SYMPHYSIOTOMY WAS EFFECTIVELY banned in France in 1798.

The procedure – now described as barbaric, torturous and brutal – was carried out in Ireland until 1987.

Young women (and, in some cases, teenage girls) were subjected to the surgery which involved having their pelvises unhinged before, during or after childbirth.

“Their arms held down by midwives, their feet manacled in stirrups, high and wide in the lithotomy or ‘stranded beetle’ position, many recount how they screamed and struggled to get free as they were being operated upon, wide awake, in the height of labour, in front of a large audience of generally male students,” reads a 50-page submission to the United Nations Committee Against Torture (UNCAT)

…After these operations, in the vast majority of cases, they were still in the throes of labour. Survivors generally faced further hours of labour after theses operations, two days in one case.”

The Survivors of Symphysiotomy’s (SOS) complaint to UNCAT, submitted today, outlines how 24 hospitals and maternity homes across Ireland favoured the procedure over Caesarean Section, long after the practice had been discontinued in other developed nations.

According to the advocacy group, the State failed abjectly in its duty to prevent “dangerous and maverick medical practice”.

“The performance of these mutilating childbirth operations in the absence of medical necessity and without patient consent constituted torture, cruel, inhuman and degrading treatment. Ireland has violated its obligations under international law,” says SOS chairperson Marie O’Connor on the publication of the document, which identifies hospitals and doctors – including the now infamous Michael Neary.

Survivors believe their complaint is still eligible (despite the events taking place before the 2002 ratification of the Convention Against Torture) because of a precedent set by another case taken against Azerbaijan which was allowed because the effects of violations continued after it came into effect.

About 1,500 symphysiotomies were carried out in Ireland between 1941 and 1987. Some 300 of these patients are still alive today.

Most of the women left hospital not knowing their pelvises had been broken during childbirth. The majority found out decades later – through the media – after a lifetime of chronic pain, walking difficulties, incontinence, sexual difficulties, PTSD and other associated problems.

“In every case,” reads the submission to the UN, “the injuries inflicted by medical practitioners were compounded by their failure to treat them as surgical patients and this negligent care served to maximise the opening of the pelvis.

“Indeed, the success of the surgery in ensuring future vaginal births was premised on the partial recovery of the patient.

Had the joint healed fully or the bone knitted properly, then the permanent increase in pelvic diameter sought by doctors would have been unlikely and the operation would have failed its objective, which was to guarantee future vaginal births without limitation, by averting future Caesarean sections.

The operations did not actually deliver a baby. They merely sundered the pelvis and made labour much more severe, with, as doctors acknowledged, the baby’s head acting as a battering ram during the first stage of labour to prise open the pelvis, while, during the second stage, the woman’s efforts to expel the baby opened the pelvis still further.

Influence of the Catholic Church

Women who had undergone symphysiotomies and pubiotomies (a variant of the operation which sunders the public bone and results in a compound fracture of the pelvis) were not treated as surgical patients.

Often, they were forced to walk on their broken pelvises within a day or two of delivery.

Survivor groups contend that the operations were carried out by doctors because of “religious zealotry”.

They say that because C-Sections were associated with sterilisation and contraception, doctors hostile to birth control sought to widen the pelvis to enable future childbearing without limitation.

Medical ambition may also be a factor, according to the submission, because it was used as a teaching tool in the absence of medical necessity.

The National Maternity Hospital was building itself up as an international training centre in the 1940s and symphysiotomy was seen as a low-cost operation that required neither hospital nor electricity. It was thought that it could be exported to Africa and India where major surgery was not possible.

Pregnant women were used as “clinical material for training purposes” in the three main Dublin maternity hospitals and the IMTH in Drogheda, according to SOS. For those medical experiments, the young, healthy women on their first child were the preferred choice and historical writings and hospital clinical reports show the selection was quite deliberate.

“At the IMTH, women suspected of disproportion, many of whom were of small stature, were routinely allowed to go over their due dates so that their babies, inevitably, grew bigger and more difficult to birth, thereby testing the potential of symphysiotomy more fully.”

The 1960 Coombe Hospital Report carried details of symphysiotomies performed the previous year on three teenagers – one aged 15 and two aged 17.

Complaint to the UN

SOS says the performance of symphysiotomy and pubiotomy constituted torture under Article 1 of the Convention Against Torture as severe pain and suffering, both physical and mental, were intentionally inflicted on women and girls, for reasons based on discrimination – but for the fact that they were pregnant, they would not have had these abusive surgeries perpetrated upon them.

“These acts were deliberately and knowingly perpetrated – without patient consent – by ‘persons acting in an official capacity’ – consultant obstetricians and midwives – with the consent or acquiescence of public officials (in the Department of Health),” the group writes.

Many survivors believe the current government has adopted a “deny until they die” policy as they are conscious of their advancing years (the eldest is 91).

“This complaint is being made because of the Government’s failure to promptly and impartially investigate the practice of symphysiotomy, as required under international law,” according to the group.

“The UNCAT complaint details how since 1999, when the practice was first exposed, the State’s response was to deny it. In 2001, the Department sought a report from the very body whose members had carried out these abusive surgeries; the Institute of Obstetricians and Gynaecologists (IOG).

“The IOG portrayed symphysiotomy as the ‘norm’ for difficult births until the 1960s, a fiction that persists today. The only ‘inquiry’ ever carried out by the State into symphysiotomy is the Walsh report, the final version of which the Government has suppressed.

The draft Walsh report was a whitewash that effectively found 97 per cent of these operations medically acceptable. The Government, to this day, refuses to acknowledge the wrongfulness of these operations.

O’Connor added that victims have a right to proper restitution and effective remedy. About 250 legal actions are due to be heard in the High Court in the coming years.

The full submission, which includes survivor testimony, can be downloaded here.

‘Appalling’, ‘ghastly’ and ‘brutal’ – doctors describe symphysiotomy ordeal

A history of symphysiotomy: the impact of Catholic ethics on Irish medicine

Symphysiotomy survivors gather to recount stories of torture

Interview: ‘I didn’t know if my baby was dead or alive for two days’