Shortly after writing an opinion piece for the Sunday Independent on the practice of ‘Caesarean hysterectomy’ at the Lourdes Hospital in September 2008,1 I received a telephone call from a survivor of symphysiotomy: a meeting with three casualties of this operation followed. I had a background in policy-oriented research and a special interest in obstetrics, having been commissioned by theDepartment of Health to do a national survey on intentional home birth. My first book documented women’s experiences of maternity care, while my most recent one explained why our health system is as it is. So believing that I could make some contribution to survivors’ long running quest for justice, I agreed to see if I could help.
Survivors of Symphysiotomy (SoS) is a remarkable organisation by any standards. Dotted all over Ireland,members range in age from the late 50s to the late 80s. The sole dedicated voice of survivors in Ireland, SoS has been trying to secure an independent inquiry into the surgery for almost a decade. All such attempts have been thwarted. Founding members, such as Rose Magee, did not live to see the day. Despite the promises made to her by a former Minister for Health, the failure of Dublin City Council to install a stair lift left Rose a prisoner in her own home during her last years. Other indomitable founding members, such as Matilda Behan, Eileen Murphy and Claire Kavanagh—some now well into their 80s—continue to fly the flag. The courage, tenacity and determination of SoS members has been an unfailing inspiration to me in preparing this report. For very many of them, symphysiotomy has been a life sentence without remission.
It has taken me nearly three years of research to understand this childbirth surgery in all of its dreadful dimensions. Doctors described symphysiotomy as ‘widening the pelvis’, a benign description that obscured the fact that the surgery severed the pelvis, and one that had made its way into the media. The fact that symphysiotomy was carried out by doctors as a matter of personal preference meant that Caesarean section—the treatment of choice for obstructed labour at that time—was being withheld from the patient. Doctors also performed a related operation, cutting the pubic bone rather than the joint of the symphysis pubis. This operation, known as pubiotomy, was even more dangerous than symphysiotomy. I was also to learn that the operation posed significant risks to babies as well as mothers: medical evidence suggests that one baby in ten did not survive the operation of symphysiotomy, and survivor testimony shows one baby born in this way suffered catastrophic injuries.
Some symphysiotomies, particularly those performed in the aftermath of a Caesarean section, were more hideous than others. Those carried out during late pregnancy were almost equally unprecedented. However, even the more usual symphysiotomies, those done during labour, were cruel in the extreme.Women found the experience utterly traumatising: after being left in labour for many hours, they were generally operated upon without warning, in the labour ward or in theatre, under local anaesthetic. And after the surgery, there was still a baby to be born: they were still in labour.
The pain of pushing a baby out with an unhinged pelvis was followed by the agony of walking on it. Instead of immobilising the pelvis, hospital staff further destabilised it by requiring women to walk. Discharged home with a broken pelvis, women were left to sink or swim, without medical advice or painkillers. Many of the serious health problems—of mobility, pain and incontinence—endured by women today are related to the negligent failure to treat them as surgical patients.
In addition to medical negligence, there were other issues, such as the use, or abuse, of medical power and knowledge. The idea that major surgery could be performed on a pivotal structure of the body without patient consent was troubling enough. I knew that women were generally not informed in advance about their surgery, that the its risks and benefits had not been explained, nor the existence of a safer alternative, Caesarean section, mentioned. The failure of hospital staff to inform women of their surgery postnatally was even more disturbing, however. Even general practitioners refused, on occasion, to tell women what had been done to them.
Several decades were to elapse before many women finally understood that their pelvises had been broken. It was as though these were secret operations, not to be disclosed to the patient. Was it because the surgery was so aberrant that it could not be revealed?
Finally, there was the discovery that symphysiotomy is now enjoying a revival in resource poor countries, where it is promoted by some as a ‘safe’, low cost alternative to Caesarean section. However, as the lived experience of survivors shows and medical writings attest, the safety of symphysiotomy is a fallacy.
Bodily Harm examines in detail how the authorities in Ireland have dealt with demands for truth, justice, health and disability services since the surgery was first exposed in the media by Dr Jacqueline Morrissey in 1999. The report sets out the history of symphysiotomy and pubiotomy, describes how these operations were revived in an era when women in Ireland had few rights, and scrutinises the various claims that have been made for the surgery. In the closing chapters, I look at these operations from a legal perspective, show how the surgery was driven by medical ambition as well as religious beliefs and present survivors’ case for truth and justice.
