Symphysiotomy is an obstetric procedure usually performed when a caesarean section is not possible. During this procedure, the cartilaginous pubic symphysis, or the point where the right and left ileum meet, is severed in order to create more room through which the baby can exit. This procedure is typically done when a baby is breech, or positioned to leave the uterus either feet first or buttocks first, is mechanically stuck in the birth canal or if the baby's or mother’s life is threatened. Some of the risks of this procedure include bladder or urethra damage and permanent or long-term impairment of walking. There is great controversy over whether a symphysiotomy is humane or if this procedure should be permanently replaced by caesarean sections.
During a symphysiotomy procedure, the patient is first given local anesthesia to numb the pubic area. Next, an incision of about 0.5 to 1.5 inches (1.3 to 3.8 cm) is made in the lower abdomen to gain access to the pubic symphysis. The ligaments of the pubic symphysis are then severed to create approximately an additional 0.8 inches (2 cm) to ease the passage of the baby through the birth canal. Most of these obstetric procedures are coupled with a vacuum extraction or a suction device to help pull the baby free. It is also essential that the thighs of the patient are not pushed beyond 45 degrees outside the midline.
The primary risk of this procedure is harm to the urethra, or the tube passing between the bladder and the genitalia or injury to the bladder. These issues are most often caused by obstetric forceps used to mechanically remove the infant or when the patient’s thighs are allowed to spread apart once the cartilage has been cut. Allowing the legs to separate may also produce long-lasting or even permanent problems with walking and extreme pain.
Historically, this birthing procedure was used in situations where a cesarean section would have been a better option or was performed to simply make the birth quicker or easier for the physician. When cesarean sections are routine and safe, most obstetricians feel that the use of a symphysiotomy should be restricted to freeing an infant or saving the mother’s life only when a cesarean section is not possible. Cesarean sections, in most cases, do not produce as many long-lasting or painful side effects.