Symphysiotomy
January 3, 2013 2:43 AM Subscribe
“So when I was pregnant and about to give birth, I was expecting kindness, understanding, love. But, by god, was I wrong. They were torturers. They didn’t care. I was a thing. An experiment.”
Symphysiotomy is an obstetrical procedure in which a woman's pelvis is surgically widened during labour. By the 20th century, it had mostly been phased out in the Western world in favour of caesarean sections. But in Ireland, the practice was reintroduced in the 1940s - in large part because symphysiotomy, unlike caesarians, did not limit the number of a woman's future pregnancies, and so would not lead to women seeking sterilisation or contraception.
The painful and traumatic procedure was frequently carried out without the knowledge or consent of patients, and left many of them with lifelong physical and psychological side-effects. A group of former patients, 'Survivors of Symphysiotomy', continue to campaign for justice. This year, one woman was awarded damages after a judge ruled that "there was no justification whatever, in any circumstances" for the performance of a symphysiotomy during her son's birth in 1969.
Symphysiotomy is still used today, particularly in rural areas of developing countries where safe caesareans would be difficult to obtain. A recently launched documentary, titled Mothers Against the Odds (YouTube trailer), compares the Irish history of symphysiotomies to ongoing practice in Kenya.
The last Irish symphysiotomy was carried out in Our Lady of Lourdes Hospital in Drogheda, in 1984.
Symphysiotomy is an obstetrical procedure in which a woman's pelvis is surgically widened during labour. By the 20th century, it had mostly been phased out in the Western world in favour of caesarean sections. But in Ireland, the practice was reintroduced in the 1940s - in large part because symphysiotomy, unlike caesarians, did not limit the number of a woman's future pregnancies, and so would not lead to women seeking sterilisation or contraception.
The painful and traumatic procedure was frequently carried out without the knowledge or consent of patients, and left many of them with lifelong physical and psychological side-effects. A group of former patients, 'Survivors of Symphysiotomy', continue to campaign for justice. This year, one woman was awarded damages after a judge ruled that "there was no justification whatever, in any circumstances" for the performance of a symphysiotomy during her son's birth in 1969.
Symphysiotomy is still used today, particularly in rural areas of developing countries where safe caesareans would be difficult to obtain. A recently launched documentary, titled Mothers Against the Odds (YouTube trailer), compares the Irish history of symphysiotomies to ongoing practice in Kenya.
The last Irish symphysiotomy was carried out in Our Lady of Lourdes Hospital in Drogheda, in 1984.
Is it true that a CS means no more babies for a woman? I had not heard this (being a gay male, no reason I would. But I'm an adoptee, born CS).
posted by Goofyy at 3:21 AM on January 3, 2013 [1 favorite]
posted by Goofyy at 3:21 AM on January 3, 2013 [1 favorite]
How completely horrifying.
posted by Pope Guilty at 3:26 AM on January 3, 2013 [1 favorite]
posted by Pope Guilty at 3:26 AM on January 3, 2013 [1 favorite]
Goofyy -- no, that's not true (and I can't find where it says that in the linked articles, so I think the poster was mistaken). You can have children after having a Cesarean section.
posted by Houstonian at 3:28 AM on January 3, 2013
posted by Houstonian at 3:28 AM on January 3, 2013
Is it true that a CS means no more babies for a woman?
It's not true- but there is concern that a second child is more likely to also need a c-section (although not always, my second son wasn't). I assume the idea was that if women knew they had the likelihood of another c-section later, they'd be more likely to use contraception- which is all kinds of messed up, considering this operation's effects.
posted by jenkinsEar at 3:29 AM on January 3, 2013
It's not true- but there is concern that a second child is more likely to also need a c-section (although not always, my second son wasn't). I assume the idea was that if women knew they had the likelihood of another c-section later, they'd be more likely to use contraception- which is all kinds of messed up, considering this operation's effects.
posted by jenkinsEar at 3:29 AM on January 3, 2013
No, goofyy. It can cause complications with subsequent vaginal births, but they can happen. General advice is for subsequent births to also be c-section, but that's not necessary in all cases.
posted by coriolisdave at 3:31 AM on January 3, 2013 [2 favorites]
posted by coriolisdave at 3:31 AM on January 3, 2013 [2 favorites]
No, but it does increase the risk of uterine rupture in a second labour. Older procedures, or a requirement to use a vertical rather than horizontal Caesarian incision are associated with a higher risk. There's an online calculator for background risk which can give you an idea of the scale of the problem.
posted by cromagnon at 3:33 AM on January 3, 2013 [3 favorites]
posted by cromagnon at 3:33 AM on January 3, 2013 [3 favorites]
I wouldn't be surprised if I discovered that last one was conducted by obstetrician and butcher Michael Neary, who was reknowned for cutting the womb out of young women at C Section.
I refuse to put Dr in front of his name.
posted by Wilder at 3:37 AM on January 3, 2013 [12 favorites]
I refuse to put Dr in front of his name.
posted by Wilder at 3:37 AM on January 3, 2013 [12 favorites]
Croakers.
posted by telstar at 3:44 AM on January 3, 2013 [1 favorite]
posted by telstar at 3:44 AM on January 3, 2013 [1 favorite]
Is it true that a CS means no more babies for a woman?
Actually what the linked articles say is that
1) having a Caesarian means you are much more likely to need a second Caesarian - particularly if the vertical cuts method has been used, and
2) There are practical limits on the number of Caesarians a woman can safely have, generally 3-4.
