“The Torture Began”: Symphysiotomy and Obstetric Violence in Modern Ireland

“They just took me into the ward and put me on the bed and told me they were going to do some little job … ‘you’ll be very sore, and your legs will be tied together,’ [said the doctor]. And by God, it’s a thing you’ll never forget the rest of your life.”¹

Twenty-one-year old Rosaleen O’Connor was in labor with her second child when she received the above procedure in Dublin, Ireland. O’Connor was one of hundreds, and likely thousands, of Irish women who were given symphysiotomies and pubiotomies during childbirth from the 1940s to the 1980s.

Symphysiotomy and pubiotomies are medical procedures that involve the breaking of the pelvis to assist a difficult vaginal birth.² In a symphysiotomy, physicians sever the cartilage and unhinge the pelvis; in a pubiotomy, they cut the pubic bone. Although doctors had used symphysiotomies since the late eighteenth century in Europe, they became largely extinct in the western world in favor of the less debilitating and safer Cesarean section by the late nineteenth century. Things were different, however, in twentieth-century Ireland. Here, a Church-State coalition ensured that a Catholic ethos ruled the land. By enshrining motherhood in the 1937 Irish Constitution, the state declared that women’s primary, and only, duty was childbearing and motherhood.

This worldview complicated the practice of Cesarean sections, which were thought at the time to be tantamount to contraception (popular medical opinion asserted that a woman could only undergo 3 or 4 C-sections in a lifetime). In a culture that vehemently opposed any limitation to childbearing capabilities, the Cesarean section was viewed as an unsatisfactory and even untenable option. While most of their peers in Europe and the US had discounted symphysiotomy, then, Irish physicians, particularly in the 1950s, preferred its use in challenging deliveries.

Hastings Tweedy, the master of the Rotunda Hospital, Dublin, wrote in 1909 that he had to perform a symphysiotiomy “under most unfavourable circumstances … [on] a woman with contracted pelvis complicated by a brow presentation.” He described the “unexpected” death of the infant and wrote that the only item of note in the case was that the woman recovered quickly, walking after only seventeen days.³ Tweedy’s remarkably unconcerned observation that his patient was bedridden for more than two weeks reflects the views of much of the Irish medical establishment, who viewed the debilitating physical results of symphysiotomy as negligent side effects of a procedure that would allow women to continue bearing children. Such views were not universal, however; just a few years earlier, Dr. Purefoy, President of the Academy of Medicine in Ireland, debated with Tweedy over the potential drawbacks of symphysiotomy. After Tweedy described performing the procedure successfully, Purefoy responded that he “could not see how pubiotomy could take the place of Caesarean section in certain cases” and that he “thought that its danger had perhaps been passed over too lightly.”⁴

In 1957, Rita McCann received a pubiotomy. She described it as follows:

[gblockquote]”I was pulled to the bottom of the bed. My legs were strapped into stirrups. I was nine months pregnant, flat on my back …. I was helpless and I did not know what was going to happen. [Then] I got a local anesthetic and the torture began.” As a room full of medical students and doctors looked on, McCann says she could feel the pressure of a scalpel cutting into her. From then on, it was “just agony, literally agony,” she recalls. “I got a cramp down my left side and I could not move at all to get myself any relief.”⁵[/gblockquote]

In the years and then decades after their symphysiotomies, Irish women endured chronic back pain, difficulty walking and lifting things, and incontinence.⁶ Astoundingly, and sometimes for decades, many women did not even know what had so disabled them: doctors never told them that their pelvises were fractured during labor and birth.⁷

By the new millennium, and in the aftermath of other Irish scandals over abortion and the Magdalene Laundries, survivors of symphysiotomy began organizing and demanding recognition. Some took their cases to court, and in 2012, the Irish Supreme Court awarded 450,000 euros to a symphysiotomy survivor. A few years later, a government-sponsored investigation into the practiced produced the Walsh Report, and the government announced a redress scheme for the survivors of symphysiotomy, agreeing to pay between 50,000 and 150,000 euros for each applicant. Like other Irish redress schemes, this one was controversial; although it paved the way for some survivors to receive damages, it also allowed the government to avoid admitting any wrongdoing.

Survivors of Symphysiotomy (SOS), an organization founded in 2002 to assist surviving women in receiving recognition and compensation for their pain and suffering, has called the procedure “cruel, inhuman and degrading.” SOS has worked to publicize the government’s inadequate responses to this crisis and even filed a complaint with the United Nations Committee Against Torture. “Nothing can change what happened,” declares SOS’s web page, “but the truth must be told.”

(#SOS Survivors of Symphysiotomy)

(#SOS Survivors of Symphysiotomy)

Attempts at recognition and recompense continue to be troubled, however. Earlier this year, the Irish government announced its plans to destroy the medical records of symphysiotomy survivors collected as part of the redress scheme. Claiming that it could not keep the records because of data protection laws, the government argued that if women did not retrieve their records quickly, it would have no choice but to shred them. For those women who survived these operations, here was another injury. That the state would continue its attempt to erase their experiences while they still suffered was, for many, an affront akin to the physical torture they had survived.

Ireland is no stranger to controversies over its treatment of women; its abortion “problem” has been well documented, and scandals over the abuse of women in Magdalene Laundries and illegal adoptions have dominated headlines for years. Now, the symphysiotomy controversy exposes more sores in Irish history. As Orla O’Connor of the National Women’s Council of Ireland recently remarked, “… one day, Ireland must accept and understand the extent and prevalence of institutional abuse of women and children.” For symphysiotomy survivors, many of whom are now elderly and infirm, that day may come too late.

Cara Delay

Cara Delay, Associate Professor of History at the College of Charleston, holds degrees from Boston College and Brandeis University. Her research analyzes women, gender, and culture in nineteenth- and twentieth-century Ireland, Britain, and the British Empire, with a particular focus on the history of reproduction, pregnancy, and childbirth. She has published in The Journal of British Studies, Lilith: A Feminist History Journal, Feminist Studies, Études Irlandaises, New Hibernia Review, and Éire-Ireland and written blogs for Nursing Clio and broadsheet.ie. Her co-edited volume Women, Reform, and Resistance in Ireland, 1850-1950, was published with Palgrave Macmillan in 2015, and her monograph on Irish women and the creation of modern Catholicism is forthcoming from Manchester University Press. At the College of Charleston, she teaches courses on women’s history and the history of birth and bodies.

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