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A different sort of female genital mutilation

About thirty years ago, there was an informal secret society in the city of Cork. Perhaps a loose net of those with a shared interest might be more accurate. This group passed the names of certain professionals around – who could be trusted, previous experiences, and religious beliefs. The information was gathered from many sources. It was shared among women of childbearing age because none wanted a fervently Catholic gynecologist.

A fervently Catholic gynecologist might put his beliefs into practice on the delivery table. He might choose to save the life of the child over the mother, or regardless of consequences make sure the woman would conceive again, or choose to mutilate a woman’s body rather than allow the idea that the woman might choose contraception in the future.

In the grand tradition of submission to the catholic church, Irish doctors used the surgical technique of symphysiotomy, long after the rest of the developed world had discredited its practice. Symphysiotomy was developed in 1597 and was routinely used to widen the pelvis during childbirth. By dividing the cartilage of the symphysis pubis, the pelvis can be widened by up to two centimetres.

Known complications include haemorrhage, injury to the urethra or bladder, vesicovaginal or urethrovaginal fistula, stress incontinence, sepsis, and pelvic osteoarthropathy. In some cases women experienced difficulty in walking and an unstable pelvis.

The technique was largely abandoned in the late nineteenth century after improvements in the hygiene and clinical practice of Caesarean section. It is still practiced in developing countries when Caesarean section is too risky and it can save the life of the mother and/or that of the child.

However, in Ireland, women were subjected to symphysiotomy without consent for religious reasons, even though Caesarean sections were relatively safe. It was thought that women subjected to repeated Caesareans might be tempted to use contraception and that could not be allowed to happen.

[Dr] Alex Spain was the champion of symphysiotomy at the National Maternity Hospital. In 1944, he revived the technique because Caesarean sections might lead to “contraception, the mutilating operation of sterilisation, and marital difficulty.” At that time Caesarean sections were perfectly safe and symphysiotomy had fallen into disrepute. Spain admitted his decision went against the weight of the entire English-speaking obstetrical world’.

From 1944 to 1983, 1,500 women underwent this unnecessary and traumatic surgical procedure leaving many in pain for the rest of their lives because of the religious beliefs of a few men. Many survivors have spoken of feeling the saw cut through the public bone and seeing horrific injuries on their newborns. These are just two stories:

“I’ve been in pain ever since. I’ve still attending hospitals with back pain and kidney problems. I’d go to bed one night and would be ok but the next day I would not be able to get out of the bed, I wouldn’t be able to put my feet to the ground, all because of the operation, and I didn’t know at the time. I had x-rays taken of my legs to see what was wrong but they couldn’t find anything wrong.”

and

“They gave me hardly any information, whatsoever, until I got to the theatre. The only thing I remember is the nurses saying I had lovely red hair. They showed me the saw. It was an ordinary hand saw, they showed me where they were going to open the pelvic bone. They didn’t explain — they said: “You are going to have your baby now.” It was such agony, a terrible severe pain.”

Women were subject to this outdated practice because Catholic doctors believed that women would not choose to undergo multiple Caesarean sections. Such women might turn to contraception, the idea of which was unacceptable to those doctors at the time. These doctors saw themselves as upholding the laws of the Catholic church and those who are still alive show no remorse. They deny the damage they inflicted.

Records show that in 2001, the issue of symphysiotomy was being discussed in Government Buildings

It now appears that hundreds of Irish women, over at least a 20 year period, had to undergo this brutal, experimental operation. It has left many of them suffering permanent health problems. The operation, known as symphysiotomy, was carried out – as far as we can determine – in Dublin maternity hospitals between 1944 and 1964, and it could have gone on as late as 1975. Evidence is emerging which suggests it was also carried out in a number of Cork hospitals.

The operation – and the details are not for the squeamish – involved sawing through the woman’s pelvis so that it opened like a hinge. International medical experts repeatedly criticised this practice. They stated that caesarean section should have been the preferred option for difficult pregnancies. Some Irish doctors persisted with symphysiotomy, because they apparently believed that women who underwent Caesarean section would use contraception to avoid pregnancy. The use of contraception, of course, conflicted with the prevailing Catholic ethos.