This isn't a problem in countries where birth control is available as women rarely choose family sizes of 4+ spontaneously. However the doctors in Ireland were concerned that if a woman needed a Caesarian for her first baby, in practice they were going to end up having to tell her that she was unlikely to safely have more than 3 or 4 children, and she would be 'tempted' to use sterilisation or birth control to save her own life. This was heightened by the fact that they believed that mismatches between the size of the baby's head and the size of the mother's pelvis were quite common and easy to identify using an X-Ray (this isn't thought to be the case any more). Their theory was that performing a symphysiotomy left the door open for a woman to have a more typical-for-Ireland family size of 8+ children. In practice this seems not to have been true, but it seems the doctors' desire to tell themselves that they had not limited a woman's potential fertility, or more specifically put her in a situation where she had to choose between birth control and serious risk to her life, trumped almost anything else.
posted by Acheman at 3:48 AM on January 3, 2013 [20 favorites]
Actually what the linked articles say is that
1) having a Caesarian means you are much more likely to need a second Caesarian - particularly if the vertical cuts method has been used, and
2) There are practical limits on the number of Caesarians a woman can safely have, generally 3-4.
This isn't a problem in countries where birth control is available as women rarely choose family sizes of 4+ spontaneously. However the doctors in Ireland were concerned that if a woman needed a Caesarian for her first baby, in practice they were going to end up having to tell her that she was unlikely to safely have more than 3 or 4 children, and she would be 'tempted' to use sterilisation or birth control to save her own life. This was heightened by the fact that they believed that mismatches between the size of the baby's head and the size of the mother's pelvis were quite common and easy to identify using an X-Ray (this isn't thought to be the case any more). Their theory was that performing a symphysiotomy left the door open for a woman to have a more typical-for-Ireland family size of 8+ children. In practice this seems not to have been true, but it seems the doctors' desire to tell themselves that they had not limited a woman's potential fertility, or more specifically put her in a situation where she had to choose between birth control and serious risk to her life, trumped almost anything else.
posted by Acheman at 3:48 AM on January 3, 2013 [20 favorites]
Their theory was that performing a symphysiotomy left the door open for a woman to have a more typical-for-Ireland family size of 8+ children. In practice this seems not to have been true, but it seems the doctors' desire to tell themselves that they had not limited a woman's potential fertility, or more specifically put her in a situation where she had to choose between birth control and serious risk to her life, trumped almost anything else.
This makes sense and puts the matter into its proper, morally complicated context.
posted by three blind mice at 4:04 AM on January 3, 2013 [3 favorites]
This makes sense and puts the matter into its proper, morally complicated context.
posted by three blind mice at 4:04 AM on January 3, 2013 [3 favorites]
Is it true that a CS means no more babies for a woman?
No, although when I last read up on this, obstetric guidelines for best practice topped out at 3 c-sections. VBAC (vaginal birth after caesarean) is also sometimes possible.
I am not at all surprised this was still taking place in Ireland in 1984. For context regarding birth control and safety of future child bearing, you need to understand that birth control in Ireland was not available until late 1980 and wasn't made widely available until 1985.
For broader context, the last Magdalene Laundry did not close until 1996. Savita Halappanavar died in October. Sentences for rape in this country are a joke. Women have been routinely institutionally, medically and legally victimised in this country for decade upon decade and the pace of change has only recently accelerated.
This is what it's like for women here and now in a first world country; many days, I am literally unable to bear contemplating the circumstances of women in the many, many nations where we're worse off. It shreds something inside me.
posted by DarlingBri at 4:04 AM on January 3, 2013 [29 favorites]
No, although when I last read up on this, obstetric guidelines for best practice topped out at 3 c-sections. VBAC (vaginal birth after caesarean) is also sometimes possible.
I am not at all surprised this was still taking place in Ireland in 1984. For context regarding birth control and safety of future child bearing, you need to understand that birth control in Ireland was not available until late 1980 and wasn't made widely available until 1985.
For broader context, the last Magdalene Laundry did not close until 1996. Savita Halappanavar died in October. Sentences for rape in this country are a joke. Women have been routinely institutionally, medically and legally victimised in this country for decade upon decade and the pace of change has only recently accelerated.
This is what it's like for women here and now in a first world country; many days, I am literally unable to bear contemplating the circumstances of women in the many, many nations where we're worse off. It shreds something inside me.
posted by DarlingBri at 4:04 AM on January 3, 2013 [29 favorites]
This makes sense and puts the matter into its proper, morally complicated context.
Ha. It's just more proof that women in Ireland were little more than cattle until not all that long ago, who didn't need to be informed, let alone asked for consent.
posted by MartinWisse at 4:06 AM on January 3, 2013 [9 favorites]
Ha. It's just more proof that women in Ireland were little more than cattle until not all that long ago, who didn't need to be informed, let alone asked for consent.
posted by MartinWisse at 4:06 AM on January 3, 2013 [9 favorites]
Ah, just when I thought I couldn't be more disgusted by or ashamed of my own country...
posted by steganographia at 4:53 AM on January 3, 2013 [1 favorite]
posted by steganographia at 4:53 AM on January 3, 2013 [1 favorite]
I have never heard of this before and I am horrified by what I've just learned.
posted by iamkimiam at 5:06 AM on January 3, 2013 [10 favorites]
posted by iamkimiam at 5:06 AM on January 3, 2013 [10 favorites]
Is it true that a CS means no more babies for a woman?
Not as such. But it does get riskier and riskier. Many obstetricians do not recommend delivering naturally after a Caesarean, as cutting open the womb and the muscles surrounding it makes them far more likely to rupture during delivery. Many obstetricians also recommend no more than three Caesareans, as after that point the risk of a rupture during pregnancy start to go up, just from the stresses of carrying the baby.
posted by valkyryn at 5:07 AM on January 3, 2013 [2 favorites]
Not as such. But it does get riskier and riskier. Many obstetricians do not recommend delivering naturally after a Caesarean, as cutting open the womb and the muscles surrounding it makes them far more likely to rupture during delivery. Many obstetricians also recommend no more than three Caesareans, as after that point the risk of a rupture during pregnancy start to go up, just from the stresses of carrying the baby.
posted by valkyryn at 5:07 AM on January 3, 2013 [2 favorites]
Absolutely a disgusting practice! I never heard of such a procedure. It does explain why I saw so many Irish women who needed canes to get around.
