Docs' sympathy on symphysiotomy

The Institute of Obstetricians and Gynaecologists has offered its 'unreserved sympathy' to women who suffered complications the controversial obstetric procedure symphysiotomy performed on many women in Ireland from the 1940s until the 1980s.

The obstetrics body says it fully supports initiatives by the HSE and Department of Health to assist women who have suffered complications arising from the procedure. Side effects from the procedure, used to enlarge the pelvis in difficult births, include chronic pain and incontinence.

The Institute said symphysiotomy was re-introduced to some Irish hospitals in the 1940s 'in response to the prevailing legislative and religious environment.' In most instances the procedure was used for cases of mild to moderate pelvic disproportion, and was safer than caesarean section, but was not promoted as an alternative, it said.

However, the victims' group, Survivors of Symphysiotomy, has disputed the contention that caesareans were an unsafe alternative to symphysiotomy and has claimed doctors at the time performed symphysiotomies as they regarded caeasreans as an unacceptable form of contraception that could potentially limit the number of babies women would have.

It says that as women could have no more than around four caesareans, so doctors effectively saw them as birth control - a way of capping the family size.

Symphysiotomy was a rare intervention, used in 0.035% of births, according to the Institute. It is believed that around 1,500 women underwent symphysiotomies, according to the obstetricians' report.

The Institute admitted it was used inappropriately in some cases.

"Its continued use in Our Lady of Lourdes Hospital (Drogheda) until 1984 was contrary to its decline in the rest of the country from the mid 1960s," the Institute said.

The Institute said when symphysiotomy was more common in Ireland,  families were larger and Caesarean section, particularly a repeat of the procedure was a risky procedure 'with potentially grave consequences.' 

Symphysiotomy appeared to offer a method of safe birth in some cases of obstructed labour in mothers with contracted pelvis, according to the Institute.

It said at the time, contraception was not a solution to avoid future difficult births, as it was illegal and doctors offering contraceptive advice were liable to prosecution. Contraception was only legalised in 1979.

The Department of Health has published a draft report which examined symphysiotomy practice from the 1940s to the 1980s.

The report says the controversial operation was partly used to obey laws influenced by the Catholic Church that banned contraception and sterilisation.

Symphysiotomy use was at its peak in Ireland when it was in decline in other developed countries, the report points out.

It said symphysiotomies were considered appropriate in some difficult births during the 1940s and 1950s. It said this was because of safety concerns about repeated Caesarean sections and the ban on contraception and sterilisation.

However, the report admitted some symphysiotomies were wrongly used.

It said although some obstetricians beleived the operation to be a solution to difficulties in labour, others refused to perform it because of fears for the long-term health of mothers.

The SOS group says doctors used symphysiotomy without consent to control women's reproduction.



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