A medical textbook used in hospitals in Ireland in 1960 described women on their first pregnancy as a "dark and untried horse", the Court of Appeal has heard.
“This was 1960,” Emily Egan SC said on Wednesday.
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 alleges a symphysiotomy carried out on her in 1963 was unjustified, had said she could not skip, dance or ride a bicycle afterwards, counsel agreed.
The symphysiotomy was performed on the woman, then aged 24, in a Dublin hospital 12 days before her first baby was born. The procedure divides the cartilage of the pubic symphsis 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 and suffered lifelong consequences, including incontinence and depression.
The case is regarded as a test case for others suing over symphysiotomy. The hospital has cross-appealed a finding the case was not statute barred.
In the High Court last May, Mr Justice Kevin Cross found the practice in 1963 here of prophylactic symphysiotomy was not "without justification".
Core issue
A core issue in the appeal 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 vaginal delivery was not possible.
A second core issue is whether, if it was decided vaginal delivery could or should not be achieved, it was generally acceptable practice in Ireland in 1963 to carry out prophylactic symphysiotomy rather than a Caesarean Section.
In arguments, Ms Egan said there was evidence symphysiotomies were generally accepted practice in 1963 in the three Dublin maternity hospitals – the Rotunda, Coombe and National Maternity Hospital.
Between 1948 and 1965, 24 symphysiotomies were carried out at the Rotunda, 202 at the Coombe and 250 at the NMH. A small percentage of those were prophylactic symphysiotomies and there was “compelling” evidence this prophylactic symphysiotomy was not unjustified.
Due to lapse of time, there was no direct evidence from the doctors involved and it was very difficult to criticise a practice which is not contemporary without its proponents, she said.
There was evidence of real fears at the time of risks from multiple C Sections and of perceived “benign” effects of symphysiotomy compared with C-Sections. There were eight deaths per 1,000 at the three Dublin hospitals between 1950 and 1960 as a result of C-Sections, counsel said.
Ciarán Craven SC, 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, counsel 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 master of this hospital said in a 1955 report the procedure could be done in cases of mild to moderate pelvic disproportion, should not be “overdone”, he would not recommend it and the average patient should have a trial of labour.
On arguments symphysiotomy was motivated by concerns about risks to women from multiple C Sections, he said there was one maternal death in this hospital between 1955 and 1963 following a C-Section and it had returned “stunning” results in preventing maternal mortality.
Sterilisations were not illegal, but were not being carried out at the time, counsel added. Whether that reflected an “excess of Catholic zeal”, the self-imposed restrictions on which doctors seemed to operate should not be elevated to “a de facto legal position”.
The appeal continues on Thursday before the three judge court.