And yes, laws on matters like rape, birth control, divorce in Ireland have been totally at odds with the pre-Christian laws and customs of Ireland.
posted by Katjusa Roquette at 5:07 AM on January 3, 2013 [1 favorite]
And yes, laws on matters like rape, birth control, divorce in Ireland have been totally at odds with the pre-Christian laws and customs of Ireland.
posted by Katjusa Roquette at 5:07 AM on January 3, 2013 [1 favorite]
I first heard of this horrific procedure a couple of months ago via Pharyngula; that post links to this Jezebel post on the subject.
posted by TedW at 5:24 AM on January 3, 2013
posted by TedW at 5:24 AM on January 3, 2013
cutting open the womb and the muscles surrounding it makes them far more likely to rupture during delivery
The risk of uterine rupture in a birth following a c-section is actually pretty low, but many doctors and women aren't willing to take even that minuscule risk when their life and their baby's life could be jeopardized.
From the American Congress of Obstetricians and Gynocologists: "The risk of uterine rupture during a TOLAC [trial of labor after cesarean] is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation."
posted by chiababe at 5:26 AM on January 3, 2013 [1 favorite]
The risk of uterine rupture in a birth following a c-section is actually pretty low, but many doctors and women aren't willing to take even that minuscule risk when their life and their baby's life could be jeopardized.
From the American Congress of Obstetricians and Gynocologists: "The risk of uterine rupture during a TOLAC [trial of labor after cesarean] is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation."
posted by chiababe at 5:26 AM on January 3, 2013 [1 favorite]
Four years ago, when my best friend had her first child in Galway, she complained about the treatment she received at the hospital. How the doctors and nurses were callous, cold and willing to downplay her pain and exhaustion in order to get her out of there faster. At the time, I admit, I kind of thought it might have just been the overwhelm of such a big event talking. Then that woman died in Galway a month ago because the doctors refused her an abortion that would have saved her life. Now this.
Jesus H Christ, I'm so glad I never got pregnant when I lived in Ireland.
posted by LN at 5:40 AM on January 3, 2013 [3 favorites]
Jesus H Christ, I'm so glad I never got pregnant when I lived in Ireland.
posted by LN at 5:40 AM on January 3, 2013 [3 favorites]
Wilder, Neary is named in the first link as having done this to Maria Kelly in '74.
I don't even know what to say anymore when more of our atrocities come to light.
posted by Iteki at 5:58 AM on January 3, 2013
I don't even know what to say anymore when more of our atrocities come to light.
posted by Iteki at 5:58 AM on January 3, 2013
I have been following Ireland for a while, and not much surprises me any more in how they deal with women's reproduction. But, are there similar cases in other mostly RC countries like Spain or Malta or Brazil, or is it unique to Ireland. Is it a connection between the church and the state there? (what about Newfoundland)
posted by PinkMoose at 6:35 AM on January 3, 2013
posted by PinkMoose at 6:35 AM on January 3, 2013
You'll be happy to know that it's still the Catholic Church that deals with much of the education system in Ireland. No points for guessing if this will come up in history lessons.
posted by jaduncan at 6:52 AM on January 3, 2013
posted by jaduncan at 6:52 AM on January 3, 2013
An excellent comment on the history:
posted by jaduncan at 7:19 AM on January 3, 2013 [3 favorites]
Paul MoloneyThe link to Catholic beliefs is extremely clear in the mind of the very doctor implementing the policy.
on June 13, 2012 at 5:44 pm said:
Some extracts from Ferriter’s book make the link clear:
http://www.politics.ie/forum/oireachtas/184092-statements-symphysiotomy-post5071805.html?highlight=ferriter#post5071805
“Alex Spain revived symphysiotomy at the National Maternity Hospital (NMH) in 1944. By then, symphysiotomy had long fallen into disrepute. Spain himself admitted that symphysiotomy was ‘an entirely new procedure … that has to be faced against the weight of the entire English-speaking obstetrical world’. By 1944, Caesarean was well established in that world as the treatment of choice for obstructed labour.
Contrary to what the Institute of Obstetricians and Gymaecologist would have us believe, symphysiotomy was never a norm. It was shunned––also on the continent of Europe–– because of its dangers, which had been amply described in the medical literature. In addition to the prospect of a dead or damaged baby, there was the certainty of a severely injured mother. As far back as 1803, the procedure had been damned by Prof James Hamilton of Edinburgh: ‘in no case whatsoever’, he said, should it be resorted to.
Spain’s successor, Arthur Barry, championed the practice in the 1950s. But it was attacked by British doctors, who counted the number of babies left dead and brain damaged as a result of the surgery. Donal Browne of the Rotunda also pointed out that Caesarean would result in fewer infant deaths and less maternal injury.
Symphysiotomy was preferred to Caesarean section for ethical reasons. Barry described Caesarean as ‘the chief cause of the unethical procedure of sterilisation’. Caesarean also encouraged the laity ‘in the improper prevention of pregnancy or in seeking termination’, he told a Catholic medical congress in 1954. ‘If you must cut something, cut the symphysis’, he urged”
posted by jaduncan at 7:19 AM on January 3, 2013 [3 favorites]
Much of the risk from repeat c-sections comes not just from possible ruptures (which is actually not much higher than the risk of rupture if you've never had a c-section, oddly enough, not to mention the risk of infection/complication you incur any time you have a surgery), but from adhesions--connections of scar tissue tend to form between, for example, the uterus and the abdomen wall, or bladder, and they can tear, painfully, or cause obstructions. And the more surgeries you have, the higher your risk of them.
(Hi, I spent a lot of time with post c-section folk at ICAN, for all your c-section/VBAC questions).
