Symphysiotomy, any political implications?

silverharp · 13-06-2012 8:29am #1

I was watching Vincent Brown's programme last night and his subject was the harrowing abuse of women in Irish hospitals who suffered having their pelvis split apart during childbirth as it suited Catholic ethics and "hopefully" "helped" women to avoid family planning. One angle was that the medical staff were often members of lay Catholic organisations and as bad as the Bishops have been on occassion they even thought some of these groups were bonkers with various daft proposals they often received from them.
So while I dont care what groups my state employed bus driver is involved in, is it acceptable for teachers, medical staff, police even to be members of such groups and presumably not have to declare it some way so that patients and parents in particular are aware of it?

Regarding the past and now, it appears that that the HSE want to drag this out so that most of the women will die off before they get a chance to have their stories heard. According to the survivor on Vinny's prog. they were not contacted in relation to the report that is coming out. The last of these operations was the late 80's early 90's so there must be staff working still that were involved, will they be held to account?

silverharp · 18-06-2012 7:08am

small article in the IT today

http://www.irishtimes.com/newspaper/opinion/2012/0618/1224318138373.html

.....Most of the operations were carried out at Our Lady of Lourdes Hospital in Drogheda (348), the National Maternity Hospital (281) and the Coombe in Dublin (242). Indeed the Drogheda unit, referred to elsewhere as a hospital with “an unswerving Catholic ethos” uniquely continued to perform the procedure until 1984, long after the safety of Caesarean section was established.

The Institute of Obstetricians and Gynaecologists has expressed concern about revisionism in the context of health procedures, technology and medicines of the time. However, even allowing for the rose-tinted lens of retrospection, it is impossible to justify the barbaric practice of sawing through a woman’s pubic bone while she was conscious, held down by nursing staff. To knowingly render a woman incontinent and unable to walk with the procedure is morally and ethically indefensible.

The Department of Health says the Walsh report is the first in a two-part process and that the views of women and interested parties will be considered over the coming months. The process must end with a firm set of proposals offering a full formal apology and practical aid to surviving victims of symphysiotomy.

djpbarry · 18-06-2012 2:28pm

The Institute of Obstetricians and Gynaecologists has expressed concern about revisionism in the context of health procedures, technology and medicines of the time. However, even allowing for the rose-tinted lens of retrospection, it is impossible to justify the barbaric practice of sawing through a woman’s pubic bone while she was conscious, held down by nursing staff.

Actually, it’s quite possible to justify. First of all, the pubic bone is not sawn through, cartilage is. Secondly, the woman may be conscious, but she would be under local anaesthetic. Finally, and most importantly, a symphysiotomy can be a life-saving procedure where a Caesarean, for whatever reason, is not an option.

I am not suggesting that there should not be a review/investigation into the use of the procedure in Ireland in the past – there absolutely should be if it was routinely carried out without consent and where safe alternatives existed. But, let’s get the facts straight first. That’s asking a lot from the Indo, I know. But we can always hope.

antoobrien · 18-06-2012 4:52pm

Also there was a decent analysis piece on this in indo last Friday.

The statement says: "The risks of maternal and infant death and morbidity at that time were greater with caesarean section, even when mothers were healthier and the attendant problems related to anaesthesia, blood transfusion and infection were lessened".

So what did we expect doctors to do back then, perform caesarean sections rather than symphysiotomies even when the former was medically riskier than the later?

The fact is that in developing countries even today -- and back in the 1950s we were basically a developing country -- symphysiotomy is still being used. And it is being used at the recommendation of the World Health Organisation (WHO).

And here is (some of) the W.H.O advice

Prevalence of uterine rupture

Uterine rupture, or tearing of the uterine wall during pregnancy or delivery, often results in the death of the baby and sometimes of the mother. In some cases, the uterus suffers irreparable damage and has to be removed. An HRP systematic review covering all the available data on this morbidity found that in most countries prevalence rates are in the 0.1%–1.0% range. The median prevalence rates of uterine rupture in community- and hospital-based studies were 0.05% and 0.31%, respectively. In women who had had a previous caesarean section, the prevalence of ruptured uterus was about 1%. The review was based on 86 groups of women participating in 83 studies. Less developed countries had a higher prevalence rate than more developed countries. Reports from four developing countries— Bangladesh, Ethiopia, Ghana and Nigeria—showed that about 75% of cases of uterine rupture occur in women with an unscarred uterus. They also found that in 1%– 13% of cases of uterine rupture the mother dies and that in 74%–92% of cases the baby dies. The authors of the systematic review suggest four approaches to reducing the prevalence of rupture of an unscarred uterus: (i) by reducing the number of unwanted pregnancies, particularly in high-parity women; (ii) by increasing access to obstetric services, including caesarean section for obstructed labour; (iii) by innovative solutions such as symphysiotomy or caesarean section with local analgesia in areas were conventional caesarean section facilities are unavailable; and (iv) by wide distribution of guidelines on the use of miso-prostol to induce labour to ensure that the drug is used in safe doses.

Source: Hofmeyr JG, Say L, Gülmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG, 2005,112:1221–1228.

djpbarry · 18-06-2012 4:56pm

Fair enough - consider my criticism of the Indo withdrawn.

For now.

antoobrien · 18-06-2012 5:03pm

djpbarry wrote: »

Fair enough - consider my criticism of the Indo withdrawn.

