Image of Erinville Maternity Hospital (photo credit: Conach Gibson-Feinblum)

 

Cork Lying-in Hospital came about because of the philanthropic  “voluntary efforts of a group of energetic women and men” (St. Leger, 2006: p. 25)  and the reforms and developments in science, medicine and maternity practices.
 

Dr Lucy E. Smith

​

Dr Lucy Smith, was the second female graduate in medicine from Queen’s College Cork in 1898, and worked as a physician in the Erinville Maternity Hospital for 28 years from 1901 to 1929. Alongside her dedication to maternity work, she also treated women prisoners in Cork City Gaol and during the First World War she served at Victoria (now Collins) Barracks in Cork tending to wounded soldiers, women and children (University College Cork Heritage Services, 2020).  Dr Lucy Smith was also involved  “with early maternity and child welfare work in Cork City” and as a member of the Cork branch of the Women’s National Health Association (WNHA) a non denominational philanthropic association established by Lady Aberdeen, the wife of the Viceroy Of Ireland, she along with other female doctors Dr Alice Barry, and Dr Lucia Fitzgerald were concerned about  high maternal and infant death rates (Law 2020:np).  

​

By the early 1910s, the Cork branch operated a dental clinic for mothers and a maternity and child welfare centre in the city, which taught ‘mother-craft’ lessons to educate new mothers on the importance of proper infant feeding methods and domestic hygiene. (Law 2020:np). 

​

A memorial in the form of a bed was dedicated to Dr Lucy E. Smith at the Erinville Hospital.  “The Dr Lucy E. Smith Room on the fourth floor of The Hub, UCC, is named in her honour. Smith studied in this building when a student… she was the only female member of the first Governing Body of University College Cork in 1908” (University College Cork Heritage Services, 2020: np).

 

Erinville closed in 2007, together with Cork’s other maternity hospitals, St Finbarr’s and the Bon Secours, when a new maternity facility, Cork University Maternity Hospital, was opened. Erinville is now used as office accommodation by the HSE and UCC College of Medicine and Health. 

 

Symphysiotomy survivors’ battle for truth 

​

In this article, Marie O’Connor, Chair of Survivors of Symphysiotomy, shares her research, advocacy and knowledge of the practice of symphysiotomy in Irish hospitals; the religious motivation behind this practice; the human rights violations it entailed; and the vital importance for symphysiotomy survivors of establishing the truth about these birth operations.  

 

Symphysiotomy

​

Symphysiotomy is an eighteenth-century birth operation that involves severing one of the three pelvic joints, the symphysis pubis, which fuses the two pubic bones to the front, thereby unhinging the woman’s pelvis.

 

An estimated 1,500 symphysiotomies were performed in Ireland on two generations of women, mainly in private Catholic hospitals, from 1944 to 1987 (UN Human Rights Committee 2014, O’Connor 2023). No one knows how many women were operated on in this way, as the State has never obliged hospitals to produce their records.

 

Erinville is one of three Cork hospitals to practise forced symphysiotomies. The other institutions were St Finbarr’s, a public facility managed by the Sisters of Mercy, a Roman Catholic congregation, and the Bon Secours, owned by Catholic nuns. 

 

Doctors refused to carry out symphysiotomy in the 19th century even as a last resort, because they saw it as unacceptably dangerous for women. Instead, to save the mother’s life, they performed craniotomy, an operation which was mortal if performed on a living foetus. Symphysiotomy also endangered babies: one in ten died, and children were also at risk of brain damage. 

 

Symphysiotomy policy and practice

​

Symphysiotomy was not an emergency operation, it was done as a matter of policy. Some women had their pelvises sundered before labour began, during late pregnancy, or in the aftermath of Caesarean section, under a general anaesthetic. These latter operations were labelled ‘on the way out’ in hospital clinical reports: the mother’s pelvis was divided after the baby had been born. This was the type of symphysiotomy at issue in Kearney v McQuillan (one of only two symphysiotomy cases in Ireland to have gone to full trial). In this case, Ireland’s highest court found the performance of symphysiotomy following a successful Caesarean delivery to be ‘deeply and fundamentally flawed’. The plaintiff, Ms Kearney, had her pelvis incised in 1969, at the age of eighteen, in Our Lady of Lourdes Hospital, Drogheda, without her prior knowledge or consent, as she lay unconscious in the operating theatre. 