And before we get sidetracked into a c/section risks derail, the fact that there is so much contention over what is safest that women have formed their own advocacy groups to take on trade groups such as ACOG stems from a looong history of practices such as the one highlighted in this post.
The history of obstetrics is littered with practices (episiotomies, insistence on women giving birth flat on their backs, abusive use of pitocin, etc. etc.) that have very little to do with medical safety and lots to do with seeing women as second-class citizens to be controlled/experimented on by (mostly) male medical establishment.
Which makes it that much harder for women who want good medical advice, and practitioners who want to give good advice, to find each other. So much so that local branches of groups like ICAN spend a lot of time trying to find "good" doctors who treat women with respect and take an evidence-based approach, and sending their members to them. Some women are so traumatized by their hospital births that they end up taking the greater risk of birthing at home, unattended (if they can't find a midwife willing or able to take them) just to avoid the hospital. Birth is a uniquely vulnerable time for women, and there are many who feel violated and hurt even if they come out ostensibly healthy with a healthy baby. Some of the stories I've heard, from women and from nurses who've seen what happens, would break your heart.
posted by emjaybee at 7:19 AM on January 3, 2013 [16 favorites]
(Hi, I spent a lot of time with post c-section folk at ICAN, for all your c-section/VBAC questions).
And before we get sidetracked into a c/section risks derail, the fact that there is so much contention over what is safest that women have formed their own advocacy groups to take on trade groups such as ACOG stems from a looong history of practices such as the one highlighted in this post.
The history of obstetrics is littered with practices (episiotomies, insistence on women giving birth flat on their backs, abusive use of pitocin, etc. etc.) that have very little to do with medical safety and lots to do with seeing women as second-class citizens to be controlled/experimented on by (mostly) male medical establishment.
Which makes it that much harder for women who want good medical advice, and practitioners who want to give good advice, to find each other. So much so that local branches of groups like ICAN spend a lot of time trying to find "good" doctors who treat women with respect and take an evidence-based approach, and sending their members to them. Some women are so traumatized by their hospital births that they end up taking the greater risk of birthing at home, unattended (if they can't find a midwife willing or able to take them) just to avoid the hospital. Birth is a uniquely vulnerable time for women, and there are many who feel violated and hurt even if they come out ostensibly healthy with a healthy baby. Some of the stories I've heard, from women and from nurses who've seen what happens, would break your heart.
posted by emjaybee at 7:19 AM on January 3, 2013 [16 favorites]
The risk of uterine rupture in a birth following a c-section is actually pretty low, but many doctors and women aren't willing to take even that minuscule risk when their life and their baby's life could be jeopardized.
Given that the likelihood of a successful malpractice lawsuit in such a situation approaches 100%, this shouldn't come as a surprise. Obstetrics is one of the disciplines most subject to malpractice litigation. Babies are emotional focal points, everyone wants a good outcome, no one wants to think it was their fault, and no one wants to think it was no one's fault. If there's a bad outcome, the doctor must have been at fault.
This is why it was actually hard to find obstetricians in some states a decade or so ago. But there have been some developments, including tort reform, that have changed this a bit.
posted by valkyryn at 7:29 AM on January 3, 2013 [1 favorite]
Given that the likelihood of a successful malpractice lawsuit in such a situation approaches 100%, this shouldn't come as a surprise. Obstetrics is one of the disciplines most subject to malpractice litigation. Babies are emotional focal points, everyone wants a good outcome, no one wants to think it was their fault, and no one wants to think it was no one's fault. If there's a bad outcome, the doctor must have been at fault.
This is why it was actually hard to find obstetricians in some states a decade or so ago. But there have been some developments, including tort reform, that have changed this a bit.
posted by valkyryn at 7:29 AM on January 3, 2013 [1 favorite]
Everyday I learn something which confirms my belief that having deeply held un-provable beliefs is the best way to do something evil.
posted by TheLittlePrince at 7:40 AM on January 3, 2013 [10 favorites]
posted by TheLittlePrince at 7:40 AM on January 3, 2013 [10 favorites]
Some women are so traumatized by their hospital births that they end up taking the greater risk of birthing at home, unattended (if they can't find a midwife willing or able to take them) just to avoid the hospital. Birth is a uniquely vulnerable time for women, and there are many who feel violated and hurt even if they come out ostensibly healthy with a healthy baby.
Can't favorite this hard enough. Support your local midwives.
posted by Otis at 9:06 AM on January 3, 2013 [5 favorites]
Can't favorite this hard enough. Support your local midwives.
posted by Otis at 9:06 AM on January 3, 2013 [5 favorites]
I'm 24 weeks along, planning a birth center birth, and even though I saw this article a few weeks back, it's still a punch to the gut. Makes me wonder what we're doing now (to pregnant women, to women, to human beings in general) that will be seen as barbaric in 100 (or even 50) years?
posted by offalark at 9:21 AM on January 3, 2013 [1 favorite]
posted by offalark at 9:21 AM on January 3, 2013 [1 favorite]
My experience with pregnancy left me deeply terrified of the medical community and unwilling to attempt another. And I'm in a place where supposedly care is good.
I saw pregnant women treated as nothing more than the source of a revenue stream. (This was a private doctor, by the way, not a clinic.) Wait times in a cramped, overheated waiting room were unendurable, and once given access, the "care" was perfunctory and at times dismissive. I was a tough case--had violent, unrelenting nausea and vomiting--and was treated as though I chose to have the problem. Ultimately I miscarried, and again, received not a jot of sympathy--it was as though I'd chosen to kill my own child.
I had PTSD symptoms for months after this experience.
I was shocked by what I saw as the dismissive treatment of vulnerable women by an overwhelmingly male medical establishment. This story takes the concept to its logical extreme, but does not surprise me in the least. The layer of "belief" makes this all the more disgusting.
