SAKHUBAI'S STORY
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- SAKHUBAI'S STORY
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Sakhubai's Story
(Information on uterine prolapse)
MASUM Health team
Art work: Pallavi Apte
March 2002
Mahila Sarvangeen Utkarsh Mandal (MASUM)
Purandar Taluka, Pune District * Parner Taluka, Ahmednagar District
Address: 11, Archana Apts, Kanchanjanga Arcade, 163 Solapur Rd, Hadapsar, Pune 411 028.
Telephone: 6875871, 6814889 Fax: 6811749 Email: masumfp@vsnl.com
Printed by: Impact Printers
1. We will be sharing Sakhubai’s health concern
with you today. Sakhubai is a 40 year old woman
and has approached the health centre with some
complaints that she has been suffering for a long
time. She tells the health worker, "My lower back
hurts a lot and I also have some white coloured
fluid coming out of my body (vagina). Whenever
I sit in a squatting position something comes out
of my body (vagina). I have come to you because
it has become so unbearable now ”.
Mahila Sarvangecn Utkaish Mandal (MASUM), March 2002
2. The health worker asks Sakhubai to sit in a
squatting position and cough. On examining her
internally, she tells Sakhubai, "Your uterus has
shifted and is coming out through the vagina."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
3. On hearing this information Sakhubai is very
worried. She asks the health worker, "What do
you mean by that? How can the uterus come out
of the vagina? What has happened to me? Will I
die?”
Mahila Sarvangeen Utkarsh Mandal (MASUM). March 2002
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4. The health worker explains, “This illness
causes a lot of pain and suffering but it is not
fatal. Uterine prolapse means the uterus has
shifted from its original position. It occurs in three
stages or degrees”.
. When the cervix descends into the vagina it is
called the first stage of uterine prolapse. Picture
one shows the uterus in the normal position and
picture two shows the first degree of prolapse.
. When the uterus slides further down to the level
of the vulva it is the second stage or second
degree of uterine prolapse. See picture three.
. Stage three is characterised by the uterus coming
out of the vagina especially when coughing or
sitting in a squatting position. See picture four.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
5. Having heard this information Sakhubai tells
the health worker, "Only when I saw the uterus
outside the vagina did I realise that something was
wrong. So I must be in the third stage now. How
could I have known about my problem in the
earlier stages?"
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
6. The health worker replies, " Prolapse has
certain symptoms even in the first and second
stage. A woman needs to get herself examined if
she notices any of the following symptoms."
• In the first stage (when the cervix descends into the
vagina) a woman experiences acute lower backache,
pelvic heaviness, excessive white discharge and
painful or difficult sexual intercourse.
• In the second stage (when the cervix descends to the
level of the vulva) the woman experiences acute
lower backache, pelvic heaviness, feeling of
something having fallen out, feeling the existence of
a foreign body in the vagina, tugging or pulling of
the pelvic and or calf muscles, excessive white
discharge and painful or difficult sexual intercourse.
• The third stage is easy to recognise as the uterus comes out of the vagina especially when
coughing or sitting in a squatting position. A woman also experiences all the symptoms
mentioned in stage two namely acute lower backache, pelvic heaviness, feeling of something
having fallen out, feeling the existence of a foreign body in the vagina, tugging or pulling of the
pelvic and or calf muscles, excessive white discharge and painful or difficult sexual intercourse.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
7. Sakhubai's eyes filled up with tears. The health
worker was concerned and so she asked "Why are
you crying? Please tell me what is bothering you.
Are you experiencing a lot of discomfort?"
Sakhubai replied, " I experience a lot of pain
during sexual intercourse. It is sometimes
intolerable but how do I refuse my husband? Do
you think he'll take no for an answer? What would
happen to me if he got another woman to fulfill
his needs?"
Points for discussion:
• How do you feel about Sakhubai's fears? Are
they real?
• Can a woman refuse to have sex with her
husband?
© What would the consequences be if she refused
sex?
o Why is it that a husband can take a second wife
if he so desires? Are women allowed the same
sexual freedom?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
8. The health worker says, "Sakhubai, I know
some other women who also have uterine
prolapse. This condition is rather common in our
area. These women have formed a group where
they share their problems and discuss remedies or
options. You too can be part of this group."
Points for discussion:
• Do you think that forming a group for women
with similar problems is beneficial?
• What would the benefits of such a group be?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
8. The health worker says, "Sakhubai, I know
some other women who also have uterine
prolapse. This condition is rather common in our
area. These women have formed a group where
they share their problems and discuss remedies or
options. You too can be part of this group."
Points for discussion:
• Do you think that forming a group for women
with similar problems is beneficial?
