Report on 'Brutal' Childbirth Surgery will be Flawed, Claims Survivors' Group
Irish Times, October 21, 2010 by Carl O'Brien, Chief Reporter
WOMEN WHO underwent “brutal” forms of childbirth surgery have said a report being commissioned by the Minister for Health into the practice will be “fatally flawed” due to major conflicts of interest.
The Survivors of Symphysiotomy (SOS) group has criticised the involvement in the planned review of a UK-based doctor who, it said, is a proponent of symphysiotomy in developing countries.
Thousands of women in Ireland underwent symphysiotomies, a procedure which involves breaking the pelvis, between the 1940s and the 1980s. Many women say they have been left with a legacy of health problems such as incontinence and poor mobility.
However, obstetricians have defended the practice on the basis that it saved many lives and alternatives such as Caesarean sections were not easily available.
Earlier this year Minister for Health Mary Harney asked the Institute of Obstetricians and Gynaecologists to prepare a report for her on the practice of symphysiotomy in Irish hospitals from the 1960s onwards.
However, the SOS support group said there were “multiple conflicts of interest” in the way the institute was going about compiling this report.
It is understood that the institute is proposing to hire the Liverpool School of Tropical Medicine to compile a literature review of symphysiotomy.
The SOS group said the school advocated teaching symphysiotomy in developing countries as part of “skilled birth attendance” training programmes.
It also said the institute had approached a doctor who had written in support of symphysiotomy, Dr Nynke van den Broek, to head up this literature review.
In a recent article in BJOG – an international journal of obstetrics – Dr van den Broek advocated symphysiotomy where access to safe surgery is not available in developing countries.
“This is a clear conflict of interest and smacks of self-interest,” said SOS spokeswoman Marie O’Connor.
The SOS group also said the institute was finalising a three-person team to carry out a review of the practice in Ireland led by a Belfast obstetrician-gynaecologist Dr James Dornan.
It said the fact that Dr Dornan was vice-president of the Royal College of Gynaecologists – which it said was closely aligned with the institute – was also a significant conflict of interest.
Ms O’Connor said: “The body in Dublin that represents the doctors who carried out these operations has now asked the vice chair of a related body in London to head a report into operations that, for four decades, must have enjoyed the approval of both bodies. This is surely another conflict of interest.”
In a statement, the institute declined to comment on the SOS group’s claims and added that it was assisting the Department of Health in establishing a report team and terms of reference.
As part of this process, the institute said it had engaged with both Patient Focus and SOS in the “spirit of openness and good faith”. In this context it would not be appropriate or sensible to engage in public discussion on this particularly sensitive issue, it said.
It added: “We are disappointed that SOS chose to undermine this delicate process with public statements and comments that are inaccurate and unhelpful.
“The sole objective of the institute in helping to facilitate the production of this report is to ensure that the women who underwent this procedure in Ireland get answers to the questions they have been asking for many years.”
In 2004, The Irish Times reported that an expert commissioned by the Department of Health to conduct a review into the practice was also an advocate of symphysiotomy.
Prof Kenneth Bjorklund of the Karolinska Institute in Sweden had advocated the “reinstatement of symphysiotomy in the obstetric arsenal for the benefit of women in obstructed labour and their offspring”.
A spokesman for the department at the time defended the decision to appoint Prof Bjorklund, and said he was an internationally recognised expert. It later emerged that Prof Bjorklund was unavailable to compile the report due to “work commitments”.