Catholic Church did urge doctors to use symphysiotomy operation

 

Contrary to church assertions, the brutal midwifery practice was once seen by it as a means of avoiding 'unwarranted' Caesareans, writes John Cooney.

Cardinal Desmond Connell has moved quickly to exonerate Catholic bishops and doctors from the charge of having promoted the dangerous and discredited midwifery practice of symphysiotomy that left women with permanent back problems and habitual incontinence.

In his rush to denial, however, the cardinal's spokesman has overlooked the appalling fact that almost 50 years ago this practice of widening a woman's pelvis in difficult pregnancies was advocated at an international congress of Catholic doctors which was held in Dublin under the patronage of one of his predecessors, Archbishop John Charles McQuaid.

Along with Cardinal John D'Alton, Archbishop McQuaid applauded a paper delivered at the congress in Blackrock College by Dr Arthur Barry, then Master at the National Maternity Hospital in Holles Street, in which he revealed that he had done over 100 symphysiotomy operations in the previous five years, from 1949 to 1954.

Insisting that symphysiotomy, the widening of the woman's pelvis in difficult child-births, was a natural procedure in accordance with the moral law and the teachings of the Catholic Church, Dr Barry called for its use rather than "unwarranted and unnecessary" resort to Caesarean section. He even argued that "all the bogies and pitfalls" mentioned in the textbooks against symphysiotomy were "sheer flights of imagination on the part of inexperienced writers".

Contrary to Dr Barry's contention, symphysiotomy proved to be a harmful procedure that was abandoned in the mid-1960s. The extent to which it was practised - and an assessment of the damage which it inflicted on women - has become a matter of fresh controversy with TDs demanding a public inquiry into the practice.

Central to the renewed debate is the claim that the Catholic Church accepted Dr Barry's argument that symphysiotomy was a safer and more wholesome alternative to repeated Caesarean sections, which he warned could encourage women to use contraceptives.

In response to this claim, Father Martin Clarke, the cardinal's spokesman, has maintained that he had found "no evidence that the Catholic Church has said anything on the matter, or that Catholic doctors carried out this practice because of their Catholic beliefs".

However, Dr Barry's paper was published in 1955 as part of the congress proceedings in a book which carried not only Archbishop McQuaid's approval - in the form of an imprimatur - but also contained, literally, purple prose about "the brilliant minds" of Catholic doctors working in the service of "the Faith" from the pens of McQuaid, Cardinal D'Alton and the Papal Nuncio, Archbishop Gerald O'Hara. Moreover, it highlighted a congratulatory message from Pope Pius XII signed by Archbishop Montini, the future Pope Paul VI.

Dr Barry was a devout and highly conservative Catholic, who was a member of the Irish branch of the Guild of Saints Luke, Cosmas and Damian, which dedicated itself to promoting orthodox Catholic practice under the direction of the bishops, who in 1951 had defeated Dr Noel Browne's Mother and Child welfare scheme. Barry was also a member of the powerful Catholic secret society, the Knights of Columbanus, of which McQuaid was a member and its chief spiritual mentor.

In his book on the history of Holles Street, the writer Tony Farmar notes that Barry's mastership reinforced the public identification of the National Maternity Hospital with the full rigour of Catholic moral doctrine and its practical implications in traumatic mother-and-child situations.

Half a century later Barry's Blackrock address reads more like a preacher's tirade against sexual sin than a learned scientific piece of research. "It is unnecessary to stress to Catholic doctors that the practices of contraception, sterilisation and therapeutic abortion are contrary to the moral law," he thundered. "But what we must all guard against and especially is this so in the teaching centres, is the unwarranted and unnecessary employment of Caesarean section."

Dr Barry told the congress that every Catholic obstetrician should realise that the Caesarean operation was probably the chief cause for the practice by the profession of "the unethical procedure of sterilisation". Furthermore, it was very frequently responsible for encouraging the laity "in the improper prevention of pregnancy or in seeking termination".

After extolling the merits of symphysiotomy and bragging about his prowess in this line of surgery, he urged Catholic doctors to follow his method. "If you must cut something cut the symphysis" was his closing advice.

Interestingly, in the ensuing discussion, which was chaired by Prof T.F. Cunningham, the only questioning voice was that of Dr D. T. O'Driscoll, who asked Dr Barry about the danger of permanent disability among women following symphysiotomy and inquired as to the loss of infant life.

Unfazed, Dr Barry was adamant that permanent disability very rarely followed symphysiotomy, but he acknowledged that the loss of infant life was higher following symphysiotomy than after Caesarean section because the former involved a trial of labour. He insisted that maternal mortality was lower and that in the long term symphysiotomy was better policy.

While I have not come across any specific endorsement by Archbishop McQuaid of symphysiotomy in his archives, there can be no doubt that Dr Barry would have been unable to advocate its adoption as the orthodox practice among Catholic doctors if he had not had McQuaid's approval. The son of a doctor, McQuaid prided himself in his knowledge of medical matters and revelled in displaying that knowledge in intimate conversations with his many doctor friends.

What is now needed is complete access to the McQuaid papers and a thorough examination of Holles Street Hospital's records - as well as those of other maternity hospitals in Dublin and throughout Ireland - to find the true answers to Dr O'Driscoll's pertinent but ignored questions.

John Cooney's John Charles McQuaid: Ruler of Catholic Ireland was published recently in paperback