Madam, - This year approximately 50,000 women around the world will die from an avoidable complication of childbirth, obstructed labour. Many of the babies will also die. Among the ways of preventing these deaths are two operations, A and B.
Both operations are equally effective in saving babies' lives. The rate of long-term complications such as backache, urinary incontinence, infertility and leg pain are also the same for both operations. However, death of the mother is six times more frequent with operation A, and the need for blood transfusion is twice as common. No cases of walking difficulty following operation operation B have been identified, despite long-term follow-up.
Operation A is Caesarean section; operation B is symphysiotomy. These are the facts, revealed in a review of the world literature on this question in the 20th century, written by Dr Bjorklund from the Karolinska Institute in Sweden.
In June of last year I sent this review to the chairwoman of the "Survivors of Symphysiotomy", Ann O'Donnell of the National Women's Council. During a conversation with her I suggested that the group might benefit from expert assistance in clarifying the origins of their particular problems. Ms O'Donnell reassured me that they already had expert advice - from a lawyer!
Women who believe they have been harmed by symphysiotomy deserve to have their cases considered sympathetically, with accurate information regarding the clinical circumstances surrounding the relevant birth. What women don't need is inaccurate information based more on prejudice than correct analysis of the evidence, for such an approach only perpetuates a feeling of grievance without allowing an opportunity for resolution.
Judging by your report in last Wednesday's paper referring to symphysiotomy as a "barbaric" procedure it would appear that someone in a position of reponsibility is seriously misleading the women by either suppressing, or ignoring, the evidence. A grave injustice is being done if this is the case. - Yours, etc.,
PETER BOYLAN, MAO, FRCPI, FRCOG, National Maternity Hospital, Holles Street, Dublin 2.