My heart breaks for these women--but am glad they've found a voice.
posted by kinnakeet at 9:23 AM on January 3, 2013 [2 favorites]
I saw pregnant women treated as nothing more than the source of a revenue stream. (This was a private doctor, by the way, not a clinic.) Wait times in a cramped, overheated waiting room were unendurable, and once given access, the "care" was perfunctory and at times dismissive. I was a tough case--had violent, unrelenting nausea and vomiting--and was treated as though I chose to have the problem. Ultimately I miscarried, and again, received not a jot of sympathy--it was as though I'd chosen to kill my own child.
I had PTSD symptoms for months after this experience.
I was shocked by what I saw as the dismissive treatment of vulnerable women by an overwhelmingly male medical establishment. This story takes the concept to its logical extreme, but does not surprise me in the least. The layer of "belief" makes this all the more disgusting.
My heart breaks for these women--but am glad they've found a voice.
posted by kinnakeet at 9:23 AM on January 3, 2013 [2 favorites]
But, are there similar cases in other mostly RC countries like Spain or Malta or Brazil, or is it unique to Ireland. Is it a connection between the church and the state there?
Oh hey, I can speak to this just the tiniest bit. When I studied abroad in Madrid, I was in a class called Women in Spanish History which was taught by a Spanish professor. One day, after we watched the Magdalene Sisters, my prof started talking about the experience in Spain for pregnant women (not such a weird segue: some of the Magdalene Laundry women and girls were put away because of supposed 'promiscuity' which sometimes included unplanned/unmarried pregnancy and sometimes just included hanging out with too many guys for the local busybodies' taste).
She herself had given birth in the late '70s at the tail end of the Franco regime. The story she told thirty years later in that quiet dusty classroom left her in tears--and the rest of us horrified. The main thing that I remember is that she talked about giving birth completely without anaesthetic because the hospital staff believed childbirth was a woman's Eve curse (apparently basing medical decisions on Genesis 3:16), which was horrific enough. Evidently the pain had been awful (she was a tiny woman) and the experience left her (understandably) fairly bitter about the Spanish medical establishment.
I wouldn't be surprised if other heavily Roman Catholic countries had similar beliefs about women and pain in childbirth (not to mention episiotomies and hysterectomies and other procedures open to abuse). All I can say is, after my professor's class I wasn't surprised by this article.
posted by librarylis at 9:28 AM on January 3, 2013 [1 favorite]
Oh hey, I can speak to this just the tiniest bit. When I studied abroad in Madrid, I was in a class called Women in Spanish History which was taught by a Spanish professor. One day, after we watched the Magdalene Sisters, my prof started talking about the experience in Spain for pregnant women (not such a weird segue: some of the Magdalene Laundry women and girls were put away because of supposed 'promiscuity' which sometimes included unplanned/unmarried pregnancy and sometimes just included hanging out with too many guys for the local busybodies' taste).
She herself had given birth in the late '70s at the tail end of the Franco regime. The story she told thirty years later in that quiet dusty classroom left her in tears--and the rest of us horrified. The main thing that I remember is that she talked about giving birth completely without anaesthetic because the hospital staff believed childbirth was a woman's Eve curse (apparently basing medical decisions on Genesis 3:16), which was horrific enough. Evidently the pain had been awful (she was a tiny woman) and the experience left her (understandably) fairly bitter about the Spanish medical establishment.
I wouldn't be surprised if other heavily Roman Catholic countries had similar beliefs about women and pain in childbirth (not to mention episiotomies and hysterectomies and other procedures open to abuse). All I can say is, after my professor's class I wasn't surprised by this article.
posted by librarylis at 9:28 AM on January 3, 2013 [1 favorite]
I shouldn't even be reading this thread but it reminds me of my best friend's decision a couple of years ago, that too in Yorkshire, not Ireland. Her first child was born in a hospital and the callous treatment left her so determined not to undergo that, though she wanted babies that she ultimately left her job in IT, went back to train in natural childbirth (she's now a counselor in breastfeeding) and finally, when she got pregnant with her second child, some 6 years later, she gave birth in her own home. In a warm bath. And her firstborn cut the cord. Her mother was the trained doula. I don't think I ever understood what led her to take this long path but recent days are opening my eyes. Savita's death was a nightmare. Among so many others.
I recommend "For Her Own Good: 150 Years of the Experts' Advice to Women" as an interesting and readable history of how women were shut out of medicine (healing) systematically. Hysteria comes from the concept of an empty womb, well then, allow me to go into hysterics.
posted by infini at 9:45 AM on January 3, 2013 [8 favorites]
I recommend "For Her Own Good: 150 Years of the Experts' Advice to Women" as an interesting and readable history of how women were shut out of medicine (healing) systematically. Hysteria comes from the concept of an empty womb, well then, allow me to go into hysterics.
posted by infini at 9:45 AM on January 3, 2013 [8 favorites]
What a ghastly practice.
posted by Mister_A at 10:07 AM on January 3, 2013 [1 favorite]
posted by Mister_A at 10:07 AM on January 3, 2013 [1 favorite]
Jesus!
posted by stormpooper at 10:11 AM on January 3, 2013
posted by stormpooper at 10:11 AM on January 3, 2013
Some women are so traumatized by their hospital births that they end up taking the greater risk of birthing at home, unattended (if they can't find a midwife willing or able to take them) just to avoid the hospital.
