‘The murder of infants’? Symphysiotomy in Ireland, 1944–66: updated

via History Ireland magazine:

In 1944 the National Maternity Hospital (NMH) in Dublin pioneered the use of the symphysiotomy operation (see sidebar) as the procedure of choice in certain cases where the woman’s pelvis was deemed too small to permit a normal birth (termed ‘disproportion’). The NMH was Ireland’s leading Catholic-identified maternity hospital. NMH doctors were motivated by the perceived need to avoid the practice, common among non-Catholic doctors in Britain and elsewhere, of recommending sterilisation to women after a third Caesarean section (CS). The resurrection of symphysiotomy was controversial; one British obstetrician, Chassar Moir, speaking at a Royal Academy of Medicine in Ireland meeting in 1951, called it ‘the murder of infants’. Despite evidence of a high infant mortality rate and other problems, the NMH experiment lasted until 1966. Dublin’s Coombe Hospital also adopted the procedure from 1950 onwards. The Rotunda did not adopt NMH practice, although the Draft report on symphysiotomy notes that, although ‘rarely used,’ symphysiotomy was employed there occasionally, mainly as a post-CS procedure.

Motivation for revival of symphysiotomy

Symphysiotomy was thought to permanently enlarge the pelvis, and therefore, when carried out in a first pregnancy, it might remove the necessity for a woman with ‘disproportion’ to face repeated CS in future pregnancies. This was a particular problem for Catholic doctors. Contraception was practised in most developed countries, making repeat problem pregnancies less common, and non-Catholic doctors advised sterilisation after three CS. Irish Catholic doctors were unable or unwilling to do this. They were aware of criticism by colleagues who believed that Catholic religious strictures disadvantaged patients. In the same period, research had been undertaken in the NMH on pregnant women with heart disease, intending to prove that it was not medically necessary to offer them information on contraception, sterilisation or abortion. One author of that research noted, in a telling phrase, that it ‘proves that good morals and sound medical advice are compatible’.


more from The Journal.ie:

Symphysiotomy victims tell the UN about cruel and barbaric childbirth operations

SYMPHYSIOTOMY WAS EFFECTIVELY banned in France in 1798. The procedure – now described as barbaric, torturous and brutal – was carried out in Ireland until 1987. Young women (and, in some cases, teenage girls) were subjected to the surgery which involved having their pelvises unhinged before, during or after childbirth.
“Their arms held down by midwives, their feet manacled in stirrups, high and wide in the lithotomy or ‘stranded beetle’ position, many recount how they screamed and struggled to get free as they were being operated upon, wide awake, in the height of labour, in front of a large audience of generally male students,” reads a 50-page submission to the United Nations Committee Against Torture (UNCAT)...The Survivors of Symphysiotomy’s (SOS) complaint to UNCAT, submitted today, outlines how 24 hospitals and maternity homes across Ireland favoured the procedure over Caesarean Section, long after the practice had been discontinued in other developed nations. According to the advocacy group, the State failed abjectly in its duty to prevent “dangerous and maverick medical practice”.

“The performance of these mutilating childbirth operations in the absence of medical necessity and without patient consent constituted torture, cruel, inhuman and degrading treatment. Ireland has violated its obligations under international law,” says SOS chairperson Marie O’Connor,” says SOS chairperson Marie O’Connor on the publication of the document, which identifies hospitals and doctors – including the now infamous Michael Neary ...Most of the women left hospital not knowing their pelvises had been broken during childbirth. The majority found out decades later – through the media – after a lifetime of chronic pain, walking difficulties, incontinence, sexual difficulties, PTSD and other associated problems. “In every case,” reads the submission to the UN, “the injuries inflicted by medical practitioners were compounded by their failure to treat them as surgical patients and this negligent care served to maximise the opening of the pelvis.

“Indeed, the success of the surgery in ensuring future vaginal births was premised on the partial recovery of the patient....The operations did not actually deliver a baby. They merely sundered the pelvis and made labour much more severe...

Influence of the Catholic Church

Women who had undergone symphysiotomies and pubiotomies (a variant of the operation which sunders the public bone and results in a compound fracture of the pelvis) were not treated as surgical patients. Often, they were forced to walk on their broken pelvises within a day or two of delivery. Survivor groups contend that the operations were carried out by doctors because of “religious zealotry”. They say that because C-Sections were associated with sterilisation and contraception, doctors hostile to birth control sought to widen the pelvis to enable future childbearing without limitation....Pregnant women were used as “clinical material for training purposes” in the three main Dublin maternity hospitals and the IMTH in Drogheda, according to SOS. For those medical experiments, the young, healthy women on their first child were the preferred choice and historical writings and hospital clinical reports show the selection was quite deliberate.. “At the IMTH, women suspected of disproportion, many of whom were of small stature, were routinely allowed to go over their due dates so that their babies, inevitably, grew bigger and more difficult to birth, thereby testing the potential of symphysiotomy more fully.”

Complaint to the UN

SOS says the performance of symphysiotomy and pubiotomy constituted torture under Article 1 of the Convention Against Torture as severe pain and suffering, both physical and mental, were intentionally inflicted on women and girls, for reasons based on discrimination – but for the fact that they were pregnant, they would not have had these abusive surgeries perpetrated upon them...“These acts were deliberately and knowingly perpetrated – without patient consent – by ‘persons acting in an official capacity’ – consultant obstetricians and midwives – with the consent or acquiescence of public officials (in the Department of Health),” the group writes...About 250 legal actions are due to be heard in the High Court in the coming years.

Here is more information about Michael Neary via Wikipedia:

Michael Neary is a retired Irish consultant obstetrician/gynaecologist. He gained notoriety when it was discovered that he had performed what was considered an inordinate number of caesarian hysterectomies during his time at Our Lady of Lourdes Hospital in Drogheda, County Louth. He was suspended by the Irish Medical Council in 1999 pending their investigations, and then struck off the Register of Medical Practitioners in 2003. As a result of the Medical Council's investigation, which discovered a number of alarming aspects to the case, an inquiry was set up in April 2004 by the then Minister for Health and Children, Micheál Martin to investigate the matter....During the inquiry, Judge Harding-Clarke's offices were broken into at least three times, she has said....The Inquiry found that Dr. Neary carried out 129 of 188 peripartum hysterectomies carried out in the hospital over a 25-year period, some on very young women of low parity. The average consultant obstetrician carries out 5 or 6 of these operations in their entire career. The judge also found that numerous patient files had disappeared from the hospital, obviously removed by people sympathetic to Michael Neary, she wrote. She was unable to find out who removed the files but believes the person to be female. She criticised the 'Catholic ethos' of the hospital at the time. Sterilisation was forbidden, contraception was unavailable, but she reported that 'secondary' sterilisations were commonly and sympathetically carried out on women who did not want more children but were forbidden to use contraception by the Church...A junior consultant pathologist at the hospital in the early 80s asked his senior colleague why a perinatal uterus specimen he received seemed to have nothing wrong with it. The senior consultant replied "that's Michael Neary for you".