Rose Magee was 17 years old when she went into labour in 1963. Her pains lasted 56 hours. Normal practice elsewhere was to perform a Caesarean section, lest mother or baby die. But Rose was Irish, poor and unmarried, writes Medb Ruane.
Her doctors did a different procedure which, deliberately or otherwise, ensured that she could not be sterilised in the future.
All Rose could think of was what her ma would say when she saw the baby was black, but the baby's skin colour had nothing to do with race and all to do with the length of delivery. As it was, she was lucky her baby survived, and she kept her daughter, defying the mores of the time. She had nine more children.
Rose had to teach herself to walk again after the birth and still needs to lean against a wall after a few minutes on her feet. She had thought this was her fault, along with her unbearable backache, frequent incontinence and sense of shame. She's worn sanitary towels every day of her life and takes strong painkillers.
So, too, do many women who went through the same operation. Others are dead.
The practice Rose endured is called symphysiotomy, which involves sawing through the pelvis to open it up like an oyster shell. Non-Roman Catholic countries used it only in exceptional cases, but in Latin America and Ireland, some doctors practised it as a way of avoiding Caesarean sections, which they thought might encourage women to use contraception or request sterilisation.
Jacqueline Morrissey exposed it in this paper in September 1999. My own researches into the politics of medicine in the 1930s had made me wonder what might have happened by the 1950s, and I had knocked on Jackie's door, knowing she was completing a thesis on maternity care. Jackie received letters from women all over the country who thought they were alone until they read her article. No one had asked their permission, or told them what to expect.
In May 2001, John Gormley TD brought the matter to the Dáil's attention, on behalf of his constituent Mrs Matilda Behan. Micheál Martin invited comments from the Institute of Obstetricians and Gynaecologists. Their reply consists of a one-page letter from Dr John Bonnar, along with a 1959 article written by Prof John Cunningham, a former Master of Holles Street and UCD professor. He defends the practice, with Dr Bonnar adding that it lasted until 1960 and that, in properly-conducted cases, complications were rare.
Phone calls and letters to campaigning Examiner journalist Carl O'Brien suggest complications were more frequent than the institute may realise. Far from being confined usually to "emergency admissions with obstructed labour where sepsis following Caesarean section would have carried a risk of death", as Dr Bonnar wrote to the Department of Health, some cases happened before the woman entered labour. Mrs Behan's symphysiotomy was carried out a fortnight before she gave birth. And, as Morrissey's research shows, the procedure resulted in some cases with the baby's death.
"In Roman Catholic countries, efforts to perfect the operation have been sustained," says Prof Cunningham's 1959 article, which Dr Bonnar supplied to the Minister on behalf of the Institute of Obstetricians and Gynaecologists. "Contraception and sterilisation are not countenanced by those who subscribe to Catholic rule."
Prof Chassar Moir of Oxford was among many doctors who tried to draw medical attention to this Irish practice, which was theologically justified on the grounds of double effect. "Is it then your policy to sacrifice the first-born baby and to use its dead or dying body as nothing more than a battering ram to stretch its mother's pelvis in the hope that subsequent brothers and sisters may thereby have [possibly\] an easier entrance into this world?" he asked Irish doctors.
The procedures began to end when the new Master of Holles Street, Dr O'Driscoll, measured scientifically the incidence of "disproportion", one of the conditions used to justify symphysiotomy. Of 1,506 first births delivered in the NMH in 1966, "disproportion" was diagnosed four times and none was suitable for symphysiotomy. He concluded that disproportion was a rare complication in Ireland - "a mote in the eye of the obstetrician". He did not go on to say that the "mote" arose from the ethos identified in the 1930s as "the Catholic position" in Irish medicine.
The Catholic position persists among some members of the Irish institute. In 1996, Prof Eamon O'Dwyer wrote that natural family planning is both "non-invasive \ unlike hormonal contraception - oral or otherwise - it is completely safe". Its reliability is another matter. Like the women of Positive Action, the Irish survivors of symphysiotomy are beginning to organise. Women from Dublin, Cork and Louth are trying to raise funds and find a place to hold their first national meeting. Positive Action and John Gormley TD have offered advice.
Given what we now know about Ireland's relative isolation in performing such procedures, can Micheál Martin fob them off with a one-page response from the institute suggesting that they were no more than creatures of their time? An independent report is surely required, lest they be treated with the callousness meted out to Hepatitis victims. For Rose, Matilda and others, tears are still part of their pain.