Just for accuracy, I think that we should be clear that home birth with a trained and experienced midwife and appropriately screened patients is as safe if not marginally safer than hospital birth. (This is however obviously not the case with unattended birth.) There is a legal right to home birth here, and the health service must provide midwives for homebirths.
posted by DarlingBri at 10:19 AM on January 3, 2013 [5 favorites]
Just for accuracy, I think that we should be clear that home birth with a trained and experienced midwife and appropriately screened patients is as safe if not marginally safer than hospital birth. (This is however obviously not the case with unattended birth.) There is a legal right to home birth here, and the health service must provide midwives for homebirths.
posted by DarlingBri at 10:19 AM on January 3, 2013 [5 favorites]
I've been reading this report (Bodily Harm by Marie O'Connor, linked in one of the articles) all day. It's very well-written and systematically addresses all the myths and spurious justifications surrounding the practice. It also makes clear that these women were not only subjected to an awful and unnecessary surgical procedure, they were also offered entirely inadequate care following it, and often urged to walk - with a severed pelvis! - immediately after the birth. They were not even offered the standard of care given to women whose symphysis pubis tore during birth. It's difficult to explain this except as a deliberate blindness on the part of the doctors to the nature of what they had done.
posted by Acheman at 10:22 AM on January 3, 2013 [1 favorite]
posted by Acheman at 10:22 AM on January 3, 2013 [1 favorite]
Nothing could be more emblematic of the belief that women are not whole human beings, but vehicles for delivering babies.
It deeply disgusts me that this underlying assumption is shared widely, far outside Ireland's borders.
This is just one illustration of what happens when people who devalue women are in charge.
posted by bearwife at 10:54 AM on January 3, 2013 [4 favorites]
It deeply disgusts me that this underlying assumption is shared widely, far outside Ireland's borders.
This is just one illustration of what happens when people who devalue women are in charge.
posted by bearwife at 10:54 AM on January 3, 2013 [4 favorites]
Makes me wonder what we're doing now (to pregnant women, to women, to human beings in general) that will be seen as barbaric in 100 (or even 50) years
I don't know if this is still done, but in '85 when I was pregnant with my first I was a little past my due date so during my check up my OB did something called "stripping the membranes." It was horrific. I remember waddling to my car, crying, and feeling like I had been violated. It didn't do any good.
It is amazing what "discomfort" and indignities a pregnant woman is supposed to take in her stride without complaint.
posted by Secret Life of Gravy at 1:28 PM on January 3, 2013 [1 favorite]
I don't know if this is still done, but in '85 when I was pregnant with my first I was a little past my due date so during my check up my OB did something called "stripping the membranes." It was horrific. I remember waddling to my car, crying, and feeling like I had been violated. It didn't do any good.
It is amazing what "discomfort" and indignities a pregnant woman is supposed to take in her stride without complaint.
posted by Secret Life of Gravy at 1:28 PM on January 3, 2013 [1 favorite]
I'm feeling like we need a group hug.
posted by infini at 2:00 PM on January 3, 2013 [3 favorites]
posted by infini at 2:00 PM on January 3, 2013 [3 favorites]
This is absolutely not a defense of this seemingly awful practice, nor of any other abuses and unpleasantness perpetrated upon women.
However, let's not forget that the maternal and infant mortality rates without modern medicine are horrific. "Catholic" nonsense aside, they were trying to make things better.
posted by gjc at 2:14 PM on January 3, 2013
However, let's not forget that the maternal and infant mortality rates without modern medicine are horrific. "Catholic" nonsense aside, they were trying to make things better.
posted by gjc at 2:14 PM on January 3, 2013
However, let's not forget that the maternal and infant mortality rates without modern medicine are horrific. "Catholic" nonsense aside, they were trying to make things better.
a) this is more an argument for using Casesarians rather than procedures rejected as harmful 200 years ago, no?
b) why the speech marks? It was a Catholic doctor in a Catholic Church-run hospital.
posted by jaduncan at 2:31 PM on January 3, 2013 [3 favorites]
a) this is more an argument for using Casesarians rather than procedures rejected as harmful 200 years ago, no?
b) why the speech marks? It was a Catholic doctor in a Catholic Church-run hospital.
posted by jaduncan at 2:31 PM on January 3, 2013 [3 favorites]
However, let's not forget that the maternal and infant mortality rates without modern medicine are horrific. "Catholic" nonsense aside, they were trying to make things better.
The standard of care is now, and should have been then, a caesarian section. The post jaduncan links to above makes it clear that the Irish medical establishment was aware of this fact and chose to ignore it in favor of their religious biases.
posted by mr_roboto at 2:32 PM on January 3, 2013 [6 favorites]
The standard of care is now, and should have been then, a caesarian section. The post jaduncan links to above makes it clear that the Irish medical establishment was aware of this fact and chose to ignore it in favor of their religious biases.
posted by mr_roboto at 2:32 PM on January 3, 2013 [6 favorites]
It saddens me greatly that Ireland should have been throttled by the poisonous tentacles of the Catholic Church. I wonder how different their history might have been without the influence of Rome. I'm guessing that far fewer abused wives would have stayed with their husbands for one thing.
posted by Secret Life of Gravy at 3:08 PM on January 3, 2013 [1 favorite]
posted by Secret Life of Gravy at 3:08 PM on January 3, 2013 [1 favorite]
Gould & Pyle's Anomalies and Curiosities of Medicine (1905) references a story of an ancient Irish custom of breaking the pelvises of female infants to ease their childbirth later in life, resulting in a "waddling, lamish gesture in their going." The story immediately impressed itself upon me, but I have yet to find a cite for it. The same paragraph refers to it as practiced in a region in Italy.
Whether this would be worse or better to live through than foot-binding, I cannot quite decide.
posted by Countess Elena at 3:40 PM on January 3, 2013
Whether this would be worse or better to live through than foot-binding, I cannot quite decide.
posted by Countess Elena at 3:40 PM on January 3, 2013
I'm guessing that far fewer abused wives would have stayed with their husbands for one thing.
Ireland got divorce in 1996. The vitrol and drama around that was epic; it failed once and finally passed under the narrowest of margins - 0.28%. What was more common than women stuck in marriages was for one spouse to leave, still be married, but have second families with a subsequent partner out of wedlock. This created a host of legal issues with property and inheritance because these children were illegitimate and had a different legal status until quite recently.