• What would the benefits of such a group be?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
9. Sakhubai asks the health worker, "What causes
prolapse?" The health worker answers, "Prolapse
is caused by a number of factors. Let us look at
them one by one”.
Mahila Sarvangeen Ulkarsh Mandal (MASUM), March 2002
The pressure while pushing should not be on
we are constipated."
10. "Women in labour are asked to push as soon
as the contractions begin, which might sometimes
be more than twelve hours before the child is
actually delivered. This is especially true when
the woman is giving birth for the first time. This
stresses the uterine ligaments and can cause
prolapse.
During labour a woman should not start pushing
as soon as the first contraction starts. Childbirth
has three distinct stages. The first stage is
characterised by contractions which occur every
three to five minutes and each contraction lasts for
a minute. In this stage a woman should NOT
push, because the cervix has not yet opened fully.
It is only when the contractions occur in rapid
succession that she should start pushing.
vagina, but on the rectum, the way we push when
Points for discussion:
• Women’s experiences related to the time required for delivery from the time contractions start
during the first childbirth and the consequent deliveries.
• Women’s positive and negative experiences related to pushing during labour.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
11. "Delivery should be performed by either a
trained dai (trained birth attendant) or in a
government hospital. The trained dai (trained birth
attendant) should use the safe delivery kit
provided by the government. This kit contains the
following items:
soap-to wash the dai’s hands with
sterilised thread- to tie the cord
sterilised blade- to cut the cord
antiseptic powder- to sprinkle on the cord after it
has been cut
cotton- for dressing
If the area between the vagina and the anus
(perineum) tears during delivery it should be
stitched as soon as possible by taking the woman
to a hospital or getting a nurse to stitch it.”
Points for discussion:
• Right to health care
• Do women have access to safe deliveries and post-delivery care?
• What needs to be done to increase access to such care?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
12. "Some simple postnatal exercises help the
uterus move back to its original position. After
childbirth, a woman needs to exercise her pelvic
floor muscles to strengthen them. We can locate
our pelvic floor muscles by trying to stop and start
the flow of urine. Tighten the muscles (as you
would hold the flow of urine) and hold them that
way until you count ten. Release the pressure
slowly.
Repeat upto five times. Do this three or four times
every day. We can slowly increase the time of
holding the muscles to twenty counts. This
exercise can be done anytime and anywhere
without anyone realising it.”
Demonstrate the exercise. Get women to do it and
share their experiences with others.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
13. "Getting back to strenuous work soon after
delivery can also cause prolapse, because the
pelvic muscles are still weak. A woman needs to
rest for at least seven weeks after childbirth or
abortion. During this period she should avoid
lifting heavy goods or undertake any strenuous
activity which would hamper the uterus from
getting back to its original position or stress it
further."
Points for discussion:
• Is it possible for women to rest for two months
after delivery?
• What needs to be done so that women can have
an opportunity to rest?
• Can the rest of the family members help in the
household work?
• Can we discuss sharing of household
responsibilities at home?
Mahila Sarvangecn Utkarsh Mandal (MASUM), March 2002
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14. "Pregnancy at a young age, a number of
successive deliveries with very little gap between
them is also one of the reasons for prolapse. Often
women have to undergo many deliveries until a
son is bom"
Points for discussion:
• Why does the family and society consider it so
important to have a son? Do we think the
same?
• What consequences does a woman have to face
when a son is not born? Are these fair?
• Can a woman decide that she does not want
any more children even if she does not have a
son?
• Can she decide when she wants to have a child
or the number of children she wants to have?
• How can we increase women’s decision
making about her own body?
(If this discussion is taking place with elderly women, one can talk about giving support to the
daughter in law and speaking with the son on her behalf.)
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
15. “Lack of a balanced and nutritious diet can
also be a contributory factor to prolapse.
Generally women's diet lacks in nutrients required
for her growth. To support the processes of
menstruation, pregnancy and childbirth it is
necessary to have a wholesome diet. Sometimes,
the diet needs to be supplemented with additional
nutrients such as iron, folic acid, vitamins and
calcium.”
Points for discussion:
What do women generally eat? Is the food
sufficient and fresh?
Who eats first? How much of what was served to
the first person remains for the last person?
Is there a difference in the diet of men and
women? If so what?
What would be a wholesome diet? (taking into
consideration food available in our area)?
Discuss misconceptions about food intake during
pregnancy and after childbirth.
Why do women not get enough food? (Discuss
poverty and gender discrimination)
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
16. The health worker continues saying, "We have
just seen the causes of uterine prolapse as well as
the precautions which need to be taken to prevent
it. Let us now see the various options available if
the uterus has already prolapsed."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
17. The following exercises will prevent the
uterus from further prolapse.
