Medical error: Woman can’t control urine after childbirth

A botched surgery during childbirth has left a 34-year-old mother of four in Ashaiman incontinent and reliant on diapers, forcing her to grapple with a debilitating condition that erodes her dignity and threatens her livelihood.

“I can’t urinate on my own. It flows whether I am standing or sitting, and I don’t feel it,” the woman, who wants to be known as Ruth for fear of stigmatization, told The Fourth Estate. “I always have to use diapers.”

Ruth’s ordeal began after the birth of her fourth child at the Ashaiman Polyclinic. Having delivered her first three children naturally, she was determined to do the same with the fourth. But plans changed when complications arose, and the doctor decided on a Caesarean Section (CS). According to Ruth, the medical team attributed the need for the CS to the baby’s weight.

However, The Fourth Estate has not been able to establish the birth weight of Ruth’s baby as she claims she lost her antenatal record book in tense, bureaucratic exchanges with the polyclinic. Before the CS, she was fitted with a urinary catheter (a standard for surgical procedures), but it never drained her urine as intended. Rather than flowing through the catheter, her urine leaked onto her body. For four days in the hospital, the catheter remained in place, yet the problem persisted. Discharged with the same faulty setup, Ruth quickly realized something had gone wrong.

“After the operation, I experienced issues with my urethra,” she recounts. “I don’t feel the urge to urinate; it just happens. I only notice when it is flowing on me.”

Lost Dignity

Conversations she overheard during postnatal care suggested she might have suffered bladder or urethral damage. An eventual diagnosis revealed vesicovaginal fistula, an abnormal opening between the bladder and the vagina that causes uncontrollable urine leakage.

Fistula often results from difficult childbirth, certain surgical complications, or radiotherapy. For Ruth, the cause seems linked to her CS. She asked to have the catheter removed so she could at least manage with diapers, but the leakage continued, leaving her with unrelenting embarrassment. She often avoids public spaces: the strong odour during bus rides triggers curious stares, and even in church, she fears soiling herself if she sits for a few minutes.

“I’m not able to go to church,” she said. “I will soil myself if I sit right now, so I always stand. At the market, if I sit, by the time I get home, I’m completely soaked in urine. I feel shy and use unapproved routes to avoid people.”

To compound her misery, she also struggles with defecation. Health professionals describe it as obstructed defecation or dysphasia, meaning she cannot push or pass stool unless she has diarrhea.

Beyond her physical agony, Ruth’s incontinence has financial implications. She is the breadwinner for her family, earning GHS600 monthly by selling beef at the Ashaiman Market. Her husband, who once operated a commercial motorbike business, is out of business after he sold his motorbike to cover Ruth’s early medical bills.

With four children to feed, she can barely afford her own diapers and medication. On some days, she relies on old clothes as makeshift pads because she has no money for proper diapers.

“My husband’s job has been affected. He’s at home, and I’m the only one going out, trying to find something for us to eat. It has been really difficult,” she says. “Sometimes, I spend more than GHS200 a day on medications. I earn so little, but it all goes toward drugs. Yet my situation is the same.”

Ruth believes negligence at the Ashaiman Polyclinic caused her condition and blames one Dr Osei T. Owusu, the attending doctor at the time she delivered her last child. She says multiple follow-ups at the facility yielded no solution beyond a referral to the Greater Accra Regional Hospital. Expecting some accountability from the polyclinic, she felt abandoned when she was simply told her problem required more specialized care elsewhere.

At the Greater Accra Regional Hospital, Ruth was told she needed surgery to correct the fistula, but she had to wait three months for her caesarean wounds to heal. Financial constraints prevented her from returning, leaving her to endure the constant leakage. “They mentioned a figure that could buy a car,” she recalls, unable to provide the precise cost but certain it was far beyond her means.

Her husband, Lawson, feels equally helpless. He was once an amateur goalkeeper and an ‘okada’ rider, but the income from that job was spent covering Ruth’s mounting medical expenses. Their intimate life has also suffered as a result of Ruth’s condition, he says.

