A normal pelvic X-ray. Photo via Wikimedia Commons
Symphysiotomy is one surgical procedure that should have been left in the Middle Ages. But the brutal childbirth operation, which was first introduced in the 18th century, was being practiced in Ireland up until the 20th century. Now a public row is brewing over how the Irish government is planning to preserve the historic records of the practice.It is estimated that some 1,500 women in Ireland were subjected to symphysiotomy without their knowledge and consent. In 1944, the National Maternity Hospital (NMH) in Dublin pioneered its use as the procedure of choice in certain cases where the woman's pelvis was deemed too small to permit a normal birth.
The operation itself involves the slicing of the cartilage and ligaments of a pelvic joint during childbirth, resulting in the permanent widening of the pelvis to make more space for the baby to be born. In the most extreme cases, some women had their pubic bone sawn through, leaving them with lifelong disabilities, chronic pain and mental distress.Although the practice officially cased in 1984, around 200 Irish women who underwent the procedure are alive and living with the fallout. 83-year-old Rita O'Leary, who had her first baby at the NMH in 1957, tells Broadly she underwent the procedure without consent."When I went into labour, I couldn't see anything because I was lying on my back. No one briefed me on what they were about to do to my body," O'Leary remembers. "I had no idea what was going on, when suddenly severe levels of pain came over the left side of my body. I was expecting to hear my baby cry, but I didn't hear anything; I was in agony."For the next six months, O'Leary was unable to walk without pain or carry her newborn baby. She moved back into her parents' home; they helped to raise her daughter. "I had continuous back pain for the next fifty years of my life," she says. "I was constantly limping because my pelvis hurt. It was difficult to go to the toilet, and I couldn't look after my child properly. It's just so humiliating. The only way I could get through it was to believe it was God doing this, and that this was meant to happen all along."
According to Jacqueline Morrissey, a historian who began investigating the practice in the 1990s, claims Catholicism—not medical judgment—that guided the actions of Alex Spain, the master of the NMH until 1948. At the time, the established medical consensus was that having more than three caesarean sections was dangerous, and that further pregnancies would have to be stopped by sterilization or contraception. Spain considered this unacceptable, says Morrissey, and talked about "the mutilating operation of sterilization and marital difficulty."
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But not everyone agrees with the analysis; some doctors argue that critics fail to account for wider changes in medical culture. "Symphysiotomy is rarely used nowadays but is recommended for use, by the Royal College of Obstetricians and Gynaecologists in London, in cases of vaginal breech delivery where the head gets stuck and the baby will die if not delivered, and in rare cases of shoulder dystocia where a similar outcome for the baby is likely," says Dr. Peter Boylan, the chairman of the Institute of Obstericians and Gynaecologists in Ireland. "The techniques used now are no different from before. Side effects are uncommon; short term problems relate to pelvic pain but this soon settles. Long term side effects are no more common than in women of the same age group who have had uncomplicated vaginal deliveries without symphysiotomy."
Although a 2002 study concluded that any pain tends to subside after three to six months, it also reported long term problems include walking difficulties, pelvic joint pain and urinary incontinence. "I had symphysiotomy when I was 23, and it affected me for 60 years," O'Leary says. "I'm now 83, but it's only been in the last ten years where things have been slightly easier. I still have to do hourly exercises for my legs twice a day, and still experience severe pains down my lower back once or twice a day. The daughter who I gave birth to through symphysiotomy now has to look after me."In July 2014, the UN Human Rights Committee ruled that the practice was a breach of women's rights to freedom from torture, inhuman and degrading treatment. It called for the Irish government to conduct an investigation into the practice, which resulted in the Walsh inquiry. The government subsequently established the Symphysiotomy Payment Scheme, offering survivors compensation sums of between £40,000 and £120,000 depending on the severity of their injuries.
Although the scheme was met with criticism at the time, it is reigniting debate as it completes its work this year. One of its tasks was to handle over 700 medical records gathered from women who had applied for compensation. However, a note on its website has caused uproar. According to the government, it must destroy the symphysiotomy records of any woman who has not yet requested for the return of their documents. The Department of Health claims that the move is required under the Data Protection Act 1988, and that it is only destroying records that have been supplied to the scheme.
Marie O'Connor, chair of Survivors of Symphysiotomy and author of the Bodily Harm report, has launched a petition to hit back at the initiative. "It is untrue to say that no records will be shredded without permission," she tells Broadly. "As so many woman are elderly and infirm, to require them to claim their records is to manufacture 'consent' to shred. [Harding-Clark] is flying in the face of the terms of reference laid down for her by the government; we have questioned the legality of her plan to destroy all unclaimed records."However, Dr. Boylan has defended the destruction of the documents. "There are serious issues surrounding data protection, patient consent, and confidentiality when it comes to conducting research involving individual patient records," he says. "The Symphysiotomy Payment Scheme under the direction of Judge Harding-Clark, has no original patient records. All she has are copies supplied by the women themselves or their legal advisers. None of the documents in her possession will be shredded without the permission of the women. This is made absolutely clear on the payment scheme website. So, the question of shredding is really irrelevant."
According to the World Health Organisation, some countries still use symphysiotomy as a life saving procedure for the mother and infant in circumstances where C-section is not an option. But for survivors like O'Leary, the medical records provide important evidence of why the practice should not happen anywhere. "If the records go, our history is erased. There is only a few of us left to tell what happened," she says. "My request to claim my records has been submitted, and now I'm now just waiting to receive them.""To say that Harding-Clark hold 'no original patient records' is to ignore the fact that these copies may be the only copies in existence," O'Connor adds in response to Boylan's claims. "Hospitals hold birth records for 25 years, but as these records go back half a century and more, they are at risk of being destroyed."Regardless of any governmental intervention, O'Leary cannot reverse her past. "I wasn't explained about what was going to happen, and the pain has lasted forever," she says."Young women have the right to be healthy and enjoy their lives, but this operation stopped me from having one for the rest of my life. I wouldn't wish it for anybody to go through what I did. No one. It must never happen again to anyone."
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