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Bodily Harm: Symphysiotomy and Pubiotomy in Ireland 1944–92

Marie O’Connor

First edition. Cathair na Mart: Evertype, 2010. ISBN 978-1-904808-75-6.
Price: €14.95, £12.95. $16.95.
Bodily Harm

Shortly after writing an opinion piece for the Sunday Independent on the practice of ‘Caesarean hysterectomy’ at the Lourdes Hospital in September 2008,1 I received a telephone call from a survivor of symphysiotomy: a meeting with three casualties of this operation followed. I had a background in policy-oriented research and a special interest in obstetrics, having been commissioned by theDepartment of Health to do a national survey on intentional home birth. My first book documented women’s experiences of maternity care, while my most recent one explained why our health system is as it is. So believing that I could make some contribution to survivors’ long running quest for justice, I agreed to see if I could help.

Survivors of Symphysiotomy (SoS) is a remarkable organisation by any standards. Dotted all over Ireland,members range in age from the late 50s to the late 80s. The sole dedicated voice of survivors in Ireland, SoS has been trying to secure an independent inquiry into the surgery for almost a decade. All such attempts have been thwarted. Founding members, such as Rose Magee, did not live to see the day. Despite the promises made to her by a former Minister for Health, the failure of Dublin City Council to install a stair lift left Rose a prisoner in her own home during her last years. Other indomitable founding members, such as Matilda Behan, Eileen Murphy and Claire Kavanagh—some now well into their 80s—continue to fly the flag. The courage, tenacity and determination of SoS members has been an unfailing inspiration to me in preparing this report. For very many of them, symphysiotomy has been a life sentence without remission.

It has taken me nearly three years of research to understand this childbirth surgery in all of its dreadful dimensions. Doctors described symphysiotomy as ‘widening the pelvis’, a benign description that obscured the fact that the surgery severed the pelvis, and one that had made its way into the media. The fact that symphysiotomy was carried out by doctors as a matter of personal preference meant that Caesarean section—the treatment of choice for obstructed labour at that time—was being withheld from the patient. Doctors also performed a related operation, cutting the pubic bone rather than the joint of the symphysis pubis. This operation, known as pubiotomy, was even more dangerous than symphysiotomy. I was also to learn that the operation posed significant risks to babies as well as mothers: medical evidence suggests that one baby in ten did not survive the operation of symphysiotomy, and survivor testimony shows one baby born in this way suffered catastrophic injuries.

Some symphysiotomies, particularly those performed in the aftermath of a Caesarean section, were more hideous than others. Those carried out during late pregnancy were almost equally unprecedented. However, even the more usual symphysiotomies, those done during labour, were cruel in the extreme.Women found the experience utterly traumatising: after being left in labour for many hours, they were generally operated upon without warning, in the labour ward or in theatre, under local anaesthetic. And after the surgery, there was still a baby to be born: they were still in labour.

The pain of pushing a baby out with an unhinged pelvis was followed by the agony of walking on it. Instead of immobilising the pelvis, hospital staff further destabilised it by requiring women to walk. Discharged home with a broken pelvis, women were left to sink or swim, without medical advice or painkillers. Many of the serious health problems—of mobility, pain and incontinence—endured by women today are related to the negligent failure to treat them as surgical patients.

In addition to medical negligence, there were other issues, such as the use, or abuse, of medical power and knowledge. The idea that major surgery could be performed on a pivotal structure of the body without patient consent was troubling enough. I knew that women were generally not informed in advance about their surgery, that the its risks and benefits had not been explained, nor the existence of a safer alternative, Caesarean section, mentioned. The failure of hospital staff to inform women of their surgery postnatally was even more disturbing, however. Even general practitioners refused, on occasion, to tell women what had been done to them.

Several decades were to elapse before many women finally understood that their pelvises had been broken. It was as though these were secret operations, not to be disclosed to the patient. Was it because the surgery was so aberrant that it could not be revealed?

