Feb 232010
 

Symphysiotomy is a surgical procedure used mainly in the third world, when women are experiencing a difficult labour but cannot access a hospital because they’re too far away.  The woman’s pelvis is sawn apart to make room for the baby to be born. This “room” is temporary, but the procedure does not scar the uterus (like a caesarean section would), so the woman can go on to have many more pregnancies.

This was seen as a great idea in Ireland.  If a woman had a caesarean section to deliver her first child, she would always need a section, it was believed. It would only be safe to have a limited number of sections, so the woman could only have a limited number of babies.  It seems that doctors were afraid that this would encourage women to use contraception, a most grievous sin.  That was not a good thing for populating Ireland with Catholics so symphysiotomy was seen as the answer.

Unfortunately, there were horrific side effects for the women – including incontinence,  horrific pain and  inability to walk.

Unfortunately too, consent for this horrific surgery was not sought.  Women were treated with such disdain that consent was never even suggested.  The women never even knew that this surgery had been performed on them until years and years later.  Very unfortunately too, some babies were killed as a result of the procedure, yes killed.

Prime Time did a programme about this scandal during the week, and the procedure continued in Ireland until 1982, despite being phased out in the UK at the turn of the last century!  One woman on the programme described how the surgery killed her baby girl by perforating her skull! Dear Jesus!

They thought it was better to kill a few babies than to limit the overall production of Catholics? Better than a woman using contraception, the Lord save and preserve us.

These women have formed a support / action group and have asked for an enquiry, but no-one seems to think it’s worth bothering with it.  Sure they’re only women.  What’s the point?  The point is that these women were abused, and deserve at the very least a few answers. Mary Harney has refused.

This story got me thinking, and do you know what? Having a baby in Ireland can still be a fairly savage experience. Thank God the shocking symphysiotomy has finally ceased, and Neary is finally gone – but – I wonder how “green” first time mothers are treated today in Ireland?

I know that when I had my first baby, I was at the mercy of the consultants’ holiday and the hospital’s timetable. I was induced so that the consultant could clear his cases before he went on his holiday. I was rushed along (as if I could control the speed of my labour!) to suit the hospital’s timetable. Forceps were produced when I was too slow with the pushing, and all that goes with that procedure followed… I could go on and on.

Second time around I knew what was happening. I demanded a lot more respect and got it, but I’m still sad that I was treated as a slab of meat that first time. A time when I was naieve and frightened. I relied on the doctors and the hospit to do the right thing for me, to respect me as a human being.

My experience is nothing compared to the women who were butchered by symphysiotomy.  The women who were given symphysiotomyies without their consent need our support.
Mary Harney – give these women what they need and deserve.

______________

(Additional comment from Bock:  Also here are the posts on  Michael Neary,  who recently accused the women destroyed by symphisiotomy of smelling money, and who denied carrrying out the operation, the miserable, cynical, lying, power-mad bastard.)

  42 Responses to “Having a Baby in Ireland – Symphisiotomy and Other Horrors”

Comments (41) Pingbacks (1)
  1.  

    Absolutely shocking.

  2.  

    It is, Seconds, and very hard to write and to read.
    We can’t let down these women because we are shocked into silence.
    It cannot go unchallenged.
    It just cannot.
    It’s another example of why we cannot be ruled any longer by Rome.

  3.  

    PrimeTime are discussing this again now.
    It seems that Minister Harney has asked the Drs to examine Neary’s old hospital in this regard.
    The survivors are not at all happy that the “inmates” seem to be examining and auditing themselves.
    I wouldn’t blame them!

  4.  

