Symphysiotomy injustice requires lifting of legal bar

OPINION:A lobby group wants the statute of limitations to be temporarily lifted for survivors of what were covert, unnecessary and injurious operations

A YOUNG, healthy woman expecting her second child, and a repeat Caesarean section, was admitted to a Dublin hospital in 1967. Operated upon 24 hours later, she was discharged after nine days, unable to walk. She now suffers from some of symphysiotomy’s known side-effects: chronic pain, a “crippled” back and incontinence.

A cruel and high-risk procedure, symphysiotomy – an operation to open a woman’s pelvis during difficult childbirth – severs the symphysis pubis, while pubiotomy (a variant) sunders the pubic bones.

An estimated 1,500 of these discredited operations were performed here between 1942 and 2005, mostly in Catholic teaching hospitals, but also in the Rotunda in Dublin. About 200 women survive today, many of them disabled. Symphysiotomy ruined lives and brought physical, emotional and sexual devastation. Long shunned internationally by doctors due to its dangers, symphysiotomy was revived in 1944 at the National Maternity Hospital (NMH) to replace Caesarean section in selected cases. Personal beliefs and medical ambition drove the Dublin experiment, which intensified at the International Missionary Training Hospital in Drogheda.

A draft report on symphysiotomy by Prof Oonagh Walsh under contract to the Department of Health has found only those symphysiotomies performed post-Caesarean section were wrong. This conclusion rests largely on the following findings:

• That symphysiotomy in the 1940s “was considered to be the most suitable thing to do in order to obey the laws of the time. The law between 1944 and 1984 was very much influenced by the teachings of the Catholic Church . . .”;
• That “symphysiotomy was a safer way of dealing with difficult births than Caesarean section in the 1940s and 1950s”;
• That “symphysiotomy was used mostly in emergencies”.

Survivors of Symphysiotomy (SoS) believes these findings, which are supported by the Institute of Obstetricians and Gynaecologists (IOG), are wrong. These operations were not driven by medical necessity. The surgery was exhumed at the NMH to treat cases of pelvic disproportion that in other Irish hospitals were managed by Caesarean section.

The revivalists were determined to control women’s reproductive health.

They viewed symphysiotomy (wrongly) as a gateway to childbearing without limitation, seeing Caesarean section – the norm for difficult births – as morally hazardous, capping family size and leading to sterilisation and contraception. Symphysiotomy was promoted as permanently widening the pelvis, enabling an unlimited number of vaginal deliveries, whereas four C-sections was widely regarded as the maximum for safety.

Training was also a driver: symphysiotomy was an operation that needed neither theatre nor electricity. Hospitals that aspired to become international teaching centres in the 1940s recognised the surgery’s potential for students from Africa and India.

Ireland was the only country in the developed world to practise this discarded surgery as a procedure of choice in the 1940s. No laws and no ethos forced a doctor to sever a woman’s pelvis in childbirth. The theory that symphysiotomy was “safer” than Caesarean section in the 1940s and 1950s, first suggested by the IOG (letter from the chairman to the chief medical officer, May 4th, 2001), is baseless.

Survivors do not accept symphysiotomy was “safer” than Caesarean section, whose sequels did not include walking difficulties, chronic pain or depression. While the Walsh report states that “fewer mothers and babies died as a result of symphysiotomy”, its statistical tables giving maternal and foetal deaths from symphysiotomy and Caesarean are flawed: they do not compare like with like.