 

Most women underwent this joint surgery wide awake, after they had been left in labour for many hours. Many survivors recall being physically restrained by midwives as they struggled against the scalpel, their feet tied in stirrups in a ‘stranded beetle’ position. They found the experience terrifying and many described the pain as excruciating. After the operation, they were still in labour. The pain of pushing a baby out on an unhinged pelvis was followed by the agony of being forced to walk within a day or two of the operation. 

 

Women were nursed in the postnatal ward as though they had not had a surgical procedure. Unlike other mothers, they were separated from their children, who, unknown to them, were in intensive care (for either ill health or policy reasons). Their mothers were discharged from hospital twelve or so days after their surgery, unable to walk, without painkillers or medical advice. Once home, these young mothers, often incontinent of urine and in severe pain, were left to sink or swim with small babies they were physically unable to care for. 

 

Irreparable, life long  damage 

​

Some fifty years after the surgery, almost every woman continues to suffer from severe pain in her lower back, especially in her sacroiliac joint and pelvis.  A great number continue to walk with a limp, as well as suffering from a range of musculoskeletal disorders. Many mothers suffered bladder and, less commonly, bowel injuries, which have led to lifelong incontinence. Depression is common. Babies born following symphysiotomy were also affected. Several mothers reported that their children had been brain damaged and others continue to suffer mental health problems.      

 

A secret operation 

​

It was through the media that women found out they had been subjected to symphysiotomy decades earlier, without their knowledge and without their consent. Delayed discovery was the norm. Hospitals, such as Erinville, did not inform their patients that doctors had severed their pelvis in the labour ward or in theatre. General practitioners, informed by letter of their patients' surgery, mostly failed to inform them, ignoring their inability to walk properly six weeks after the birth. The operation remained hidden from the public until 1999, when historian Dr Jacqueline Morrissey revealed the practice in a national newspaper. National and local coverage followed. The plaintiff in the above case learned of her surgery thirty three years later, in 2002, listening to an interview with a woman who seemed to describe her own experience of maternity care at the same hospital in 1969: the sequel, severe back pain, incontinence and depression, was identical.  

 

Why did doctors do it? 

​

The Guardian correctly headlined Homa Khaleeli’s seminal feature on symphysiotomy ‘Ireland’s brutal alternative to Caesarean section’ (2014). Symphysiotomy was done to maximise a woman’s reproductive capacity, as Professor Linda Connolly underlined in Walking Borders (2018). Obstetricians performed symphysiotomy in preference to Caesarean section, which they disapproved of for religious reasons. One Caesarean delivery tended to be followed by another, and three was often seen as the upper safety limit. These doctors saw Caesarean section as leading to such immoral practices, as they saw it, as sterilisation, contraception and abortion, all forbidden under Roman Catholic law. What devotees of symphysiotomy wished to ensure was childbearing without limitation. This may help to explain why women’s informed consent to the operation was never sought. 

 

Resistance

​

Survivors of Symphysiotomy (SoS) formed in 2002 and promptly demanded a public inquiry into the practice. The then health minister, Micheál Martin, refused to hold one, as did successive administrations.  SoS finally took its case to the United Nations Human Rights Committee in 2014, ending years of State stonewalling. The Human Rights Committee condemned the practice, concluding that ‘symphysiotomy, a childbirth operation which severs one of the main pelvic joints and unhinges the pelvis, was introduced into clinical practice and performed on approximately 1,500 girls and women in public and private hospitals between 1944 and 1987 without their free and informed consent’. Ireland’s policy practice of symphysiotomy was unique: it made international news, with the story being covered repeatedly by Al Jazeera, BBC Radio 4’s ‘Woman's Hour’ and CNN. 

