Madam, – On reading the letter from Christine Buckley and many others (February 23rd) I was reminded of similar correspondence in the Irish Medical Timeslast summer suggesting that the doctors involved in symphysiotomy were as guilty as the Brothers referred to in the Ryan report on child abuse. This was an abuse of women.
I worked in St Kevin’s Hospital (now St James’s) in the early 1950s in the admission unit. I examined all patients before their admission. Most of the patients were from the poorer parts of the city. I was appalled at the evidence of malnutrition – vitamin deficiencies, especially rickets, and anaemia – a result of poverty and living through the war years.
I worked in the National Maternity Hospital, Holles Street as an anaesthetist from the mid-1950s. Contracted pelvis, resulting from rickets was a not altogether rare disorder. There was no room for the baby to get out! The options for management were: 1. Caesarean section. Fifty years ago this was not without its risks. I served on the Irish Medical Association committee on maternal mortality. We assessed on average about 30-40 deaths per annum. Many were related to Caesarean section. (Quite a number were related to anaesthetic problems.)
2. An alternative was symphysiotomy. This involved cutting the cartilage at the front of the pelvis – the symphysis. This was done under local anaesthesia using a Gigli saw. A separation of two or three centimetres enabled the pelvic outlet to increase and, hopefully allow for a vaginal delivery. Fifty years ago neither sterilisation nor contraception was tolerated. As a result, it was not infrequent for the woman with the contracted pelvis to become pregnant again. If she had had a Caesarean section, there was a significant risk of a ruptured uterus. This was a very serious problem. On the other hand, had she had a symphysiotomy, she might then have a normal delivery.
As regards the complications of symphysiotomy, I have no doubt there were many. These also occurred following a normal delivery. As regards problems with gait – I can recall papers from orthopaedic surgeons in Ireland, and, perhaps more important, one from one of the Scandinavian countries, noting that problems were relatively infrequent. Looking back at this era – 50 years ago and more – the obstetricians did what they thought was best for their patients. – Yours, etc,
Madam, – Symphysiotomy was a very good idea for women with a narrow bony outlet. However, re-wiring of the pelvic bone severance was absolutely essential, a simple and relatively superficial procedure. I cannot understand why this was not done. – Yours, etc,