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.