For now.

tbh I don't know why you started on the indo, the only source I've seen referenced was the IT.

djpbarry · 18-06-2012 5:07pm

antoobrien wrote: »

tbh I don't know why you started on the indo, the only source I've seen referenced was the IT.

You're absolutely right - sorry, got my wires crossed.

The Times drops another notch in my estimation so.

K-9 · 18-06-2012 7:08pm

antoobrien wrote: »

Also there was a decent analysis piece on this in indo last Friday.

And here is (some of) the W.H.O advice

Well David Quinn would say that, hardly unbiased analysis.

I'll await the publication of the final report after consultation with the women involved. Going on the Prime Time show they haven't been involved in the draft report. I think even the head of the body representing the women couldn't point to direct Church involvement but she did paint a very good picture of the Catholic ethos of the hospitals together with sexism.

steddyeddy · 18-06-2012 10:11pm

I listened to Teresa Devoy talk about Symphysiotomy on the vincent browne show and I have to say shes a very brave woman for talking about her ordeal in such detail.

The only political implications I can see is the lack of action taken by previous ministers of health on the issue. Apart from the operation reported there are disturbing parralels evident amongst the survivors reports. The lack of consent sought and the lack of explantion given over the operation need to be addressed. I dont hear that the patients were given proper after care either.

It also seems like the operation was phazed out in a lot of hospitals except some of the Irish ones. The operation itself was used as a safer alternative to c-section however c-sections became a lot safer in the 20th century. Major questions need to be asked about why this operation was practised in certain Irish hospitals and why the situation warranted them. In my humble opinion its quite hard to justify how common this operation was in Ireland and also the way the patients were treated.

Even considering the possiblity that the operation was thought to be completely warrented at the time (warrented for medical reasons not relgious belief) there still will have to be justice for the survivors. Thalidomide was thought to be safe at the time yet its use resulted in the thalidomide children. The makers of thalidomide rightfully paid out. I recognise that this case is more clear cut than the Symphysiotomy cases however.

Manach · 18-06-2012 10:19pm

Little enough mention of the excellent work Catholics have done to keep the welfare of the State afloat when it could ill afford it. Hard work and few resources kept dispensaries going provide much needed medical services for the poorer sections of the community. Blind adherence to other passed practices have been glossed over, but the mere hint of Catholic involvement is enough to unleash liberal angst.

poeticseraphim · 19-06-2012 8:30am

This procedure is rarely used and it's debateable if its needed at all.

It is only used in developing countries were they don't have the conditions necessary for a C-section.

It was also preformed without the women's consent and in many cases without their knowledge.

It is not true to say C-sections at this point were less safe ..well not exactly....at that time there was a firm anti contraception law...

Once a woman has a C-section ..she will (or used to be) discouraged from giving birth vaginally again......and she would be encouraged to nave a C-section again

In Ireland women were having multiple births due to church/state laws on contraception..

And there were worries about how many C-sections a woman could have safely....

The current number is 2-3 safe C-sections.....and at that time if you had a C-section it might not be advisable for you to have a vaginal birth.

So it was not really have been that C-sections were considered unsafe....it is just that they were and still are unsafe for women who have many children.

As contraception was not available an Irish women would on average have more children.

It was really a choice between a rock and a hard place...risk many C-sections and assoiated risks or symphisiotomy

It was the lack of contraception that really caused this whole issue that is why the catholic church is to blame.....

Contraception only became legal in Ireland in 1980..but only under STRONG restrictions...

Manach the catholic church STILL today is against contraception leading to multiple pregnancies in women, mostly in developing countries, where conditions for medical treatment are not favourable.

And the Church is as guilty as hell, in putting the reproductive health of women at risk with it's teachings.

You seem to be under the illusion that it is a charitable istitution. It is a rich company and to be honest it has given a lacklustre response to the fiscal crisis.

But it's response to the crisis HAS NOTHING TO DO WITH THIS.

And don't think the state is not to be held equally responsible for holding the draconian contraception laws until the 80's.

Manach wrote: »

Little enough mention of the excellent work Catholics have done to keep the welfare of the State afloat when it could ill afford it. Hard work and few resources kept dispensaries going provide much needed medical services for the poorer sections of the community. Blind adherence to other passed practices have been glossed over, but the mere hint of Catholic involvement is enough to unleash liberal angst.

Manach whether you are liberal or conservative you should be secularist. And this is just one of the many instances of why there must be a separation of church and state.

An objective pragmatic view is crucial in state and medical matters .....abortion contraception etc must be decided by the individual.

The state and medical profession must stop letting the church infliuence law in a secular society.

There is little to no involvement of the church in the healthcare system today....they don't have the vocations nor the expertise and qualifications nor the public trust. And they certainly do not have the trust of women.

And yes there is a justifiable rage and disgust in Irish society at the church and they brought it on themselves. Infact many priests themsleves share this same rage and disgust.

And they STILL pontificate to us on matters to do with a woman's body and the state listens to them more thann women themselves.

It disgusts me....

djpbarry · 19-06-2012 9:37am

Manach wrote: »

Little enough mention of the excellent work Catholics have done to keep the welfare of the State afloat when it could ill afford it.

Oh, sorry.

Catholics were great at the aul' healthcare.

Happy now?

Ok if we go ahead and investigate potential wrongdoing?

Symphysiotomy, any political implications?

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