The black area marked by a "5" is the pubic symphysis, which is divided during the procedure
Symphysiotomy is a surgical procedure in which the cartilage of the pubic symphysis is divided to widen the pelvis allowing childbirth when there is a mechanical problem. It is also known as pelviotomy, synchondrotomy,, pubiotomy, and Gigli's operation after Leonardo Gigli, who invented a saw commonly used in Europe to accomplish the operation.
Symphysiotomy was advocated in 1597 by Severin Pineau after his description of a diastasis of the pubis on a hanged pregnant woman. Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. They became less frequent in the late 19th century after the risk of maternal death post-caesarean section decreased due to improvement in techniques, hygiene, and clinical practice.
Indications for the procedure
The most common indications are a trapped head of a breech baby, shoulder dystocia which does not resolve with routine manoeuvres and obstructed labor at full cervical dilation when there is no option of a caesarean section. Currently the procedure is rarely performed in developed countries, but is still routine in developing countries where caesarean section is not always an option.
Symphysiotomy results in a temporary increase in pelvic diameter (up to 2 cm) by surgically dividing the ligaments of the symphysis under local anaesthesia. This procedure should be carried out only in combination with vacuum extraction. Symphysiotomy in combination with vacuum extraction can be a life-saving procedure in areas of the world where caesarean section is not feasible or immediately available. Since this procedure does not scar the uterus, the concern of future uterine rupture that exists with cesarean section is not a factor.
The procedure is not without risk, including urethral and bladder injury, infection, pain and long-term walking difficulty. Symphysiotomy should, therefore, be carried out only when there is no safe alternative. It is advised that this procedure should not be repeated due to the risk of gait problems and continual pain.
Abduction of the thighs more than 45 degrees from the midline may cause tearing of the urethra and bladder.
- Give appropriate analgesic drugs.
- Apply elastic strapping across the front of the pelvis from one iliac crest to the other to stabilize the symphysis and reduce pain.
- Leave the catheter in the bladder for a minimum of 5 days.
- Encourage the woman to drink plenty of fluids to ensure a good urinary output.
- Encourage bed rest for 7 days after discharge from hospital.
- Encourage the woman to begin to walk with assistance when she is ready to do so.
If long-term walking difficulties and pain are reported (occur in 2% of cases), treat with physical therapy.
In the Republic of Ireland it is estimated that 1,500 women unknowingly and without consent underwent symphysiotomies during childbirth between 1944—1992. Some survivors were left with severe lifelong after effects, including extreme pain, impaired mobility, incontinence, and depression. Then-Minister for Health and Children, Mary Harney, ruled out a review on 19 February 2010.
However, gathering public outrage eventually resulted in hearings on 15 March 2012. At that time, Sinn Féin leader Gerry Adams spoke at length to the press, linking the cause of the symphysiotomy survivors with other civil rights causes:
These groups include Justice for the Magdalenes, for other victims of institutionalised abuse, including in Bethany Home, and in our Lady of Lourdes Hospital Drogheda, and victims of symphysiotomy. All these causes are crying out for justice. They have been failed by this state. That wrong can be righted. We as Teachtaí Dala [legislators], elected by our peers, have a duty to make this happen....Given the increasing age of the victims and the chronic pain and constant medical intervention they require as a result of symphysiotomy, it is urgent that [current Health Minister Dr. James Reilly] deal with this now.
Adams described the procedure as "institutional abuse involving acts of butchery against women." Eight days later, on 23 March 2012, a County Louth woman subjected to a symphysiotomy was awarded €450,000 by the High Court.
As of the 10th of July 2012 the amount of €450k has been reduced by the high court to €350k
In June 2012, details of a draft report on the use of this procedure in Ireland was released. The report by Prof. Oonagh Walsh (UCC) found that although symphysiostomies were phased out in most medical institutions across the country, Our Lady of Lourdes Hospital was practising the procedure up until the early 1980s.
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Symphysiotomy - A Brutal Practice. A ground-breaking documentary from Primetime, RTE Television, 18/02/2010, http://www.rte.ie/news/av/2011/0621/media-2704182.html#&search=Brutal . Which revealed for the first time that up to 1500 procedures were carried out in Ireland. Morrissey, J. The Murder of Infants? Symphysiotomy in Ireland 1944-66 in History Ireland Issue 5 (Sept/Oct 2012) Vol 20, at http://www.historyireland.com/volumes/vol20/?id=115568