Note: All the exercises described below will have
to be demonstrated by the facilitator. The group
should also be encouraged to participate.
a) “Exercise the pelvic floor muscles regularly by
tightening them as described earlier.
We can locate our pelvic floor muscles by
trying to stop and start the flow of urine.
Tighten the muscles (as you would hold the
flow of urine) and hold them that way until you
count ten. Release the pressure slowly. Repeat
upto five times. Do this three or four times
every day. We can slowly increase the time of
holding the muscles to twenty counts."
b) "Sit on the edge of a chair or bed or stool with
a pillow between the knees and press knees
together as tight as possible and for as long as
possible then release. This exercise should be
done at least four times every day."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
18. One more exercise:
Note: The exercise described below will have to
be demonstrated by the facilitator. The group
should also be encouraged to participate.
.c) "Lie on the back with arms on the side and lift
both feet without bending the knees upto six
inches above the ground, hold your breath and
count upto ten, exhaling slowly. Return to original
position. Gradually increase the count to twenty.
This exercise should be done a minimum of four
times every day."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
• •••••••••••••••••••••••••••••••••••••••••<
19. "Along with these exercises the following
interventions are also necessary”:
a) herbal decoction:
Note: The preparation of the decoction will have
to be demonstrated by the facilitator. The group
should be encouraged to prepare the decoction on
their own.
The decoction of the bark of either the Palash
(flame of the forest) or Mango or Black Babool
tree should be taken every morning for a period of
three months.
The decoction is prepared by boiling a two-inch piece (half a finger length, show the bark of
appropriate length) of the inner bark of any one of the above trees in a glassful (250-ml) of water
until the water reduces to a cupful (one third).
The decoction should be taken fresh as it loses its properties when stored. If getting a fresh piece of
bark everyday is not possible, then one can get a sufficient amount of the bark, dry it in the shade,
grind it into a fine mixture and swallow a spoonful of this dry powder every morning instead of the
decoction.
b) A pessary can also be inserted inside the vagina to hold the uterus and prevent it from sliding
down. These pessaries are available in government hospitals.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
20. When the uterus comes out of the vagina (the third
stage) there is also a possibility of infection as the
uterus comes in contact with dirt, cloth and other
objects. This causes infections in the vagina, which in
turn cause irritation, itching, pain and discharge. For
prolapse in the third stage the only option today is
surgery. However if the uterus has infections it will
have to be treated before surgery can be performed.
This can be done by applying neem paste on the
prolapsed uterus. The paste is prepared by grinding
clean neem leaves. This paste has to be applied twice a
day after washing the vagina clean and continued for
atleast seven days. In case the infection is not cleared
with this treatment it is necessary to consult a
gynecologist. Remember though, that in the third stage
of prolapse, the only option that we have today is
surgery. The doctor will decide whether the uterus has
to be removed or not.
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
21. On hearing about surgery Sakhubai was
extremely worried. She asked the health worker,
"Is this surgery risky? Do I really have to have the
operation? I am very scared."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
22. The health worker explained, "I can
understand how you feel. I shall explain the
procedure to you so that you will know what will
happen during the surgery.
In case the uterus has to be removed
(hysterectomy), there are two methods by which
this can be done.
One would involve removing it from the abdomen
by making a cut on the stomach, whereas the
other way would be to take it out through the
vagina.
In case of uterine prolapse, most often a vaginal
hysterectomy is conducted. Usually there is no
risk to life but if a woman is anemic she may need
a blood transfusion. Just as a woman needs rest
after childbirth so does a woman who has
undergone hysterectomy. After this surgery the
woman needs to rest for at least a month and a
half. This surgery is performed in both
government as well as private hospitals."
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
23. "The cost that is incurred in a government
hospital is generally not more than Rs 1000 to
Rs. 1,500 which is inclusive of medicines and
expenses required for travel, whereas in a private
hospital the cost can be anywhere between 10,000
to 15,000."
Points for discussion:
• The benefits of a government hospital.
• Right to health care in government hospitals.
• Indebtedness because of illness
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
24. After hearing the information about the
operation, Sakhubai said, "If I need the operation I
will have to speak to my husband. He will want to
know why someone as healthy as me needs an
operation. He may not listen to me. Will you talk
to him?" The health worker replied, "Why don't
you try speaking with him first? If he does not
listen to you, do come with him to the centre and I
shall talk to him. I will explain the importance of
the operation to him."
Points for discussion:
• Why is it important to teach women to talk
about their needs and rights?