    Great post Mairead. Some years ago when I was working as a press photographer in Dublin, I was sent to take photos at a meeting of a group Survivors of Symphisiotomy. I had no idea what this was and the hours that followed revealed tragic, heart-breaking stories from broken women and their husbands. Older women, so many of them crying, maybe glad to be able to talk, they lived in pain forever, had no comfort and zero sex lives. The doctor in question who had performed many of these butcherings, was known to be in the Middle East practicing as a consultant in a top hospital, not doubt on a top salary. More shocking was to discover, as I talked about this, that someone I’d recently made friends with had endured the same savagery when giving birth to her first child. Interesting that she was a “single mother” and the poor thing had to hide away in the Good Shepherd here in Limerick in the recent 1980s. Incredibly she managed to cary triplets to term years later, but with huge difficulties. Her baby at the time was snapped away and adopted, the church probably got a hefty payout.
    I haven’t experienced the Irish maternity system but I know that most mothers would choose to pay private fees than go through the third-world approach to childbirth. I lived in Germany when I had both my children and couldn’t fault their natal care, mothers were treated like important people there. Given that mothers carry the population of the future in their bodies, it’s only right and normal that it be like that.
    Incredibly no major documentary or real attention has been given to these events. The church has made it clear, over and over, that women are the lowest on their pecking order. I cannot imagine the pain, the feelings of being brutalised, having your child killed by a murderer while the little thing is still inside your body. God bless them. Survivors, of what kind of life?

  5.  

    Val, thank you for adding so well to my post.
    What you have written and experienced is absolutely shocking and disgusting.
    My heart goes out to those women.
    It could have been any one of us! (Shudder!)

    As regards the church and women, you’re dead right.
    Women are viewed as unclean, evil temptresses by the Catholic church.
    Fr. (Bishop) Pat Buckley has gone a bit on the wild side, but his book – A thorn in their side – (I think?) – wrote very well about women and the church. He told how a Bishop’s conference some short few hundreds of years ago voted on whether or not women are animals or human beings!!! It was decided on one or two votes that women are human, but there was a footnote that many Bishops were unable to attend for the vote!!
    Also, a woman on the Late, Late years ago said that she couldn’t understand how the church gets away with discriminating against half of the population – the half that gets the menfolk and children up and out, shiny and brightly polished, for mass on Sunday!! I was shocked, because that had never dawned on me!

    This is all going off the point a bit, but it is also very much at the heart of this matter.
    Women are human beings!
    Women matter!
    These women that were butchered matter!
    Thank you, Val.

  6.  

    Nearys comment was despicable, HE is despicable.
    Why do these women have to battle for justice and to be heard, at this stage, in a country that has not one facet/institution/sector that has not been found to harbor corruption and lies, to some extent at some point.
    Guilty until proven innocent would be much more appropriate here.
    Regarding virgin mothers in the maternity hospital, can also confirm that first time was much more unpleasant than second time, when my wife was determined to stand up for herself and demand the respect every woman deserves.

  7.  

    I have not experienced the Irish maternity system and I am thankful for that, not only because of this article, but because I believe, that Ireland is in many ways still a backwards country, not only when it comes to health care.

    However, having said that, I do not think the German maternity system deserves such positive recognition.

    My son was born in Germany. Labour started Friday evening and my son was born Sunday afternoon (9+ pounds). I spent most of Saturday evening, night and Sunday morning alone in a hospital delivery room, with a midwife occasionally dropping in to check quickly on my unborn child.

    The doctor on duty came in once early Saturday evening. He looked at me and told the midwife that I seemed young and strong, and should be able to take it.

    The doctor was right about me. I was able to endure this cruel, hard and long birth in an uncaring German hospital.

    My son is now 24 years old and has Autism. That much for German natal care. Guess this story falls under the category of “other horrors”.

  8.  

    Mairead. As a man I suppose I have not been fully aware of this issue until now. Having seen my wife treated like a piece of meat by an obstetrician in the UK and the effect this had on her I empathise with the women who were abused. Hearing about Neary over the last few years, my initial view was that a firing squad would have been too good for him.
    What strikes me here is the fact that these “crimes against women” were not brought to the fore before now. Where have the feminists been hiding on this one. When I think of the Marys,Nells and Nualas and the other great Irish women, Why did no-one go into bat for women on this issue. Sadly feminism in Ireland seems to be a thing of the past. Your`s it would seem is a lone voice, keep it up.

  9.  

    I was shocked by this article. Indeed, these women need all the support that they can get…and more!

  10.  

