Symphysiotomy

Symphysiotomy is a surgical procedure that is performed to ease childbirth. During this procedure, the size of the pelvis is increased by splitting the cartilage (an elastic tissue) of the pubic symphysis.

The female pelvis is a basin-like structure between the hip bones that includes organs like the uterus (womb), cervix (opening of the uterus), and vagina. A woman has a wider pelvis than a man to ensure the passage of the baby during birth. Also, the bones and ligaments in the pelvis stretch to ease childbirth. However, in case of complication such as abnormal positioning of the baby or entrapment of the baby's head during childbirth, the surgeon may decide to cut the pubic symphysis. This will separate the pubic bones and create enough space for a vaginal delivery. Symphysiotomy is also performed as an alternative to caesarean section (C-section) when caesarean cannot be performed for reasons such as lack of facilities, refusal by the woman, or if the woman is not a candidate for C-section.

A symphysiotomy is performed if the following complications arise during the delivery of a baby:

• Head of the baby is arrested and engaged for more than an hour, and vacuum extraction (vacuum device that is used to deliver the baby) alone has failed to work
• Entrapped head of the breech baby (the legs of the baby comes first instead of the head) 
• The woman has refused to undergo a C-section or there aren’t enough facilities to perform one.
• Major imbalance in the size of the mother’s pelvis and the baby’s head (cephalopelvic disproportion)
• The shoulders of the baby are trapped above the mother’s lower hip bone (shoulder dystocia)
• A prolonged second stage of delivery (the stage at which the cervix is fully dilated)
• Failure to deliver the baby by other methods

Symphysiotomy is contraindicated in the following conditions:

• When the baby is not alive 
• Cervix is not fully dilated
• The head of the baby is not entrapped 
• The baby is positioned sideways or at a right angle to your spine
• An abnormal position of the baby that can create complications in the delivery process (e.g., brow presentation, in which the forehead of the baby is placed at the cervix)

Before this procedure, you will need to be prepared in the following manner:

• Tell your doctor about all the medicines that you take, including prescribed or non-prescribed medications, herbs, vitamins, and supplements.
• Also inform the doctor if you are allergic to any medicine or surgical components such as latex, iodine, tape, or anaesthesia or if you have had problems associated with excessive bleeding or blood clots in the past.

Once you reach the hospital, the medical staff will assist you in changing your clothes to a hospital gown. They will ask you to lie on your back with your thighs apart and knees flexed. A doctor will clean the incision site using an antiseptic solution. A firm catheter (tube) will be inserted in your bladder to drain urine. You will then be given local anaesthesia to numb the area of surgery.

The following steps will be performed during the surgery:

• The surgeon will insert their middle and index fingers into your vagina and push your urethra aside.
• He/she will then use a scalpel (a small, sharp blade) to make an incision (cut) above your pubic symphysis (the joining of the pubic bones). 
• Next, the surgeon will cut the cartilage until he/she feels the pressure of the scalpel on their inserted fingers. 
• He/she will move the scalpel downwards and then upwards to cut the symphysis.
• Once the symphysis is divided, the surgeon will separate your pubic bones. 
• An episiotomy (incision on the perineum, the area between the vaginal opening and anus) will be performed, and the baby will then be pulled out of your vagina using a vacuum extractor.
• Finally, the surgeon will close the episiotomy incision using one or two stitches.

This procedure is completed in two to three minutes. The catheter will be removed three days after the surgery. You will be asked to move around with the help of crutches after five days of the procedure and sent home after a week. However, your hospital stay may extend for another 10 to 14 days if you are unable to move or have traces of blood in your urine.

Once you are home, you will have to take care of your health in the following manner:

• You must take rest for at least two weeks after the surgery.
• Your doctor will prescribe a few antibiotics to reduce the risk of infection. 
• You may also have to take medicines for pain.
• You may be suggested to wear an elastic strap around your lower abdomen (pelvis area) to decrease the pain and stabilise the symphysis.
• Make sure to drink plenty of liquids to ensure a good flow of urine. 
• Avoid lifting heavy objects or performing strenuous exercises for at least three months after the surgery. 
• Avoid stretching your thighs for around three to six months.

The benefits of this surgery are as follows:

• No scars on the uterus 
• It is a life-saving surgery for breech babies 
• It reduces the chances of C-section

When to see the doctor?

Visit or call your doctor immediately if you experience the following symptoms after the surgery:

• Pain or difficulty in walking 
• Fever 
• Chills 
• Cough
• Feeling of warmth or redness on breasts 
• Vaginal discharge with a foul smell 
• Depression or suicidal thoughts
• The urge to harm your baby 
• Swelling, pain, or soreness in legs 
• Unbearable pain 
• Pain or burning during urination 
• Frequent urination 
• Cracking or bleeding from the nipple or the areola (the dark-coloured area around the nipple)

This surgery is known to carry the following risks:

• Injury to the bladder or urethra
• Bleeding 
• Unstable pelvis 
• Vesicovaginal fistula (formation of an opening between the urinary bladder and vagina)
• Osteomyelitis 
• Gait problems 
• Infection 
• Stress incontinence

You must visit the doctor if you have any discomfort or problem after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.