What did make a real difference to families living with domestic abuse was the barring order, which came into law in 1976 and is basically a 3 -5 year restraining order that is often issued with child support. Prior to that there was no way I've ever heard of to get an alcoholic or abusive spouse out of the home.
posted by DarlingBri at 3:44 PM on January 3, 2013 [3 favorites]
Ireland got divorce in 1996. The vitrol and drama around that was epic; it failed once and finally passed under the narrowest of margins - 0.28%. What was more common than women stuck in marriages was for one spouse to leave, still be married, but have second families with a subsequent partner out of wedlock. This created a host of legal issues with property and inheritance because these children were illegitimate and had a different legal status until quite recently.
What did make a real difference to families living with domestic abuse was the barring order, which came into law in 1976 and is basically a 3 -5 year restraining order that is often issued with child support. Prior to that there was no way I've ever heard of to get an alcoholic or abusive spouse out of the home.
posted by DarlingBri at 3:44 PM on January 3, 2013 [3 favorites]
> I don't know if this is still done, but in '85 when I was pregnant with my first I was a little past my due date so during my check up my OB did something called "stripping the membranes."
Yeah, they still do it. Though I think I heard it called "sweeping the membranes".
My personal inclination right now from my oh-so-lofty perch of 6 months is that I'll let the baby come when she comes and none of these shenanigans to try and "jump start" labor. Most of them sound like old wives tales, and the rest come straight out of WTF?ville.
If I hit 42 weeks, I'll let you know if my opinion on that alters.
posted by offalark at 5:41 PM on January 3, 2013 [2 favorites]
Yeah, they still do it. Though I think I heard it called "sweeping the membranes".
My personal inclination right now from my oh-so-lofty perch of 6 months is that I'll let the baby come when she comes and none of these shenanigans to try and "jump start" labor. Most of them sound like old wives tales, and the rest come straight out of WTF?ville.
If I hit 42 weeks, I'll let you know if my opinion on that alters.
posted by offalark at 5:41 PM on January 3, 2013 [2 favorites]
The main thing that I remember is that she talked about giving birth completely without anaesthetic because the hospital staff believed childbirth was a woman's Eve curse (apparently basing medical decisions on Genesis 3:16), which was horrific enough.
Now you mention it, I have two (British) friends who had their children in Spain, one about 12 years ago, the other maybe 3 years ago. Both mentioned that Spanish hospitals don't "do" pain relief for childbirth, apart from gas and air. Epidurals were certainly not an option. I had no idea this was the historical context, though.
posted by penguin pie at 5:59 PM on January 3, 2013
Now you mention it, I have two (British) friends who had their children in Spain, one about 12 years ago, the other maybe 3 years ago. Both mentioned that Spanish hospitals don't "do" pain relief for childbirth, apart from gas and air. Epidurals were certainly not an option. I had no idea this was the historical context, though.
posted by penguin pie at 5:59 PM on January 3, 2013
b) why the speech marks? It was a Catholic doctor in a Catholic Church-run hospital.
Because as far as I know, there is nothing in actual Catholic doctrine about any of this. Catholics are generally against birth control. This lunatic took that, extrapolated it somehow with the theory that C-sections cause sterilization (?) and said that's the reason why pelvises ought to be smashed? That's a silly conclusion, and it's equally silly to claim that the catholic church has anything to do with this one guy's flight of medical fancy.
posted by gjc at 5:56 AM on January 4, 2013
Because as far as I know, there is nothing in actual Catholic doctrine about any of this. Catholics are generally against birth control. This lunatic took that, extrapolated it somehow with the theory that C-sections cause sterilization (?) and said that's the reason why pelvises ought to be smashed? That's a silly conclusion, and it's equally silly to claim that the catholic church has anything to do with this one guy's flight of medical fancy.
posted by gjc at 5:56 AM on January 4, 2013
Well congrats for your depth of research there, it is very clear that you didn't read the links.
The general rule is that one cannot have more than 4 c-sections before births via the birth canal are required, and thus at 2 or 3 people with blocked birth canals frequently request birth control or sterilisation on the fairly reasonable basis that they wish to avoid their unpleasant death or having their pelvis smashed to be able to give birth. As you have noted, birth control is traditionally viewed as a problem by the CC. Birth control was often unavailable in rural Ireland in particular; Ireland allowed wide sales of condoms in 1993.
Taking some relevant bits....
Facts:
This was a publicly stated policy of wholly CC-owned and run hospitals across the Irish nation, and the CC could absolutely have made a statement at any point over a 40 year period that the policy was wrong given that it was known that it was killing babies and permanently injuring mothers. It is not exactly like they have no stated opinions or dogma relating to this area; it wouldn't even be unexpected for them to comment.
The drawback of an absolutely hierarchical church is that it does rather mean it bears responsibility for the hospitals and other institutions it wholly owns and controls.
It was also a policy not only followed by "this one guy", but a matter of policy in CC-owned hospitals for over 40 years and the majority of 1,500 operations. Why wouldn't you think that responsibility goes along with that?
posted by jaduncan at 6:31 AM on January 4, 2013 [6 favorites]
The general rule is that one cannot have more than 4 c-sections before births via the birth canal are required, and thus at 2 or 3 people with blocked birth canals frequently request birth control or sterilisation on the fairly reasonable basis that they wish to avoid their unpleasant death or having their pelvis smashed to be able to give birth. As you have noted, birth control is traditionally viewed as a problem by the CC. Birth control was often unavailable in rural Ireland in particular; Ireland allowed wide sales of condoms in 1993.
Taking some relevant bits....
Facts:
"Ireland was the only country in the developed world to practise this discarded surgery in the mid to late 20th century.Gerry Adams (himself not noticeably anti-Catholic) called this institutional abuse:
At least 1,500 of these 18th century operations were performed here from 1944 to 1992, mostly in Catholic hospitals.
