Sir, - In her article "Midwifery of darker times" (The Irish Times, September 6th) Jacqueline Morrissey wrote that in the 1940s and 1950s Catholic obstetricians in Holles Street and the Coombe deliberately rejected current best medical practices because of the Catholic Church's teaching. This rejection, she argues, caused babies, and possibly mothers, to die.
We suggest that the real story is more complex - a tragedy, not a melodrama.
Obstetric thinking at that time was dominated by a rigid model of childbirth. This attitude was strongly influenced by the high incidence of rickets in the earlier part of the century and consequent distortion of the pelvis in poorer women. However, the diagnosis of disproportion between the baby's head and the mother's pelvis and consequent failure of the baby to progress through the pelvis during childbirth was wrong in very many cases.
The diagnosis was wrong because conventional medical thinking ignored the marvellous elasticity of both the pelvis and the baby's head working together during childbirth.
When disproportion was diagnosed, the usual treatment was delivery by Cesarean section. Most of these sections were, in fact, unnecessary. Drs Spain and Barry at Holles Street and subsequently Dr Feeney at the Coombe proposed an alternative course, surgical symphysiotomy (spontaneous symphysiotomy is a complication of normal pregnancy and is a regular occurrence) to widen the pelvic outlet. This too was based on the incorrect rigid model of childbirth.
The introduction of symphysiotomy was driven not by Catholic teaching but by the medical risks associated with repeated Cesareans. The mothers served by Holles Street and the Coombe often had large families and so Cesarean delivery had more serious implications for them than for mothers in other cultures where smaller families were the norm. In fact, maternal mortality was the main concern of all obstetricians in the 1940s and 1950s.
Undoubtedly Drs Spain, Barry and Feeney were influenced by Catholic teaching with regard to sterilisation, but this should not be a surprise. Doctors surely have a duty of care to respect their patients' beliefs and the population served by Holles Street and the Coombe was largely comprised of working-class Catholic mothers.
Ms Morrissey's article denigrates three men who cared deeply for their patients and acted in good faith.
Dr O'Driscoll's contribution, starting in 1963 at Holles Street, was to recognise the rarity of disproportion and prove that both operations, Cesarean section and symphysiotomy, were unnecessary in the majority of cases. O'Driscoll clearly identified the dynamic nature of childbirth and correctly rejected the rigid model. Symphysiotomy was rapidly abandoned.
Unfortunately Cesarean section continued, and continues, to be performed unnecessarily in many hospitals under the mistaken impression that disproportion is still a common condition. Indeed, as late as the 1980s some British hospitals were still x-raying pregnant women's pelvises for disproportion, thus exposing the developing foetuses to a toxic dose of radiation.
It was not only Irish doctors who drastically overestimated the numbers of women suffering from disproportion; it was a common misdiagnosis throughout the English-speaking world. The real lesson to be learned is that erroneous thinking in medical practice can have adverse consequences for patients, in this instance submitting them to unnecessary surgery. - Yours, etc.,
Peter Boylan, Master of Holles Street, 19918, Tony Farmer, Author of Holles Street 18941995, National Maternity Hospital, Dublin 2.