    Inco, I agree, Neary’s comments last night that women were only complaining now to get money (!!) was utterly despicable.

    Soldiergirl, so sorry to hear of your labour. There seems to be an attitude too that pain is somehow “good” for us…. Is it nearly seen as a punishment for having sex? I am sorry too that you perceive Ireland as a backward country. That was shocking for me to read, but maybe we have to face the world’s perception of us to move forward?

    Mel, yes a “piece of meat” is a good description. I am by no means the only woman writing about women, but maybe Nell and Nuala didn’t roar so much on childbirth because they didn’t have children, and as you rightly said it was only when it came to your own door that you realised how labouring women were treated. No-ne can understand it unless they give birth themselves, or accompany a loved one giving birth. I certainly didn’t. I think that women are nearly ashamed to speak up about their childbirths, because it is all wrapped up in guilt that we actually had sex! We are stripped of our dignity in stirrups and a feeling that we should be able to “take the pain”.

    Bernard, yes, very, very shocking.

  11.  

    Women ruled the roost in obstetrics until the whole witch hunt thing started off in the 16th century. There was never a man present at a birth, indeed why would he be? The association of the pointy finger-nail came from the mid-wife who sometimes needed to use this nail to perforate the waters of the labouring mother. Sorry people if this is not nice for you. When traditional medicine began to take form, the male-dominated profession felt left out in the cold when it came to obstetrics. The unfortunate death of the occasional mother in childbirth gave great opportunity to determine mid-wives as witches, they were sometimes accused of “stealing the babies soul”. So young, uneducated people were convinced that it was safer to have a man deliver a baby.

    If anyone is interested in reading more about the fascinating history of childbirth I urge you to look up Sheila Kitzinger, an expert in the field who has written dozens of amazing books on the subject.

    “Health is not a medical artifact. Economics, politics, the social system in which we live, conditions in the work-place, poisons in the environment, and personal relationships are all elements in causing health and disease. Doctors treat illness; they do not make us healthy. For the vast majority of women physical health and a sense of well-being during pregnancy is nothing to do with how often they visit the doctor, but with the social conditions in which they live.”
    From Sheila’s book Birth over 35, Sheldon Press

    The need for men to subjugate women is simply explained. Women, through their ability to transubstantiate – be reborn and create new human beings- have less of a need to dominate and be “powerful” in other areas. Making human beings is a pretty good skill. Men, though they produce sperm, can’t do this. Most men are wonderful human beings, who through their own social conditioning have difficulties fulfilling what’s “expected” of them as a supposed dominant sex. The power hungry, frustrated ones will always abuse the ones they can, a physically weaker person be it a woman, a child or, as you said an animal. The abuse of women will never change the facts. Ironically, women are more often at peace with themselves than men are. This could go on…..

  12.  

    Don’t be sorry if people didn’t like it Val. Tell it as it is, and hopefully the right people will take note of your comments. Well done!

  13.  

    I wonder if women midwives would have contenanced this operation?

  14.  

    I think I made a most unfortunate Freudian slip in the comment above.
    Apologies.

    What are your / your loved ones experience(s) of childbirth in Ireland?

  15.  

    You didn’t.

  16.  

