to seek both treatment and justice.
A legal review doesn’t just address individual harm—it contributes to a safer maternity care system for everyone.
