Judge rejects woman’s claim symphysiotomy was unjustified

A High Court judge has rejected a claim by a 74-year old woman that an unjustified symphysiotomy was performed on her 12 days before the birth of her first baby at a Dublin hospital in 1963.

The case was regarded as a test case for those suing over symphysiotomies, a procedure which involved the breaking of the pelvis.

The woman, who asked to remain anonymous, was in court today with dozens of supporters when Mr Justice Kevin Cross dismissed her claim, heard over 15 days. Costs of the case will be decided later.

The woman claimed she suffered lifelong pain following the procedure and could not bond with her baby daughter after the birth because she was in such pain she could not even lift the child out of her cot. She said she felt very disillusioned, later had a nervous breakdown and “took to her bed” for a time.

In her action, the woman alleged she had a non-emergency symphysiotomy which left her with life long pain, incontinence and restricted mobility.

In his judgment,Mr Justice Cross said there was no doubt the procedure would not be carried out today or on any date after the introduction of "active management of labour" from the mid 1960s by the new master of the National Maternity Hospital.

This “remarkable” woman has suffered throughout her life as a result of the effects of this operation, the judge said.

He said he was not making any general observations about the effects of symphysiotomies on patients and was aware there is “still a limited place for symphysiotomies” especially in countries with limited hospital facilities and where mothers have great distances to travel. He also accepted that claims that symphysiotomies produce generally significant adverse effects on mothers “is hotly in dispute”.

In this case, this woman, whether as a result of the timing of the symphysiotomy or otherwise did suffer, and continued to suffer the consequences throughout her life, he said.

He accepted medical practice develops and that every procedure, now common place, must once have been “unprecedented” and may well have been very controversial.

The judge said he had concluded that, in Dublin maternity hospitals in 1963, it was accepted that trial of labour was not always required for a consultant to conclude a vaginal delivery would not be possible and that, in those cases, prophylactic symphysiotomy, as was performed in this case, was “a reasonable, though limited” option.

In this case, hospital notes and other factors convinced the treating doctors a vaginal delivery would not be possible and a symphysiotomy was performed which, at the time, they had reason to believe was not generally adverse in its effect on the mother and it was safer as far as the child was concerned, the judge said.

He had also concluded, given the “real fears” of multiple caesarean sections and the perceived benign effects of symphysiotomy, and also given the widespread acceptance of this practice among leading consultants in certain Dublin maternity hospitals, that this plaintiff had not established this practice was one with such inherent defects that ought to have been obvious to any person giving the matter due consideration.

There was also no evidence of any peer criticism of the plaintiff’s procedure, he added.

The judge ruled the practice of prophylactic symphysiotomy in 1963 “was not a practice without justification” and the strength of the defence was such it was impossible to conclude the woman had proved her case.

The fact the procedure was carried out 12 days before the birth may have been causative of some of her injuries but the time delay of itself was not a factor that could be added to the case to establish liability, he found.

In the circumstances, he must conclude “this remarkable lady, whose story indeed deserves to be told”, must fail in her case.