    Mairead; The entire area of childbirth in Ireland ( and its difficult to completly avoid freudian casualties on this subject ! ) must be overflowing with an astounding amount of stories, I have heard so many from older women who’s children would all have been born at home with assistance usually from the local district nurse, to the profound cruelty and butchering performed in hospitals for apparantly no medical reason and attributed to quite specific areas of the Country which i think is highly suspect.
    For myself I heard nothing but horror stories on my first pregnancy so naively and with great suspicion I gave birth with a certain degree of medical intervention which ultimatly created my motivation toward a more positive experience for subsequent pregnancies.
    I realised through the writings of Sheila Kitzinger and Juliette de Bairacli Levy that childbirth is a womans ” moment ” it is her time to command control and create the environment and experience she chooses, This proved something of an uphill battle in Ireland, As everything Maternity in medical terms was the premise of male Doctors, Therefore I was treated with suspicion and a resentful tolerance by both Doctors and some, but not all Mid wives.
    It is not easy to argue in the middle of a contraction, To say no to certain intervention and/or medication, to stick to your plan as opposed to the Practitioners routine.
    My experiences were good but very driven and controlled by both of us so not too comparable.
    I have since then had the privilige of being the ” birthing partner ” to 2 of my daughters, the difference between both of their experiences were worlds apart, one went for private care the other was a public patient, The treatment, care, aftercare, communication and attitude was as if they were in two different countries, However having said that, I would think a lot depends on what a woman has decided she wants for herself in the experience of childbirth.
    A lot of blatant disregard and brutality was visited upon Irish woman in childbirth because they were vulnerable, repressed and had no access to education, information and choice and were blatantly disrespected.
    Whereas I felt my experiences were good, there was an incident on my second child where the Doctor performed an episiotomy between contactions which was so excrutionally painful that my entire body lifted from the bed, at which point I was given Chloroform by the midwife, that knocked me out briefly which was completly against my wishes but she later explained and apologised for, She was equally appalled by what had occured, As it was an archaic and fairly brutal action even at that time, That particular incident did traumatise me and I opted for a home birth the next time, which was a great experience, but only once because subsequently I realised that the consequences should anything have gone wrong would have been dire.
    Writing this I realise that it is a difficult subject to really be open about, Now in my life it is my daughters giving birth so this thread you have begun is still very relevant to me, I still believe, maybe even more now , the importance of a woman asserting her role in lifes greatest event, Thank you Mairead for this.

  17.  

    Nora,  very nicely written.  I too believe that Birth belongs to Women and is a rite of passage for us.
    I have had 2 homebirths and will very soon have my third.  With a healthy pregnancy and excellent prenatal care I do not see any risk involved in Birthing at home.  I am attended by very experienced midwives who are not only competant professionals but ultimately respectful in honoring my wishes.  I am not restricted to conform with regulation or procedure.  
    While I understand that medical intervention when required can be life saving it’s unnesesary in the vast majority of births.  A csection rate of nearly 30% in Ireland is shocking and shows how we are still being pushed into procedures for the doctors sake (be that out of conveinience or fear of litigation)  Major abdominal surgery should not be treated lightly.  I fear our maternal mortality rate will begin to creep up as it has in the US. 

     If only we weren’t pumped with Fear about Birth and trusted that our bodies are capable we would be half way there.  Informed Choice is what I want to see for all Birthing Mothers.  That and Mary Harney run out of Goverment, when are we going to call time on that horrid Woman?  

  18.  

    The Freudian slip I meant was – contenanced – sounds like incontinence.
    I would never joke about such a thing.
    Bock, I see now the other slip I might have made also, but thankfully, I didn’t, as you said!

    Brilliant posts, Norma and sm, I am mad busy tonight and tomorrow, but will definitely get back to you both as soon as I possibly can. Thank you for those thoughts.

  19.  

    Norma, I agree with you that our land must be overflowing with birthing stories. It is a difficult subject for women to talk about, because it is so intimate.
    You are so right that it is very difficult to argue in the middle of a contraction. All of the books talk about making out a birth plan, and discussing it prior to the birth with your doctor. I wonder if many women do that? I did with my third child and it went well, but I was very bashful producing it, and ready for an argument. Many women now talk about having a doula with them, to speak up for them at the birth. I think that’s a great idea, but isn’t it awful that we need that? Surely, the health specialists present at the birth should be our advocates and helpers, and we shouldn’t need to bring in another rep. but in many cases we do… Sad. It should be an empowering experience, not stripping us completely of power.
    I would also have liked a home birth, but was frightened out of it.
    I wonder, Norma, if episiotomys will be the scandal of the future?
    For those who don’t know what an episiotomy is… the doctor cuts the perineum (online definition: The general region between the anus and the genital organs) to allow more room for the baby to be born, but most often to make room for forceps etc… to be used. It was thought that a cut heals better (is easier to sew?) than a tear, but Sheila Kitzinger totally disagrees, saying that far too many episitomys are performed. Anecdotal evidence from women would indicate that Sheila is right. If you have one, the perineum will most likely tear for all other births, so it’s a decision with far-reaching consequences. The after care is much better than the women in the main post received, but there are still a lot of problems with pain, urination and sex. I’m not certain that consent is always sought for it either?
    See, it’s a very intimate subject.
    I think that we need to talk about it though, so that our women are treated with dignity at this very vulnerable time.
    Fair play to those women who spoke up about their symphysiotomies. I really hope they get fair play back!

