If obstetricians in the National Maternity Hospital were standing over the use of a rectal examination while monitoring a pregnant woman's labour then, as a group, they were wrong, a British consultant obstetrician has told the High Court.
Dr Michael John Hare made the claim while being cross-examined on the sixth day of an action by the mother of a severely-disabled child who is suing the hospital, at Holles Street, Dublin, and a consultant obstetrician, Dr Joseph Stanley, for negligence in the circumstances of his birth.
The action has been brought by Blaise Gallagher (6), suing by his mother, Mrs Avril Gallagher, of Moneystown, Roundwood, Co Wicklow. The defence denies negligence.
Blaise was born at the hospital by Caesarean section on April 27th, 1992, during the 29th week of Mrs Gallagher's pregnancy. He suffers from cerebral palsy and is quadriplegic.
In court yesterday Mr Sean Ryan SC, for the hospital, said Dr Hare had been critical of the NMH use of rectal examination over vaginal examination in respect of Mrs Gallagher, and it would follow that, if the NMH's policy was rectal examination, then it was negligent.
If that was the NMH policy, then it was indeed negligent, Dr Hare said. In his view, no reasonable body of medical opinion would consider rectal examination.
Mr Ryan said the hospital would defend the practice of rectal examination as proper and reasonable.
It was not suggested the hospital's policy was that there must never be vaginal examination and that it must be rectal.
Dr Hare agreed that a pregnant woman with spontaneous rupture of the membrane might or might not exhibit signs of labour and would have to be examined several times.
Mr Ryan said it was considered there was an infection risk in such examinations, particularly vaginal examinations over rectal examinations. Dr Hare said that view had been discounted many years ago.
Mr Ryan said it was within the skill and expertise of a midwife conducting a rectal examination to examine for dilation of the cervix.
Dr Hare said that in his opinion sensitivity was not as great as when performing a vaginal examination. Within the limitation of the method, the more experienced the midwife the better the result.
Mr Ryan said Mrs Gallagher had originally been booked into another hospital, but the NMH's interest began when she came to it early on April 25th, 1992. She had been referred with a query relating to spontaneous rupture of the membrane.
Earlier, Dr Hare agreed with Mr Murray McGrath SC, for Dr Stanley, that the position of the baby's legs in the vagina had been a major complicating factor.
Mr McGrath said the evidence would be that another gynaecologist did the incision in the uterus and inserted his hand to extract the baby.
Counsel said Dr Stanley anticipated some difficulty because of the position of the legs. He went to the vagina and, using his hand, flexed the baby's knees and pushed upwards. The other doctor delivered the baby.
Dr Hare said it took five minutes from incision to delivery, and he would have expected that a skilled surgeon, working as quickly as he could, would take two minutes.
Mr McGrath said Dr Stanley would agree with the five-minute estimate but would say it could not have been done much quicker, except by perhaps 30 seconds or so. Dr Hare disagreed.
The hearing continues before Mr Justice Quirke.