‘Women on first pregnancy seen as untried horses’

A medical textbook used in Irish hospitals in 1960 described women on their first pregnancy as a “dark and untried horse”, the Court of Appeal has heard.

“This was 1960,” said counsel Emily Egan. Another textbook referred to an article featuring “charming” photographs of women in Africa “skipping” after undergoing symphysiotomies, she said.

A 76-year-old woman who claimed a symphysiotomy carried out on her in 1963 had been unjustified, said she could not skip, dance, or ride a bicycle afterwards, Ms Egan agreed.

She was making arguments for a Dublin hospital where the symphysiotomy was performed on the woman, then aged 24, 12 days before her first baby was born.

The procedure divides the cartilage of the pubic symphysis to facilitate easier delivery.

The prophylactic symphysiotomy was the only one performed in the hospital that year. Prophylactic symphysiotomy is done without trying labour on the basis of a view vaginal delivery is not reasonably possible.

The hospital is opposing the woman’s appeal against the High Court’s rejection of her claim the procedure was unjustified. She said she felt “split in two” afterwards.

In the High Court last May, Mr Justice Kevin Cross found the practice in 1963 here of prophylactic symphysiotomy was not “without justification”.

A core issue is whether doctors were entitled, without first trying labour, to decide there was such disproportion between the size of the woman’s pelvis and the baby’s head that vaginal delivery was not possible.

A second core issue was whether, if it was decided vaginal delivery could or should not be achieved, it was generally acceptable practise in 1963 to carry out prophylactic symphysiotomy rather than a Caesarean section.

Ms Egan said there was evidence symphysiotomies were generally accepted practice in 1963 in the three Dublin maternity hospitals. Between 1948 and 1965, 24 symphysiotomies were carried out at the Rotunda, 202 at the Coombe, and 250 at the National Maternity Hospital. A small percentage of those were prophylactic symphysiotomies and there was “compelling” evidence this prophylactic symphysiotomy was not unjustified.

Ciaran Craven, for the woman, said there was a “world of difference” between symphysiotomy done before and during labour.

He was not addressing these issues through a 2016 “prism” because fundamental flaws in the procedure were identified in 1955, he argued. The fact none of the doctors are still here did not mean the court could not address the issues.

Writings of the doctors and other contemporaneous material showed a “very blunt” debate on symphysiotomy in Ireland at the time and the fact masters of the three Dublin hospitals would supervise this procedure did not elevate it to the level of a generally approved practice.

The appeal continues.