  20.  

    Sm, I am delighted to hear about your happy home births, and every good wish with your third :-)
    You describe it so well when you say that we are pumped with fear about birth, we really are, and only learn through our own experiences.
    It is very difficult to access a home birth in Ireland, though.
    I was frightened out of it by reminders that I live 40 miles from the nearest hospital.
    Far from Mary Harney’s “big is beautiful” ideas, I believe that small maternity units scattered throughout the country, and home births when possible, would be a good idea.

  21.  

    Ireland is a really terrible place to give birth in:

    http://www.nationmaster.com/graph/hea_mat_mor-health-maternal-mortality

    Episiotomies the scandal of the future? would you be aware of the consequences for you if an episiotomy was not performed, 1st degree/2nd degree/3rd degree vaginal tears leaving you feacally incontinent, risk of infection, abscess formation and possibly sepsis.
    Unfortunately this evil male obstetrician/butcher image permeates through medical school ranks hence why male medical students are deserting obstetrics in their droves…thus halving the talent pool for future consultant obstetricians….just one of the reasons why there is such a crisis of manpower in it at the moment

    Oh and generally it is midwives who manage the birth for a woman, obstetricians generally only get involved if a problem is forseen/has occurred…..and as you all well know if a problem occurs in obstetrics the proverbial s**t hits the fan pretty quickly! I dont know how a community midwive present at a home birth would be able to deal with it
    just my 2 cents……

  22.  

    dont mean to go on about episiotomies but who is Sheila Kitzinger? is she an obstetrician/gynaecologist/surgeon? to be honest your citing of “anecdotal evidence from women would indicate that sheila is right” is a poor justification….dont mean to be brusque but anecdotal evidence is absolutely meaningless, one could procure “anecdotal” evidence to support any point of view!! If a Medic offered “anecdotal evidence” as a justification for his//hers actions they would be discredited and if offered as a defense in a fitness to practice hearing/high court case they would lose almost certainly!!
    So please dont use “anecdotal evidence” to argue points in future.

  23.  

    Sorry We’re even better than I previously thought!

    http://www.mdgmonitor.org/map.cfm?goal=4&indicator=0&cd=

  24.  

    You don’t seem to have had a baby in Ireland, or an episiotomy, bohemian?
    Many episiotomies are performed as routine and are not necessary.
    Yes, sometimes, they are necessary, but their incidence has risen to such an extent as to be highly questionable.
    I have had both episiotomy and tears.
    The tear healed FAR quicker, the episiotomy was months healing.
    Listen to the women!!!!!!

    Anecdotal evidence is most important in this discussion.
    This evidence is the living testimony of women who have actually given birth, and as such I feel they should be listened to, don’t you?
    I would listen to women’s evidence before their consultants’ data.
    Please do not presume to tell me what type of evidence to use in future!
    If the white coated old boys’ panel had listened to women’s anecdotal evidence, then Neary would have destroyed fewer lives!!!!

    You are incorrect about consultants only becoming involved if there is a problem.
    They become involved if you have private health cover at every, single birth.
    I personally had natural births for all of mine, no medical problems, all attended by a consultant.

  25.  

    Bohemian — Please don’t instruct contributors what to say “in future”.

  26.  