Survivors of symphysiotomy have called for a review of the cases but Minister for health Mary Harney has said that reviews are carried out for improved care of patients and since symphysiotomy is no longer in use, a review would serve no purpose.

Exposing the extent of religious control in Ireland does not seem to be on the agenda. Religious dogma has no place in an operating room, any more than it does in government or export. The Catholic Church talks of forgiveness and individual acts of evil but subjecting women to urethral and bladder injury, infection, pain and long-term walking difficulties is an example of the institutional harm done to women in theocratic Ireland.

Survivors have called for the Minister’s resignation. The Minister will not resign. With the abuse of children in care, unsafe vetting practices, unread x-rays, cancer misdiagnoses and the suppression of information in the Irish health care system, the survivors of symphysiotomy are finding it difficult to have their voices heard.

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7 thoughts on “A different sort of female genital mutilation

  1. Can you say how this was condoned or supported by the church? Or was it the doctors taking it upon themselves to do this, based on what they thought the church wanted?

  2. @ Mor Rigan

    Your column mentions Dr. Alex Spain and his own acknowledgement that his practice and promotion of symphysiotomies went against the “weight of the entire English-speaking obstetrical world.”

    This seems like an open-and-shut case of medical malpractice.
    How is it that there were no professional boards or other controls in Ireland through which Dr. Spain and his accomplices could be held accountable?

    You mention the influence of the Roman Catholic Church. But the symphysiotomies also seem to be due to a complete lack of professional accountability in the Irish medical profession between 1944 and 1964 (or 1975).

    At least in the U.K. and U.S. today, there are professional standards (enforced on the state level in the U.S.) to which medical/surgical practitioners have to adhere, regardless of their individual religious beliefs. Physicians/surgeons can and do lose their license to practice if state medical review boards find that such practitioners have continued to violate preestablished professional standards despite previous censure by the state medical review board.

    Were there no such professional review boards in Ireland between 1944 and 1964/1975? Does Ireland now have something approaching professional peer review, or malpractice laws, through which physicians can be held accountable?

  3. As I said, the fervently Catholic doctors decided to perform these actions based on what they thought was required by the Catholic Church in a culture of severe religious repression. Based on these ideas, symphysiotomy was practiced without consent in order to control the potential choices of women and their reproduction.

  4. Doctors were considered to be self-regulating in Ireland in the past. They could take any action without consequences especially since they were held in high regard and few would ask any questions as a result. I think that Irish conservatism until the 70s and 80s is hugely underrated outside the country. Afterall, unmarried mothers were still locked up in “asylums” until the 80s. Contraception was restricted until 1993. The train from Dublin to Belfast was called the Contraceptive Train.

    The papal encyclical Casti connubii (On Christian marriage), issued on 31 December 1931, was regarded as the ultimate Catholic guide to the sanctity of marriage and the immorality of birth control. In a state with an overwhelming Roman Catholic majority there was little room for dissent. This atmosphere combined with medical impunity led to women paying the price.

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  6. I AM ABSALOUTLY SURE THAT OPERATION WAS PERFORMED ON ME IN CASTLEPOLLARD BY AN OUTSIDE DOCTOR CALLED IN BECAUSE OF THE DIFFICULT LABOUR ..PLUS ENCLAMPSIA .I WENT INTO LABOR ON FRIDAY MORNING WAS GIVEN SLEEPING PILLS WHICH MADE ME FEEL DRUNK LIKE .. SATURDAY KEPT LIKE THAT SUNDAY SAME MONDAY I WAS MOVED TO LABOR WARD THEN I WENT BLIND AND THAT IS ALL I REMBER UNTIL TUESDAY EVENING ..I WOKE UP IN THE LABOR WARD AND A WOMEN WAS IN LABOR SHE TOLD ME I HAD AN OPERATION LAST EVENING WHICH WAS MONDAY 22 JAN 68..I WAS OUT COLD UNTIL TUESDAY EVENING AND BEDRIDDEN FOR OVER A WEEK WITH SIGHT LOSS AND PAIN IN PELVIC AREA WHICH I HAVE SUFFERED WITH FOR THE PAST 45 YRS AND BEEN TO DOCTORS WITH HIP AND BACK PROBLEMS ..YES THEY WELL PERFORMED THAT PROCEDURE .

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