 

National and international human rights bodies have continued to condemn Ireland’s symphysiotomies and the State’s failure to investigate them properly, despite three official reports, or to compensate survivors adequately, notwithstanding a government payment scheme. Some of these authorities have recognised these forced operations as violence against women. Ireland has always maintained that symphysiotomies were acceptable and that there has been no wrongdoing by doctors.  In 2023, the UN Human Rights Committee again condemned the Irish government for failing to 'clearly recognize the [religious] nature of the motivation of this deliberate and systematic practice without women’s prior knowledge or informed consent'. The Committee concluded that symphysiotomy caused ‘lifelong pain and disability’ to women and called for 'a prompt, independent and thorough criminal investigation' into the consequences of the surgery. 

 

Further reading on symphysiotomy 

​

Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. (2017) Concluding observations on the second periodic report of Ireland. Source: United Nations. Available from: https://documents.un.org/doc/undoc/gen/g17/255/42/pdf/g1725542.pdf?token=KuXwzWAPU9aNy6ry95&fe=true  [Accessed 18 July 2024]. 

 

Convention on the Elimination of All Forms of Discrimination against Women. (2017) Concluding observations on the combined sixth and seventh periodic reports of Ireland. Source: United Nations. Available from: https://documents.un.org/doc/undoc/gen/n17/062/74/pdf/n1706274.pdf?token=ndywqhRESgdOJeTGcR&fe=true [Accessed 18th July 2024].

 

Council of Europe: Commissioner for Human Rights. (2017) Report by Nils Muižnieks, Council of Europe Commissioner for Human Rights, following his visit to Ireland, from 22 to 25 November 2016, CommDH [online]. Available from: https://www.refworld.org/reference/countryrep/coechr/2017/en/117082 [Accessed 18 July 2024].

 

Group of Experts on Action against Violence against Women and Domestic Violence (GREVIO). (2023) GREVIO Baseline Evaluation Report Ireland. Source: Council of Europe. Available from: https://www.coe.int/en/web/istanbul-convention/-/grevio-publishes-its-report-on-ireland-1 [Accessed 18 July 2024]. 

 

Harding Clark, M. (2016) The Surgical Symphysiotomy Ex Gratia Payment Scheme Department

of Health. Source: Department of Health. Available from:

https://www.gov.ie/en/publication/544fc6-the-surgical-symphysiotomy-ex-gratia-payment-scheme-report/  [Accessed 13 July 2024].

 

Human Rights Committee (2014) Concluding Observations on the Fourth Periodic Report of Ireland. Source: United Nations. Available from: Concluding observations on the fourth periodic report of Ireland). [Accessed 18 July 2024].

 

Khaleeli, H. (2014) Ireland’s brutal alternative to Caesarean section. The Guardian, 12 December [online]. Available from: https://www.theguardian.com/lifeandstyle/2014/dec/12/symphysiotomy-irelands-brutal-alternative-to-caesareans  [Accessed 13 July 2024].

 

Morrisey, J. (1999) Midwifery of darker times. The Irish Times. 6 September [online]. Available from: https://www.irishtimes.com/news/health/midwifery-of-darker-times-1.224232 [Accessed 13 July 2024].

 

Murphy, Y. (2014) Independent Review of Issues relating to Symphysiotomy. Dublin: Department of Health.

 

Murray, J. (2014) Sheila Scott; Symphysiotomy; Feminism and Men. Source: BBC Radio 4 - Woman’s Hour. Available from: https://www.bbc.co.uk/programmes/b04t6t5w  [Accessed 13 July 2024].

 

O’Connor, M. (2011) Bodily Harm: Symphysiotomy and Pubiotomy in Ireland 1944-92. Dublin: Evertype.

