Dáil to debate symphysiotomy

 The Journal

 14/03/12

A DEBATE ON the practice of symphysiotomy is to be held in the Dáil for the first time tomorrow.
Deputies have been given an opportunity to make statements on the medical procedure following a suggestion from Sinn Féin health spokesperson Caoimhghín Ó Caoláin.

A number of women who survived the operation, during which their pelvises were unhinged, are to attend the debate. Many survivors have suffered permanent damage as a result of symphysiotomy.

Ó Caoláin described the practice which was carried out on hundreds of Irish women between the 1940s and 1980s as “barbaric”.

About 180 survivors who continue to campaign for justice and truth have called for a full and proper inquiry into why the procedures were carried out in Ireland, long after they were discontinued in other countries. The women also demand a redress scheme to include medical benefits.

Following Oireachtas meetings earlier this year, the survivors have garnered backing from TDs and Senators who have joined together in a cross-party support group.

Recent developments
In February, the Department of Health received a draft report from an academic researcher who was asked to review the practice in Ireland during the 1950s through to the 1980s.

The Attorney General is considering that report and will advise Health Minister James Reilly on whether it can be made available for consultation purposes.

Previously in the Dáil, Reilly said he was “very conscious” of the distress the procedure has caused to a number of women, adding that the Government is committed to dealing with the matter “sensitively”.
He promised to ensure the greatest possible supports and services are made available to women who continue to be negatively impacted because of the procedure.

Although Reilly admitted that the use of symphysiotomy “may well…have been utterly inappropriate”, he rejected the term “barbaric” in relation to the act.
“The method was used in the majority of cases as an emergency response to obstructed labour in women suffering from mild to moderate disproportion, and as such was an appropriate clinical intervention,” he said.
“It was a standard procedure at one time and it was reintroduced to certain Irish hospitals in the 1940s as a clinical response to the limitation imposed by specifically Catholic religious and ideological circumstances.

"The primary reasons were the fact that contraception and sterilisation for the prevention of pregnancy was illegal, and the safety of repeat Caesarean sections in the period was unproven."

The widening of the pelvis by up to 3.5 cm allows for vaginal birth when labour is obstructed, reducing maternal and infant death when Caesarean was not the chosen path.

The Survivors of Symphysiotomy group claims that the operations were carried out – without prior knowledge or consent – “mainly for religious reasons, by obstetricians who were opposed to family planning”.

 "The surgery was exhumed at the National Maternity Hospital by doctors who were hostile to the idea of family planning and who were looking to replace Caesarean section with an operation that would facilitate large families."

Nine children was the ideal family size, in their eyes. Repeat Cesarean sections thwarted this goal, they say.

At the Coombe and National Maternity hospitals, it was used in 0.35 per cent of deliveries. It was used more often – and for longer – at Our Lady of Lourdes Hospital in Drogheda.

There were apparent instances of the procedure being carried out after a baby was delivered, a practice which Reilly called “utterly disgraceful”.

Consequent mobility issues, discomfort, upset, chronic pain and difficulty were caused as a result. The Institute of Obstetricians and Gynaecologists has recognised walking difficulties, pelvic joint pain and urinary incontinence as long-term problems.

Reilly also told the Dáil: “I know people who had that procedure and have sadly passed on. I am aware of the dysfunctionality it caused them in their daily lives.”

However, he said he could not pre-empt the AG’s advice or the final report.

The technique has not been used in Ireland since 1984 and no longer forms a part of specialist training for doctors. It is still, however, taught as an emergency procedure at the Royal College of Obstetricians and Gynaecologists in London.

 

 15/03/12

A NUMBER OF women from the Survivors of Symphysiotomy (SOS) group were in Leinster House today for a Dáil debate on the procedure that left many of them with life-long chronic pain and a host of other medical problems.

The group is seeking to have the statute bar lifted so they can seek redress through the courts for the permanent damage they suffered as a result of symphysiotomy, during which their pelvises were unhinged.
They also want a public, independent inquiry to be established to examine why the procedure was still used in Ireland, long after it was discontinued in other European countries.

During the operation, a woman’s pelvis is widened by up to 3.5 cm to allow for vaginal birth when labour is obstructed. It was an intervention used in the 18th and 19th centuries to reduce maternal and infant death when Caesarean section was not the chosen path.

The Survivors of Symphysiotomy group, however, claims that many of the operations in Ireland after 1940 were carried out – without prior knowledge or consent – “mainly for religious reasons, by obstetricians who were opposed to family planning”.

“The surgery was exhumed at the National Maternity Hospital by doctors who were hostile to the idea of family planning and who were looking to replace Caesarean section with an operation that would facilitate large families,” they say.

The support group has also called for full access to promised health benefits and entitlements to be enshrined in law.

The Minister for Health James Reilly has received a draft report from an independent researcher who examined the practice – how often it was used, why it was used and when practices were changed. On submitting her report in January 2012, she told the Department of difficulties she experienced accessing historical data. Reilly has now asked the Attorney General whether he can make that report available for consultation purposes.

In the Dáil today, the Minister outlined that the medical procedure was primarily used before the advent of safe Caesarean sections.

He admitted that the practice was used for some time after it was discontinued in other developed countries, most notably in Our Lady of Lourdes Hospital in Drogheda.

It has been suggested that some 1,500 symphysiotomies took place between 1944 and 1992. At the Coombe and National Maternity hospitals, it was used in 0.35 per cent of deliveries.

Reilly said he was “conscious of the distress…and pain” that symphysiotomy has caused, adding that the Government was committed to dealing with the matter “sensitively”.

" My first priority is to make sure that the health needs of those who have had a symphysiotomy are met quickly and effectively. With this in mind, I am committed to ensuring that the greatest possible supports and services are made available to women who continue to suffer effects of having undergone this procedure."

A cross-party Oireachtas committee has been established to highlight the plight of the women who underwent the procedure between 1940 and 1984. They heard from the victims last night and Fianna Fáil TD Billy Kelleher said the “sad stories” were “emotive, disturbing and upsetting”.
“Many of the survivors have been left permanently disabled, incontinent and in constant pain. I find it astonishing that no person or agency has ever been held accountable for these cruel and unnecessary operations,” said Senator Mary Moran ahead of today’s debate.

Carlow Kilkenny representative Ann Phelan pleaded for full access to the legal system for victims of symphysiotomy. She said that because the Statute of Limitations has run out, they cannot seek redress in the courts.

This could – and should – be amended, added the Labour TD, who also called for the HSE to help survivors gain access to their medical records, something some have not yet been able to do.
She met with victims last week and said the “awful practice” was made worse because consent was not given in  many cases. ”Nor was the full extent of the operation and its aftermath fully explained to the women who underwent the operation.”


Her party colleague Anne Ferris echoed the sentiments, stating the practice has had a “devastating legacy” for many women.

“Groups like SOS are fundamentally important in bringing to light the dark side of an Irish society that liked to hide in shadows,” she said.


 ingevoegd 14-6-2012