Symphysiotomy involved cutting the cartilege joining the two parts of the pelvis. It had largely been abandoned in the twentieth century owing to its perceived dangers; Caesarean section (CS) was preferred. The after-effects of symphysiotomy included bladder injuries and impaired locomotion. By the 1940s, surgical advances and the advent of antibiotics had made lower-section CS the operation of choice in the developed world for cases of disproportion and obstructed birth. Symphysiotomy was countenanced only in rare emergencies in which CS was not feasible. Dr Alex Spain, who pioneered the symphysiotomy revival, described it as ‘an entirely new procedure to me and one that has to be faced against the weight of the entire English-speaking obstetrical world’.