    Mairead: No I have not given birth in Ireland and no I have never had an episiotomy, I will qualify my comments on the fact that I have had the privilege of delivering children both in Ireland and the third world, also I have had formal training in obstetrics/gynaecology although not pursueing a career in that specialty as its far too litigous a branch of medicine. Your perception that Ireland is a savage place to give birth does not stand up to scrutiny when comparing it to other countries by all standard parameters by which obstetric care is measured namely maternal mortality rates and perinatal mortality rates, Ireland is consistently a world leader in both parameters performing above its (now) more prosperous european counterparts, in fact obstetrics is the one area of medicine where Ireland can claim to be truly world class, where obstetricians in training come from other EU countries to do clinical/research fellowships. Your claim that episiotomies are routinely performed is not true in contemporary times (I cannot comment on previous practice – as I have no experience), episiotomies are performed on women in labour under conditions whereby there is clinical signs of fetal distress, prolonged labour, and where based on the judgement of the supervising doctor there is risk of trauma to the womens pelvic organs during delivery of the child.
    The decision to medically intervene wether with an episiotomy or forceps is made on the basis of balancing risk, if the risk of not intervening outweigh the risk of intervening the procedure will be performed, your observation that episiotomies are more traumatic than tears is fortunately quite rare and probably a reflection of the skill of the person performing the episiotomy rather than on the procedure itself. Recovery time from a surgical incision is almost always better than from traumatic injury that would of been sustained if not performed.

    Val:before the medical establisment became involved in obstetric care childbirth/pregnancy was extremely dangerous..not the occasional maternal death as you say…at the turn of the century maternal mortality rates were appraching 1 in 100 and far higher before the 16th century I’d imagine, it was only when the principles of medical science and surgery were applied to pregnancy did these mortality rates plummet, also men dont go into obstetrics as a way to subjucate women or as some way to satisfy a power lust, we have mothers, sisters, and daughters and treat women the way same we’d expect our female relatives to be treated. Men go into obstetrics because its a fascinating medcal specialty wih offers a chance to practice the principles of both medicne and surgery and at the same time use their training to bring life into the world rather than prevent death

  27.  

    You are quoting quantitative data, I am talking about people’s experiences and valid qualitative evidence, bohemian.
    I thought you were a medical doctor ok.
    It was something about the way you talked down to me………

  28.  

    axe to grind ya?

  29.  

    Not in the least.
    I just enjoy respect.
    Many doctors need to learn to respect their patients, and not talk down to them.
    They don’t always “know best”.
    Sometimes, the patients actually know something about their own bodies and can contribute to their health care.

  30.  

    Bohemian — You sound very condescending to me, though your use of certain linguistic quirks hints to me that you are rather young to be lecturing mature women. Does your obstetric and gynaecological training equip you to notice that the post is about symphisiotomy and not episiotomy?

  31.  

    You’re right I probably am younger than said poster, also I am aware that the main article is about symphisiotomy, I chose not to offer an opinion on it as it is too contoversial a topic, I was simply giving my opinion on episiotomies as I noticed some inaccurate comments being made and wanted to set the record straight, but apparently factual information / accepted wisdom isn’t appropriate to introduce to debate.
    Also my age does not exclude me from debating with “mature” women anymore than having a poorly informed opinion would stop most people posting to this blog

  32.  

    Your age doesn’t exclude you from anything, but it’s a poor outlook for your future career if you’re so patronising to an experienced woman this early. Senior consultant material, clearly. Dr Neary would approve.

  33.  

    Cheers, cast aspertions on my performance in my job and doubt about my future career prospects simply because you disagree with my tone/ opinions, you have no idea of how good or bad I am as a clinician so refrain from commenting on that which you do not know. I wouldn’t be so rude as to guess how you perform in your day job! Thanks for the neary comparison…low blow? Of course you would never dream of being condescending

  34.  

    I’m not commenting on your ability as a doctor. I’m commenting on your superior attitude to women who may well come within your care some day. It doesn’t matter whether I’m condescending or not. I have no power over you and and you can take it, unlike patients who may well be frightened and uncertain under your magisterial gaze.

  35.  

    We’re probably just going to end up arguing all day about this. Best to agree to disagree,I’m gonna finish commenting on this post now. Good site by the way, nice variety of issues discussed.

  36.  