 

O’Connor, M., Mac Aodhain, R., Smith, C., Lynn, M., and Kelly, M. (2014) Submission to The United Nations Committee Against Torture. Source: Survivors of Symphysiotomy. Available From: https://cdn.thejournal.ie/media/2014/03/symphysiotomy-submission-to-uncat-10-march-2014.pdf [Accessed 26 June 2024].

 

O’Connor, M. (2019) Submission to the United Nations Special Rapporteur on Violence Against Women: Mistreatment and violence against women in reproductive healthcare during childbirth. Source: Survivors of Symphysiotomy. Available from: https://www.ohchr.org/sites/default/files/Documents/Issues/Women/SR/ReproductiveHealthCare/SurvivorsSymphysiotomy.pdf  [Accessed 26 June 2024].

 

O’Connor, M. (2022) Submission to the Council of Europe Istanbul Convention on Violence Against Women. Source: Survivors of Symphysiotomy. Available from:

https://rm.coe.int/submission-to-convention-violence-at-coe-/1680a81396  [Accessed 26 June

2024].

 

O’Connor, M. (2023) ‘This Deliberate and Systematic Practice’: How Doctor’s Religious Beliefs Impelled Ireland’s Forced Symphysiotomies. Source: Derham for CELLS (Centre for Ethics and Law in the Life of Sciences). Available from: https://www.durham.ac.uk/research/institutes-and-centres/ethics-law-life-sciences/  [Accessed 13 July 2024].

 

Report of the UN Special Rapporteur on Violence Against Women to the UN General Assembly A human rights based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence (2019).

 

Survivors of Symphysiotomy. (2014) Submission to the UN Human Rights Committee. 

 

Survivors of Symphysiotomy. (2017) Submission to the UN Committee for the Elimination of All Forms of Discrimination Against Women.

 

Survivors of Symphysiotomy (2017) Submission to the UN Committee Against Torture.

 

Survivors of Symphysiotomy. (2019) Submission to the UN Special Rapporteur on Violence Against Women.

 

UN Human Rights Committee (2014) Concluding Observations on the Fourth Periodic Report of Ireland, UN Doc CCPR/C/IRL/CO/4, 19 August 2014.

 

UN Human Rights Committee (2023) Concluding observations on the fifth periodic report of Ireland, UN Doc CCPR/C/IRL/CO/5, 26 January 2023.

 

Walking Borders. (2018) Walk 10. Walking with sociologist Linda Connolly in Cork [online].

Available from:

https://www.walkingborders.com/post/walk-10-walking-with-sociologist-linda-connolly-in-cork 

[Accessed 26 June 2024].

 

Walsh, O. (2014) Report on Symphysiotomy in Ireland 1944-1984. Source: Department of Health. Available from: http://health.gov.ie/wp-content/uploads/2014/07/Final-Final-walshReport-on-Symphysiotomy1.pdf [Accessed 26 June 2024].

 

Marie O’Connor is Chairperson of Survivors of Symphysiotomy, author and health correspondent with the national broadcaster.

 

SoS-Survivors-of-Symphsiotomy can be found on Facebook.

https://www.facebook.com/p/SoS-Survivors-of-Symphysiotomy-100064568174645/ 

 

References for Erinville, County and City of Cork Lying-in Hospital

​

Law, K. (2020) Dr Lucy Smith’s Involvement Child Welfare Work in Cork by Eugenie Hanley. Source: Women’s History Network. Available from: https://womenshistorynetwork.org/dr-lucy-smiths-involvement-child-welfare-work-in-cork-by-eugenie-hanley/#_ftn5 [Accessed 14 July 2024].

 

University College Cork Heritage Services. (2020) Lucy E. Smith MD BCh BAO DPH [online]. Available from: https://www.ucc.ie/en/heritage/history/people/alumni/lucy-e-smith/  [Accessed 14 July 2024].

 

St. Leger, A. (2006) Born in Cork: A History of Erinville Maternity Hospital, St. Finbarr’s

Maternity Unit and Bon Secours Maternity Hospital. Dublin: ColourBooks Ltd.