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Symphysiotomy in Ireland: About Symphysiotomy

Symphysiotomy is a surgical procedure advocated by French surgeon Severin Pineau at the end of the 16th Century. Also known as synchondrotomy or pelviotomy, the procedure became a routine practice for women suffering from an obstructed labour during childbirth. As clinical practices became better and hygiene improved, the caesarean section became a less risky procedure and replaced symphysiotomy as the preferred surgery.

However, due to the influence of the Catholic Church, symphysiotomy remained prevalent in Ireland until the late 20th Century. Now, symphysiotomies are very rare in the developed world and being phased out of developing countries where caesarean sections are a safe and viable option.

When it was the standard, symphysiotomy was called upon to alleviate issues with an obstructed labour, or other such problems like shoulder dystocia or if a breech baby had a trapped head. The procedure itself sees the surgeon make an incision, under local anaesthetic, just above the pubic symphysis. Using a rocking motion, the symphysis’ cartilage is gradually divided, though a complete division of the joint is very rare. Once performed, the pelvic diameter can increase by a couple of centimetres but must be used alongside a vacuum extraction to ease childbirth.

Undergoing a symphysiotomy leads to an extended recovery period after childbirth. Elastic strapping is put in place across the front of the pelvis in order to stabilise the sliced symphysis as well as a catheter being left in the bladder for at least five days. After being discharged from the hospital, patients are advised to spend one week recovering in bed and to be given assistance when they try to start walking again. Physical therapy may be required if pain persists when walking following the recovery period after undergoing a symphysiotomy.

Nowadays, symphysiotomies are only used if absolutely necessary, but many people have suffered long-term problems following the procedure’s use in the past, with many seeing it as unnecessary at the time that it was performed. Survivors of Symphysiotomy was established to help those suffering from the side effects of the surgery, with nearly 400 women receiving payments from the Irish government, totalling €34 million.

Due to the location of the pubic symphysis, in the middle lower area of the pubic bone, performing a symphysiotomy can result in the patient enduring long-term walking difficulties. While physical therapy can help, the problem can become permanent. Patients are also at risk of other potential problems resulting from undergoing surgery, such as infection or pain, as well as injury to the bladder or urethra. A fistula may also result from the procedure. It is also noted that the surgery should not be performed more than once, if ever, due to the increased potential of long-term pain and walking problems.

It has been estimated that around 1500 women in Ireland underwent the surgery in the 40 years between 1944 and 1984, with the symphysiotomies being insisted upon by the Catholic Church.