Symphysiotomy was also advocated in 1597 by Severin Pineau after his description of a diastasis of the pubis on a hanged pregnant woman . Thus symphysiotomies became a routine surgical procedure for women experiencing an obstructed labour. In the late 19th century after the risk of maternal death after caesarean section decreased due to improvement in techniques, hygiene and clinical practice the symphysiotomy was rarely used.
The most common indications are a trapped head of a breech baby, shoulder dystocia which does not resolve with routine manoeuvres and obstructed labour at full cervical dilation when there is no option of a caesarean section. Currently the procedure is rarely performed in developed countries, but is still routine in developing countries where caesarean section is not always an option.
Symphysiotomy results in a temporary increase in pelvic diameter (up to 2 cm) by surgically dividing the ligaments of the symphysis under local anaesthesia. This procedure should be carried out only in combination with vacuum extraction. Symphysiotomy in combination with vacuum extraction can be a life-saving procedure in areas of the world where caesarean section is not feasible or immediately available. Since this procedure does not scar the uterus, the concern of future uterine rupture that exists with cesarean section is not a factor.
The procedure is not without risk, including urethral and bladder injury, infection, pain and long-term walking difficulty. Symphysiotomy should, therefore, be carried out only when there is no safe alternative. It is advised that this procedure should not be repeated due to the risk of gait problems and continual pain.
Abduction of the thighs more than 45 degrees from the midline may cause tearing of the urethra and bladder.
If long-term walking difficulties and pain are reported (occur in 2% of cases), treat with physical therapy.
Irish women who unknowingly and without consent underwent symphysiotomies during childbirth between the 1950s and 1980s say they were left them with severe side effects, including extreme pain, incontinence and depression. Irish obstetricians sought to establish this operation as an alternative to Caesarean sections because it was thought that women subjected to repeated Caesareans 'might be tempted to use contraception'.