Saturday 24 March 2018

Symphisiotomy's victims have been let down again

The State must urgently address the plight of brave women who endured a barbaric operation, writes Ciara Kelly

The findings of the Walsh Report, investigating the practice of symphisiotomy in Irish maternity hospitals, are a further insult, by medicine and the State, to women who underwent the procedure here between the 1940s and the 1990s. The report, published last week, said that the use of symphisiotomy was reasonable and appropriate.

When a woman in labour is having difficulty delivering her baby there are two ways of surgically assisting her. One is Caesarean-section. The other is symphisiotomy. A symphisiotomy is a procedure that involves splitting the pelvis by cutting through the fused ligament at the front of the pelvis or indeed splitting the bone itself. It's been long abandoned by modern obstetrics because of the ruinous effects it had on women post-operatively and the superior safety profile of the C-section.

The brutal nature of symphisiotomy causes huge problems with mobility. Survivors find walking very difficult and often extremely painful. It can cause damage to the bladder or bowel, which results in permanent incontinence. It can damage fertility and cause neurological problems. The severe nature of the pain makes performing even simple, everyday tasks such as sitting down or turning over in the bed, excruciating. These effects can continue for the whole of the woman's life. These physical symptoms often result in depression, psychological and sexual difficulties for the women affected.

The practice of symphisiotomy had been discarded internationally by the 1930s in favour of C-section, when it was revived -- in Ireland only -- in 1944, by doctors in the National Maternity Hospital, who wished to limit the use of C-sections, on religious grounds.

The fact is, a woman can only have a limited number of C-sections -- usually three or four -- before further pregnancies pose a risk to her life. So, on having had four children by C-section, a fertile young woman requires some form of contraception (be that sterilisation or medication) to prevent her becoming pregnant again -- and dying in childbirth.

This was the Ireland of John Charles McQuaid and this was the key issue for those Catholic obstetricians, who didn't believe in birth control; if a woman had recurrent C-sections they would be obliged to offer her contraception -- a mortal sin. This was what they were trying to avoid and symphisiotomy was the solution. It allowed women with small pelvises to deliver babies easily, without the limit that C-sections imposed on family size and the subsequent need for contraception. The fact that it left the women half-crippled in its wake was neither here nor there. These doctors were not acting on behalf of their patients but as instruments of the church.

That it wasn't in the best interest of the women was never even considered. From a warped point of view, a symphisiotomy kept young women on the straight and narrow and prevented them slipping into sin and wantonness. This was an unholy alliance between the church and medicine and it resulted in lifelong health problems for more than 1,500 women.

One such woman, Teresa Devoy, spoke out impressively on Tonight with Vincent Browne earlier last week about how during her prolonged, complicated labour in Kilkenny in 1963, nurses called the priest before they called the doctor. She had a symphisiotomy performed when she was just 18 years old, which left her with chronic pain and permanently incontinent.

Colm MacGeehin, a solicitor acting for survivors, spoke movingly about the plight of these women; stating that when he accompanied them to address the Dail they had to take the lift in to the chamber. Forty years after their surgery many of them still cannot climb the stairs.

I realise there's a certain amount of fatigue about class actions that hold the State responsible and there's no money in the pot to recompense anybody anyway, but these women have had an act of medical barbarism perpetrated against them. One that they never consented to. They were never asked if they wished to have their pelvises cut in two, and they were never offered any alternative to a life blighted by pain and incontinence, and caused by the action of feckless doctors.

These women have been let down and grossly abused, by the medical profession in their youth, and now again by The Walsh Report in their old age. This is a shameful episode in the medical history of our State which remains unresolved, after a campaign by ageing survivors that is already 10 years old. Unless a government strategy of waiting for the victims to die off -- before compensation is agreed to -- is not to be suspected, this must be put right now.

Ciara Kelly is a Wicklow-based general practitioner

Sunday Independent

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