Hello all!

I know what you’re thinking…“Enough of the politics. I’m sick of it!” Well, your wish is granted…somewhat. This week I’m going to spend some time writing about an often ignored topic. I will be discussing a childbirth complication in the following paragraphs, some may find it graphic but your birth may have been graphic as well.

Childbirth can be difficult and painful under even the best circumstances (so I’ve heard). Under worse circumstances, it can also be dangerous and life threatening. In impoverished countries, complications of childbirth can leave women permanently disabled with limited options for recovery (source-1).

A particularly devastating and shockingly common complication is an obstetric fistula (OF). A fistula is an abnormal or surgically made passage between organs. An OF is an abnormal connection between the vagina and the rectum or bladder. OFs may arise after a prolonged, obstructed labor [accounts for 76–97% of OFs (source-2)] when emergency intervention isn’t possible (1). This type of labor is also a major cause of maternal mortality (2).

An obstructed labor occurs when the head of the descending fetus is able to enter the vagina but the shoulders are unable to. Without medical intervention, labor may continue for days when obstructed. The pressure of the fetal head cuts off blood supply (and therefore oxygen) to the pelvic area. This lack of oxygen results in the death of tissue; as the dead tissue falls away, a hole is formed (a fistula) in the birth canal between the vagina and the bladder or the rectum. It is one of the most tragic and serious injuries that can be sustained during childbirth. Adding inconceivable insult to unimaginable injury, these fetuses are often stillborn, approximately 90% (source-3), due to the lack of oxygen during the prolonged labor (2).

These mothers, who have just lost a child, are then faced with a chronic medical condition in which either urine or feces (or both) leak uncontrollably. This can (and often does) result in frequent infections, renal disease or failure, painful sores, and infertility. They may suffer nerve damage or lose the ability to walk. They are often prevented from working and shunned into isolation by their families due to their odor, constant dribble of urine down their legs, and the puddles of urine that surround their feet if they stand for too long. They are often divorced by their husbands and forced into isolation. As any human will understand, this often leads to depression and even suicide (2).

This is especially concerning because OFs are more likely to afflict pregnant girls who are giving birth for the first time. This is because these girls are still physically immature and are at high risk for cephalopelvic disproportion (the fetus’ head is too large for the mother’s pelvis). In Mali, 45% of girls marry AND give birth before the age of 18. In addition, malnutrition (often experienced in impoverished countries) can lead to poor bone health, adding to birth complications (2).

The World Health Organization (WHO) estimates that more than two million women worldwide live with a fistula, with 100,000 new cases added each year (although no worldwide, comprehensive studies exist). However, since these women are often forced to lead isolated lives, it is likely these numbers are significantly underestimated. One study found that in Nigeria alone there are one million cases (2).

The good news concerning this seemingly dire situation is that fistulas are almost entirely preventable. They are practically unheard of in industrialized nations due to the availability of emergency intervention during a prolonged labor [usually cesarean section (c-section)] (2).

For those who are currently suffering, reconstructive surgery is possible. Unfortunately, many affected women are unaware of this and those that are aware are often too far from or too poor to afford treatment (2).

OFs are a terrible result of lack of access to quality health services and education, persistent poverty, gender inequality, child marriage, and adolescent pregnancy found throughout the world (3). Fortunately prevention can be achieved through effective programs that teach family planning, prenatal care, safe labor and delivery, and postpartum care. Other important interventions include: improving access to maternal health care and emergency obstetric care; increased rates of c-sections when necessary; increasing the minimum age of marriage; keeping girls in school; and improving overall nutrition status (2).

There are multiple organizations dedicated to these efforts. One program I think is particularly effective is Hamlin Fistula USA. Not only do they help women with fistulas, they also have the Hamlin College of Midwives. In 2016, they delivered over 22,000 babies across 32 rural centers with ZERO fistulas!
As always, I have multiple recommendations of my favorite form of media…that’s right — podcasts, baby!

First on the list: Have you been hearing more and more about the ‘Emoluments Clause’ since President Trump was elected? Would you like to learn more about it? Check out this “Planet Money” episode on the topic then.

What if you want to learn more about immigration’s effect on jobs in the United States? Check out this episode from “Science Vs.” I’m not the biggest fan of the host but I do appreciate the well researched information she puts forward.

Remember when I was writing about how I need to eat less red meat? (I did successfully avoid a burger Tuesday night). What if an allergy actually forced me to stop eating it altogether? It could happen — check out this episode of “The Sporkful” to learn more.

Two fun things (thanks, PK): 
1. I recommend trying “Touch the Sky” + “Short Skirt, Long Jacket” on this site.
2. For an excellent chuckle, click here.
SB3 & HB 77 are still chugging their way through the PA State Legislature. I’ve written about it at length here. If you want to defend women’s rights (and are a Pennsylvanian), I hope you will contact your state reps or senators and urge them to oppose this bill.

Coincidentally, I started Margaret Atwood’s “The Handmaid’s Tale” this week. I say coincidentally because I was at a rally to oppose these bills on Monday and a speaker said, “America is not The HandMaid’s Tale. America is not Iran.”

I didn’t quite know what he meant then but I do now. I highly encourage reading this book (as does my sister) with a warning that parts of it brought a noticeable look of disgust to my face. It’s going to be available to watch on Netflix soon enough as well.

I’m not quite finished but from the moment it started, I began to question the kind of person I would be in a time of crisis: Would I roll over and play dead? Would I fight? Would I flee? 
Lastly, it’s clear the Democratic Party has been and is struggling. This is further highlighted in Philadelphia’s 197th district. This district has a population that is 85% Democratic and, YET, there is NO Democratic candidate on the bill (source: man who yelled out this information at Sen. Casey’s town hall & source). This is exactly how we have lost control of most state legislatures around the country. LOCAL POLITICS ARE IMPORTANT. There is currently a write-in campaign being launched for Emilio Vasquez. I contacted flippable in reference to this vote and they support Vasquez (although there are many other write in candidates).

Just as important as local politics is THE ABILITY TO VOTE — Let America Vote is reporting that there are laws in 21 states in danger of being passed that will make it more difficult to vote. This is an organization dedicated to fighting voter suppression started by Jason Kander, mentioned in BO’s interview on Pod Save America as an up and coming Democrat to watch. 
Resistance is a ton of work. Take breaks when you need them. Focus on things you care about — you will go crazy if you try to care about everything. My top priorities are: climate action, women’s rights, and voting rights. If you have other top priorities and would like me to talk more about them, please contact me! I would love to interview you or have you write a piece for this newsletter.

Enjoy your weekend and your St. Patrick’s Day! Or as the pleasant woman in the Lowe’s parking lot remarked to me when she believed a giant paint spill was vomit, “St. Pat’s…what are ya gonna do?”

Until next time, 

PS As always, I highly recommend subscribing to Derek Nelson’s re:act newsletter. Full of info & actions you can take (big and small).

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