SYMPHYSIOTOMY IS A cruel and dangerous childbirth operation that unhinges the pelvis, severing the symphysis joint or, in the case of pubiotomy, sundering the pubic bones.

Ireland was the only country in the developed world to practise this discarded surgery in the mid to late 20th century.

Caesarean section had been the standard treatment for difficult births in Ireland since the end of the 1930s. However, doctors’ preference for symphysiotomy saw 1,500 of these 18th century operations being performed from 1944 onwards, mostly in Catholic private hospitals. Around 150 women survive today, many of them permanently disabled, incontinent and in pain. One baby in ten died during the process and a number were brain damaged.

Women were occasionally informed their pelvis would be broken, but most were not.

Some believed they were going to have a Caesarean section. Others were symphysiotomised under general anaesthetic during pregnancy, or, as in Olivia Kearney’s case, to ‘deliver’ a baby already born by Caesarean.

The majority, however, were left for many hours in the labour ward before being operated upon, wide awake, without their consent. One woman described the wire saw used to cut her pubic bone as being ‘like broken glass’, tearing into her.

Push through the agony

After the surgery, women were still in labour. Sometimes the baby took hours, or days, to come; then they had to push for as long as it took, through the agony of an unhinged pelvis. In one case, where the baby was in a brow position– incompatible with vaginal birth– it took four hours of ‘maternal effort’ to get the baby out. Those unable to give birth vaginally were eventually given the Caesarean section that had earlier been withheld.

Instead of nursing women as surgical patients, midwives further destabilised the severed bone or joint by forcing women to walk on their broken pelvises, often within a day or two of giving birth. Some fainted from the pain. Discharged from hospital without medical advice or painkillers, women were sent home to sink or swim. Many never recovered.

The surgery was an abuse of power, a pre-emptive surgical strike against the practice of birth control by obstetricians who disliked Caesarean section, on account of its association with what Archbishop McQuaid termed the ‘crime of birth-prevention’. Undergoing four such operations was widely seen as the upper safety limit. Symphysiotomy, in contrast, was viewed as a gateway to childbearing without limitation.

Long shunned by doctors on account of its dangers, symphysiotomy was revived in 1944 at Holles St Hospital as a replacement for Caesarean section in certain cases. Pregnant women were used as guinea pigs there in the 1940s and ’50s and this experimentation reached bizarre heights at the Lourdes Hospital, Drogheda, then under the ownership of the Medical Missionaries of Mary.

False claims of ‘unsafe’ Caesarean sections

Women were also used as clinical material to train staff bound for overseas. One woman reported seeing a camera in the operating theatre at the Lourdes Hospital just before she lost consciousness. The low cost operation was seen as invaluable, especially for trainees from developing countries, in hospitals that aimed to become international training centres.

Regulatory failure allowed the practice of this mutilating surgery for half a century. Hospital reports detailing these operations were ignored.

False claims that Caesarean section was unsafe until the 1960s and that symphysiotomy was performed for medical reasons are still being made.

Official briefs continue to reflect the myths propagated by the Department of Health, which has allowed itself to be captured by the body whose members committed these atrocities, namely, the Institute of Obstetricians and Gynaecologists.

The courts represent survivors’ sole route to truth and justice. But actions that are brought outside the time limit (two years since 2004) cannot succeed. The clock runs from the time that you become aware that your injuries resulted from wrongdoing or negligence. In some cases, the date of that knowledge is unclear. These were covert operations: three or four decades elapsed in most cases before women understood that their pelvises had been broken. Many were having a first baby, and knew nothing about childbirth. All of them, without exception, assumed, or were told, that whatever was done was necessary to save the life of the baby. The medical profession closed ranks, in general. Few admit any connection between women’s ill-health and their symphysiotomies.

The knowledge that this was wrongful surgery came slowly and painfully, in fragments heard in the media or read in a newspaper. Accepting that one has been abused is difficult: denial is easier.

Ms Kearney’s case was initially dismissed in the High Court on the grounds of undue delay. Now that the veil has been rent on these abusive operations, the Oireachtas should lift the statute of limitations for survivors, for a brief period. This was done for victims of sexual abuse, a far more difficult area to legislate for. There are no floodgates, only 130 or so mainly elderly women, standing, waiting, for justice.

Marie O’Connor is the author of Bodily Harm: symphysiotomy and pubiotomy in Ireland 1944-92′ and the chairperson of Survivors of Symphysiotomy, the support group for victims of the practice.