Finally, there was the discovery that symphysiotomy is now enjoying a revival in resource poor countries, where it is promoted by some as a ‘safe’, low cost alternative to Caesarean section. However, as the lived experience of survivors shows and medical writings attest, the safety of symphysiotomy is a fallacy.

Bodily Harm examines in detail how the authorities in Ireland have dealt with demands for truth, justice, health and disability services since the surgery was first exposed in the media by Dr Jacqueline Morrissey in 1999. The report sets out the history of symphysiotomy and pubiotomy, describes how these operations were revived in an era when women in Ireland had few rights, and scrutinises the various claims that have been made for the surgery. In the closing chapters, I look at these operations from a legal perspective, show how the surgery was driven by medical ambition as well as religious beliefs and present survivors’ case for truth and justice.

A word on the text. Throughout this report, I have sought to highlight and refute the myths and red herrings emanating from the specialty, both individually, and collectively (by the Institute of Obstetricians and Gynaecologists). Some of these statements appear in text panels. Except where otherwise stated, names and other identifying details have been changed to preserve womens’ anonymity.Quoted statements are from survivors’ written testimony, formal interviews and personal communication. All references to symphysiotomy in this report include pubiotomy unless otherwise indicated, as ‘symphysiotomy’ was used indiscriminately to denote pubiotomy in hospital clinical reports.

Like historian Dr Frances Finnegan, whose work on the Magdalen Asylums is as inspiring as it is meticulous, I do not think it a virtue to suspend one’s moral judgement. I have sought to bring a view to the latter day practice of symphysiotomy in Ireland that is wider than medicine, one that encompasses feminist, sociological, legal, historical and midwifery perspectives. Some of the issues raised, however, such as the role of medicine in our society, are so wide ranging as to lie outside the parameters of this report. While this report is dedicated to survivors, none have sought in any way to influence its contents, nor should they be take as reflecting the views of SoS as a voluntary organisation.

While any errors in this report are my own, I should like to thank certain individuals and organisations. My thanks to my expert readers, Mavis Kirkham, Emeritus Professor of Midwifery at Sheffield Hallam University, whose crystal-clear insights into clinical matters deepened my understanding of these operations; and to Dr Janette Allotye, a medical historian with a special interest in the history of the pelvis, whose detailed reading of my work was invaluable. Michael Lynn, barrister-at-law at the Irish Bar and an expert in patient human rights, contributed significantly to the legal chapter. Dr Jacqueline Morrissey, a historian with a special interest in the influence of religious beliefs on clinical practice, was extremely generous with her work, which threw new light on the historical record, illuminating the fine, if occasionally shocking, detail of clinical practice. My gratitude, also, goes to SoS’s legal advisor, Colm MacGeehin, whose long battle for survivors reminds one of why the oft-maligned legal profession exists: the pursuit of justice. To Sheila Martin, whose detailed and painstaking research first alerted me to some of the more shocking aspects of the surgery in the Lourdes Hospital, my thanks. Without the support of Stewart O’Connell of Johnswood Press, who printed at cost, gifted the design and layout, and secured generous offers from suppliers, Tony Swan of Swan Paper and Pamela Monaghan of Print Finishers who donated paper and binding, this report might not have seen the light of day. The same observation could be made in respect of SoS National Executive members, particularly Marie and Billy Crean, whose unswerving support could always be relied upon. Finally, I wish to acknowledge the inestimable contribution made by Kathleen Naughten and Olivia Kearney, an unfailing source of detailed information on SoS, especially its early years.

SoS’s road towards justice has been long and arduous. I hope that this report will be a milestone on that journey towards truth and justice, and that the testimony of survivors here in Ireland may ultimately help to stem the mainstreaming of these destructive operations in resource poor countries by misguided European doctors.

Marie O’Connor
Dublin, June 2011

Available from Marie O’Connor.

 
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