The report on The Surgical Symphysiotomy ex gratia Payment Scheme runs to almost 800 pages. Following its publication virtually all media coverage focused on the large number of women deemed ineligible for the scheme. Out of the 578 women who applied, 185 were unable to establish their claim because they had not actually had the operation. "How did so many [women] get it wrong," asked Judge Maureen Harding Clark, the assessor of the scheme.
A more pertinent question might be why did so many women not know what happened to them? Consultant obstetrician and gynaecologist Dr Peter Boylan, of at the National Maternity Hospital in Dublin, was "not surprised" that so many got it wrong.
“The real scandal of this whole thing is the way these women have been led to believe that their problems can be attributed to symphysiotomy when, in fact, they didn’t have one,” he told Sean O’Rourke on RTÉ1.
No, the real scandal is that 185 women did not know or were not told what procedures were carried out on them. And whose fault is that?
While not a whitewash, as claimed by Survivors of Symphysiotomy, there are several aspects of the report that deserved a more in-depth analysis. For example, the section dealing with ineligible claimants blames the women not the doctors. Women are portrayed as being so ignorant that they confused episiotomy with symphysiotomy.
According to Judge Harding Clark, “they [the claimants] can be forgiven for not distinguishing between surgical symphysiotomy and spontaneous symphysiotomy”.
Self-convinced
Amazingly, she “concluded that it is very probable that the combination of a traumatic birth experience and exposure to other women’s stories has created a self-convincing confabulation of personal history” and “it is for experts in the field of psychology to analyse the effects of group discussion on suggestive personalities”.
The women’s “recollections were based on error” and “applicants should never have persuaded themselves to make a claim for a procedure they did not have”.
Chapter 7 of the report – Symphysiotomy from Introduction to Decline: History through Comment and Publications – summarises the 523 pages of appendices and shows the disdain with which women's bodies were treated by obstetricians.
Reading this section of the report, it is impossible to escape the conclusion that all aspects of childbirth were driven by religious beliefs and misogyny. Women’s rights did not matter. According to one obstetrician “in many cases this and other difficult vaginal operations [symphysiotomies, forceps, deep episiotomies] were carried out with one object and one alone, to achieve vaginal delivery at all costs”.
There are quotes from obstetricians' meetings showing that most did not approve of Caesarean sections. "I have a great deal of sympathy for encouraging the use of the vagina in delivery" and "the obstetrician is the man who should stand by whilst nature is fulfilled per vias naturales. When he resorts to Caesarean section he has failed to stand by". "It [symphysiotomy] is 'finesse' in operative obstetrics of the highest quality, and quality is the only thing that counts." "Does he go further [do a Caesarean section] and destroy by mutilation one of nature's most important functions."
Judge Harding Clark made no comment on the general behaviour of obstetricians, their misogynistic attitudes, and determination to control all aspects of childbirth. Active Management of Labour (AML) is accepted uncritically in the report as if it was great for women’s health when it was, and continues to be, the exact opposite.
Egos
Minutes from obstetricians’ meetings show that they were more concerned with boosting their own egos than doing what was best for women. “In relation to symphysiotomy, we are disappointed that we have not yet succeeded in reducing the foetal mortality to figures that would flatter our egos.” “If symphysiotomy is the success it is held to be then it would be a very nice time indeed for the obstetrician.”
Have things changed? The HSE now has a national consent policy. However, because of the constitutional provisions on the right to life of the unborn, there is legal uncertainty regarding the extent of a pregnant woman's right to refuse treatment in circumstances in which the refusal would put the life of a viable foetus at serious risk.
Recently the HSE attempted to force a pregnant woman to have a Caesarean section by going to the High Court. For some reason maternity services will not be included in the first national patient survey due to take place soon. Obstetricians still want to control all aspects of childbirth, including the length of labour.
Although services are improving generally, maternity care still has a long way to go. Some things never change.