• How can the health worker be a part of this
process of communication without reducing the
woman’s agency? How can she increase
women’s decision-making?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
25. Sakhubai has now come to the centre with her
husband after speaking to him. The health worker tells
her husband, "Sakhubai may need to have a
hysterectomy. She has been silently suffering for a very
long time.
How many more days should she suffer like this?"
Sakhubai's husband replied, "If she is operated upon
who will take care of the house?
Treatment in a government hospital also requires
money these days. Right now it will be difficult for us
to have the operation." To that, the health worker
replied, "During her entire married life she has slogged
for you and your household. You too need to take care
of her and consider her needs. Would Sakhubai have
delayed you from undergoing an operation if you
needed it? You should get her operation done at the
earliest." Sakhubai's husband replied, “You are right. I
need to pay more attention to my wife's needs. I will get
her operation done at the earliest."
Points for discussion:
• What is the difference in men and women’s access to health care? Why?
• In which ways does Sakhubai's husband need to take care of her? (medical expenses, sharing the
household work, being sensitive about not demanding sexual intercourse and so on)
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
26. The health worker tells Sakhubai, "Take care
of your health. I will come to meet you before the
operation. Two more women from our village will
be going to the government hospital next week.
You too could go with them. If you need any help,
please come to me. I will accompany you to the
hospital."
Points for discussion:
• What help and co-operation will be required
once the operation is done? From who?
• What are the benefits of women getting
together and going to the government hospital?
• What will we have to do to get good health
care services?
Mahila Sarvangeen Utkarsh Mandal (MASUM), March 2002
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MAH1LA SARVANGEEN UTKARSH MANDAL (MASUM)
MASUM was formed in 1987 when the women of Malshiras decided to create a space for themselves and address the issues that affected their lives. Most of these women were from the oppressed
castes and minority religions. Some had been deserted by their husbands and lacked familial support. Many of them worked as daily wage labourers on the fields of rich farmers where they often faced
economic exploitation and sexual abuse. They came together to support each other and collectively fight for their rights. MASUM gradually evolved as a development group with a feminist perspective
and a democratic approach.
MASUM works in the eastern part of Purandar Taluka, Pune district and with rural and tribal people of Parner Taluka in Ahmcdnagar district. All of MASUM’s area of work comprises of drought prone
and economically poor villages.
MASUM’s objectives:
•
•
•
•
•
To make women self reliant and conscious of their human and constitutional rights
To nurture women’s physical and emotional health
To provide vocational training and credit facilities to women for self employment
To create a sustainable and humane mode of development through people’s active involvement in rural Maharashtra.
To create a progressive space in society for all its deprived people, and to specifically resist casteism, sexism, religious chauvinism and homophobia
HEALTH PROGRAMME
The focus of our health programme is to enable the most deprived sections in the community to get access to basic health services.
The health programme comprises of village level para gynaec centres called the sadaphuli centres, the rational drug centre called the Lok Seva Aushadalay and the Feminist Health Centre (FHC) located
at the taluka. The health programme has linkages with every' other programme of MASUM.
Our village health workers at the Sadaphuli (ever blossoming flower I vinca rosea) Centres, located in five villages of Purandar taluka, use self-help techniques to enable women to understand their
own bodies and participate in the process of diagnosis and treatment. They conduct whole body, speculum and bi-manual examinations for detection of RTIs and other gynecological problems as well as
breast examinations at the village level. The Sadaphulis treat women with traditional herbal remedies available in the neighborhood, allopathic drugs under their generic names, accupressure techniques,
dietary innovations and exercises.
The Lok Seva Aushdhalaya provides basic medicines, under generic names, at low cost and operates on a no-profit, no loss basis. A local woman specially trained in pharmacology and ethics continues
dispenses the medication and explains its purpose, the dosage, the side effects (if any), contra indications and drug food interactions to be expected as well as measures of controlling them.
Located at Saswad the Streewadi Arogya Kendra Feminist Health Centre provides a space for women to define their own physical, menial, sexual and reproductive health problems. Two trained nurses
provide basic health care, maternal health care, antenatal services and nutrition education to women. Examinations for cervical cancer arc also conducted by the nurses as well as the Sadaphulis here.
The FHC also implements a health out reach programme in 4 slum areas in Saswad.
The health programme also works with adolescent girls with the objective of politicising the personal and of developing a rights perspective on issues relating to health and violence. It also aims to build
life skills such as assertiveness and self-confidence, which will enable one to not only understand but demand ones right.
Mahila Sarvangeen Utkarsh Mandal, 11 Archana Apartments, kanchanjanga Arcade, 163 Solapur Road. Hadapsar, Pune 411028. phone- 6875871, 6814889. email masumfp@vsnl.com
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