Briefly, there was a vogue for symphysiotomy in some hospitals in Ireland for several decades, at a time when the procedure was generally considered obsolete.
What is a symphysiotomy? What is a symphysis?
A symphysis is a type of joint or “articulation” between two bones. It’s not the sort of joint at the knee or knuckles; a symphysis has a layer of fibro-cartilage between the bones, as a “shock absorber”.
Here, we are concerned with the symphysis pubis, the symphysis between the pubic rami of the innominate bones of the pelvis. It’s at the front, directly in front of the bladder, and very near the clitoris and urethra. There is about 2mm of movement, and perhaps 1º of rotation normally. This does increase in pregnancy, under hormonal influence.
What’s a symphysiotomy? It is the division of the symphysis, to allow greater separation of the two pubic rami. It used to be done for “disproportion”, that is where the mother’s pelvis was too small to allow the foetal head to pass through during labour. This problem was often related to poor diet and rickets.
It’s important to note that a symphysiotomy was done during labour, to allow the labour to proceed; it was in no way a prophylactic procedure.
I checked in a gynaecological textbook*: it describes the increase in the diameters of the pelvis which can be expected from the operation, that is, how much bigger the pelvis becomes. It continues,
“The writer does not approve of or recommend the operation, on account of the danger of leaving the patient in a crippled condition after it”. The author, however, describes how to do it, then, “When delivery has been completed…” describes how to attempt to repair the symphysiotomy. He recommends in addition bed rest for four weeks, and then the use of a pelvic binder “for at least a year”. And,
“There are certain risks connected with the operation which greatly detract from its value. The urethra or bladder or both may be torn. There may be lacerations about the clitoris, which may give rise to troublesome haemorrhage. The sacro-iliac joints may be much damaged or even ruptured. The pelvic symphysis may fail to unite, and thus leave the woman unable to walk properly.” [My italics.]
What’s disturbing about the cases in Ireland is that:
- The procedure was done as a prophylactic, to enable easier future deliveries. Contraception was not available at this time; the mores of the Catholic church prevailed.
- It was done as an “alternative” to Caesarian section which was felt to be more dangerous, specially for repeated pregnancies; again, there was no contraception, and “grand multipara” were very common in Ireland.
- The women were not told that the procedure had been done; their permission was not sought.
- Even when it was done, it was outmoded, outdated. And there was no attempt at "after treatment", to allow the symphysis to heal.
- And it took some women many decades to discover the truth, to discover why they couldn’t walk properly, why they were in pain.
A report has been commissioned, but not for the first time there is the feeling that the whole truth has not been exposed, and that the government is sitting on its hands.
You can read more of this truly awful story in the Irish Times at:
(and follow the associated links)
* Full declaration: I’m neither eminent nor a gynaecologist, but the author of the textbook was: my grandfather. His textbook was published in 1908. Yes, you read that correctly, the information is more than a century old: it was as correct then as it was during the 20th century.