“We are unable to have sex,” he lamented. “We haven’t done anything since our last child was born because of her problem.”

“My wife wasn’t like this before we went to the hospital,” Lawson laments. “But after the CS, this is our situation. The operation wasn’t done well. They made a mistake.”

In pursuit of justice

Despite the distress, Ruth and Lawson continue to pursue justice. They want the Ashaiman Polyclinic to acknowledge any wrongdoing, help treat and resolve her condition, and compensate them for the hardship they have endured. She also appeals for public support, hoping her story may move people to assist with medical costs or help hold the polyclinic accountable.

According to the United Nations Population Fund (UNFPA), about 500,000 women and girls worldwide live with fistula.

In Ghana alone, 1,300 new cases are reported each year. Often, it stems from prolonged childbirth, inadequate maternal care, and lack of skilled midwifery or surgical care.

Medical experts interviewed by The Fourth Estate said the Ashaiman Polyclinic should have detected possible complications during routine antenatal checks, especially if the baby’s weight was a concern.

“It is through antenatal clinic visits that we regularly monitor the weight of the baby,” Dr. Raymond Papenfuss Owusu-Ansah, medical doctor and lawyer, explains.

If a baby is large (often four kilograms or more) a CS is typically recommended, with proper counselling about risks.

Dr. Owusu-Ansah emphasizes that the hospital’s duty of care does not end at delivery. The 40-day postpartum period is critical in identifying complications and if problems arise, they must be promptly investigated and corrected.

“For someone in such a situation without the money to treat it, the most favourable route is for the institution involved to cover the cost,” according to Dr Owusu-Ansah.

Yet Ruth, lacking finances, remains untreated. Dr. Owusu-Ansah acknowledges that while legal redress might be an option, it wouldn’t solve the immediate problem: “Humanity must come into play,” he says, urging a more compassionate approach rather than a protracted court battle.

The Head of the Obstetrics & Gynaecology Department at the Greater Accra Regional Hospital, Dr. Frederickson Pobee, indicates that fistula can sometimes occur despite precautions. But there’s a clear path when they do: “When they report, the Medical and Dental Council sets up an investigative committee to go into it. They visit the facility, take records, and if someone was negligent, sanctions follow.”

In Ruth’s case, however, those steps appear not to have been taken. She claims the polyclinic brushed her off with referrals. She expected an in-depth review of what went wrong during delivery, insisting that even though she dutifully attended antenatal appointments, no red flags about the baby’s size were raised until it was too late.

Calls and letters to the Ashaiman Polyclinic for comment yielded no responses. The Fourth Estate first reached out on May 6, 2024, but was directed to the Ashaiman District Health Directorate, then to the Greater Accra Regional Health Directorate, and eventually to the Director-General of the Ghana Health Service (GHS). Repeated follow-ups over months did not yield authorization to interview the polyclinic directly.

Meanwhile, Ruth’s life remains in limbo. She stands at church to avoid embarrassment, hides from curious stares, and wraps herself in layers of cloth, hoping to mask the constant flow of urine. Even selling beef, a job that once kept food on her family’s table, feels like a burden. Earnings from her meager sales are drained by medical bills and diapers, and her baby’s needs compete with her own daily struggles.

The emotional toll is palpable. Her husband, once confident in providing for his family, is burdened with guilt and helplessness, watching his wife’s health deteriorate. The closeness they shared is replaced by frustration and worry. Still, they cling to the hope that, somehow, someone will intervene: either the hospital or compassionate donors who might ease the financial strain.

A cry for help

For Ruth, the greatest desire is to be whole again.

“Please help me because my situation is terrible and disgraceful,” she pleads. “Please help me get out of this situation.”

While the Ashaiman Polyclinic remains silent, medical professionals say her case underscores the urgent need for better oversight, thorough postpartum monitoring, and accessible corrective surgery for women who suffer injuries during childbirth. Until these interventions materialize, Ruth’s future (and that of her young family) hangs in the balance, with every new day bringing the same old heartbreak of incontinence, shame, and desperation.