Around 150 women survive today, many of them permanently disabled, incontinent and in pain. Some lost their babies during the procedure."
"The revivalists were driven by a desire to control women’s reproductive health. Caesarean section was associated with what Archbishop McQuaid termed the “crime of birth prevention”. Four such operations were widely seen as the upper safety limit.
Leading Catholic doctors saw symphysiotomy as a gateway to child-bearing without limitation, one that did not lead women into ‘temptation’ - that is, the practice of family planning."
"The Catholic Church vehemently opposed birth control methods and the use of Caesarean sections limited the number of children a woman could have. It was generally accepted that the maximum number of these that could be used on a woman was four....how do you not see that the choice of operation was explicitly due to Catholic doctrine? Outside of that, I'm unsure why you wouldn't think their own hospitals would have vicarious liability even if it wasn't motivated by doctrine; the sexual abuse of children by the clergy and teachers in Irish schools and churches wasn't motivated by doctrine either but I don't notice people trying to claim that wasn't a matter of negligent policing by the Church itself.
The use of symphysiotomy was one way of ensuring that women didn’t look to birth control."
This was a publicly stated policy of wholly CC-owned and run hospitals across the Irish nation, and the CC could absolutely have made a statement at any point over a 40 year period that the policy was wrong given that it was known that it was killing babies and permanently injuring mothers. It is not exactly like they have no stated opinions or dogma relating to this area; it wouldn't even be unexpected for them to comment.
The drawback of an absolutely hierarchical church is that it does rather mean it bears responsibility for the hospitals and other institutions it wholly owns and controls.
It was also a policy not only followed by "this one guy", but a matter of policy in CC-owned hospitals for over 40 years and the majority of 1,500 operations. Why wouldn't you think that responsibility goes along with that?
posted by jaduncan at 6:31 AM on January 4, 2013 [6 favorites]
My symphysis joint slipped and twisted while I was pregnant with my first child, at 13 weeks. From then on, the entire pregnancy was agony. The first relief I had from that pain was when they placed the epidural during delivery -- in fact, that pain was a significant factor in my decision to choose an epidural. Even with regular physical therapy, the pain of my daughter's descending head stretching that inflamed, displaced joint was unreal. At the end of my pregnancy, I could barely walk without sobbing. To have it deliberately cut? I cannot imagine.
WRT "sweeping the membranes" or "stripping the membranes," in proof that every woman is different, I had it done in my OB's office with my enthusiastic consent -- I was 39 weeks, contracting irregularly, and in really exquisite pain due to the SPD dysfunction -- and I literally barely felt it. I asked "Wait, will this hurt?" and she said "Well I'm doing it right now." My cervix was already really effaced though, that might have had a lot to do with it.
posted by KathrynT at 8:45 AM on January 4, 2013 [2 favorites]
WRT "sweeping the membranes" or "stripping the membranes," in proof that every woman is different, I had it done in my OB's office with my enthusiastic consent -- I was 39 weeks, contracting irregularly, and in really exquisite pain due to the SPD dysfunction -- and I literally barely felt it. I asked "Wait, will this hurt?" and she said "Well I'm doing it right now." My cervix was already really effaced though, that might have had a lot to do with it.
posted by KathrynT at 8:45 AM on January 4, 2013 [2 favorites]
That sounds real nice, but if it was church policy, then why wasn't it the norm in all catholic hospitals?
posted by gjc at 3:15 PM on January 4, 2013
posted by gjc at 3:15 PM on January 4, 2013
Glad it sounds real nice.
a) To answer your question, it was largely because it was the policy set in hospitals of the Irish Catholic Church, which viewed all birth control as a crime. This intensity of control was, for better or ill, not shared in other locations. This somewhat ties up with the fact that the Irish Free State was extremely poor and depended on the CC for both educational and health services, meaning that the CC had an unusual extent of involvement.
b) I note you haven't engaged with the issue that Rome retained control over the ICC and the hospitals controlled by them, thereby retaining a responsibility for policy within them in exactly the same way that the CC was ultimately responsible for not setting effective abuse control policies in the abuse cases.
c) Please note that the 1950 Mother and Baby Scheme was heavily opposed by the CC; it is clear that the CC was explicit about wishing to retain control over the medical practices and policies of their own hospitals.
TBH, this much intentional missing of the point looks unproductive to disingenuous. If you're a church member uncomfortable with my central contention I'd appreciate it if you'd just say now rather than write flip answers.
posted by jaduncan at 4:23 AM on January 5, 2013 [5 favorites]
a) To answer your question, it was largely because it was the policy set in hospitals of the Irish Catholic Church, which viewed all birth control as a crime. This intensity of control was, for better or ill, not shared in other locations. This somewhat ties up with the fact that the Irish Free State was extremely poor and depended on the CC for both educational and health services, meaning that the CC had an unusual extent of involvement.
b) I note you haven't engaged with the issue that Rome retained control over the ICC and the hospitals controlled by them, thereby retaining a responsibility for policy within them in exactly the same way that the CC was ultimately responsible for not setting effective abuse control policies in the abuse cases.
c) Please note that the 1950 Mother and Baby Scheme was heavily opposed by the CC; it is clear that the CC was explicit about wishing to retain control over the medical practices and policies of their own hospitals.
TBH, this much intentional missing of the point looks unproductive to disingenuous. If you're a church member uncomfortable with my central contention I'd appreciate it if you'd just say now rather than write flip answers.
posted by jaduncan at 4:23 AM on January 5, 2013 [5 favorites]
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“Irish doctors’ acceptance of an increased foetal death toll in those pregnancies for which they performed symphysiotomy in order to avoid CS in hypothetical future pregnancies was ethically dubious."
It seems medically and rationally dubious as well.
posted by Segundus at 3:18 AM on January 3, 2013 [3 favorites]