    I have given birth to several children, as have my mother, my aunts, my sisters, my cousins, my friends.
    I wasn’t only outlining my own experiences.
    We have first-hand experience of giving birth in Ireland.
    Our experiences are not innaccurate or misinformed, they are real.
    Text books are one thing.
    Real life is another.
    Both are valuable, but real life is what is actually happening.
    Yes, in some cases episiotomies prevent terrible tears, but they are done very often.
    Neary and co performed other operations far too often, and dared anyone to question them.
    Women were never questioned or allowed to speak about their experiences.
    They had no voice, even though they were the ones being cut.
    Time to change that.
    Symphysiotomy or its like must never happen again – that was the point of the post.

    P.S. Bohemian, do you really not know who Sheila Kitzinger is????
    She is an experienced midwife, read by millions and millions of women every year for decades now!
    Read her.

  37.  

    Mairead, thanks for this post.

    Re statistics, Bohemian doesn’t lie. Birthing in many other countries has even worse outcomes than in Ireland. But the fact that even in a country with low rates of maternal and peri-natal deaths, the birthing experiences of women can be so negative and traumatic means that much could yet be done to improve matters. And this starts with the possibility of getting both the obstetricians and women who have or who will labour into the same conversation, as is potentially happening here.

    As it happens, there is some clinical evidence that favours a restricted vs a routine use of episiotomy as part of the standard of care – reviewed here.

    Summary: Restrictive use of episiotomy compared with routine use of episiotomy Restrictive use of episiotomy seems more effective at reducing the proportion of women with posterior perineal trauma, perineal pain at discharge, healing complications, and the need for suturing, but not at reducing severe vaginal or perineal trauma, third-degree tears, dyspareunia or urinary incontenence at 3 months, or dyspareunia at 3 years. Restrictive use of episiotomy seems less effective at reducing rates of anterior perineal trauma (which carries minimal morbidity) .
    Recommendation: We found no reports of serious adverse effects associated with restricted use of episiotomy apart from higher rates of anterior perineal trauma, which carries minimal morbidity, in the systematic review….The subsequent RCT did not report any serious adverse effects associated with restricted use of episiotomy. There is strong evidence of benefit for restricted use of episiotomy compared to routine episiotomy.

    But could we do even more to reduce the incidence of perineal trauma altogether? As this study on the prevention of perineal trauma in childbirth concluded:

    Conclusion: Factors shown to increase perineal integrity include avoiding episiotomy, spontaneous or vacuum-assisted rather than forceps birth, and in nulliparas, perineal massage during the weeks before childbirth. Second-stage position has little effect. Further information on techniques to protect the perineum during spontaneous delivery is sorely needed.

    We have a long way yet to go in terms of improving the standard of obstetric care, and it would be a start if doctors such as bohemian would accept that the current rates of perineal trauma (whether by episiotomy or by spontaneous tearing) are not acceptable and can be improved, and that the experiences of women who give birth are important for obstetricians to listen to for evidence on directions for that improvement to take.

    It is great that fewer women and babies die in childbirth in Ireland than elsewhere. It is not great that so many women still face into months of soreness “down there,” with attendant difficulties in urination and sexual activity. Bohemian, there is no room for smugness here.

  38.  

    Scotlyn, that is a super post, thank you so much.
    It is exactly how I feel.
    Yes, thankfully, few women die in childbirth in Ireland, and I should hope they wouldn’t either in 2010.
    Their lives can be very seriously effected, though, by perineal trauma, as you so rightly described.
    In conversations after childbirth, one of the questions women ask is – How many stitches?
    It is possible to have zero stitches and to avoid perineal trauma.
    Let’s aim for that?

  39.  

    Thanks for your blog post. I would like to say a health insurance agent also works for the benefit of the coordinators of your group insurance. The health insurance professional is given an index of benefits looked for by a person or a group coordinator. Such a broker does indeed is look for individuals as well as coordinators which will best match up those desires. Then he presents his referrals and if each party agree, the broker formulates a contract between the two parties.

  40.  

    There is an extensive article in the last issue of History Ireland which gives the background to the Symphisiotomy debate. It is by Jackie Morrissey who wrote a PhD on it.

  41.  

    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

    Based on a UCD PhD thesis

Leave a Reply