It has been described in unforgettable terms as a barbaric procedure which opened up a woman like a hinge during childbirth. "Midwifery of darker times," was the view of one leading British obstetrician.
However, far from being a Dark Ages practice, it was performed frequently in some of this country's leading maternity hospitals until the 1980s. Symphysiotomy, as it is called, consists of permanently widening a woman's pelvis during childbirth by slicing through the cartilage joining the pubic bones.
The Human Rights Commission has now begun a preliminary investigation of the practice with a view to establishing whether it fits its criteria for a full inquiry. So far, the efforts of the survivors of the procedure to get at the truth of what happened to them have been largely ignored by the State.
Hundreds of Irish women were operated on in this way from the 1940s. About 200 remain alive today, and life-long side effects include difficulty in walking, severe back pain and persistent incontinence.
Most were not told of the procedure at the time of their operations, and never knew the reasons for their chronic health problems. It is clear that the practice had been internationally discredited long before it was discarded in this country, and fundamental questions remain as to why women were made to suffer so unnecessarily in this way.
After questions were raised in the Dáil in 2003, the Government promised an investigation by an independent expert. This never materialised, and remains a broken promise.
The huge concern surrounding the symphysiotomy procedure is that it may have been carried out primarily for religious rather than medical reasons. A number of prominent obstetricians had lauded the procedure during the 1950s as an alternative to Caesarean section, not because the latter was unsafe, but because the risks associated with future deliveries after a Caesarean might lead women to use artificial contraception, which was of course contrary to Catholic teaching. The group of women concerned were dealt a serious blow last year when the High Court dismissed the case of Olivia Kearney. Hers was the first symphysiotomy action to come before the courts.
In 1969, at the age of 18, her baby was born by Caesarean section at the Lourdes hospital in Drogheda. Her obstetrician, Dr Gerard Connolly, then carried out a symphysiotomy on her. According to evidence presented by both herself and her GP, neither was informed that she had undergone this procedure. She only discovered it when she sought and obtained her medical records from the hospital in 2002.
Dr Connolly, as head of the maternity unit at the Lourdes hospital, had presided over a total of 348 symphysiotomies at the hospital between the early 1950s and 1982, when he retired and the practice terminated abruptly. He had been employed at the hospital as an obstetrician a bare five years after graduation, and without any of the usual post-graduate obstetric qualifications. He was described as a deeply religious man, "revered" by the nuns who ran the hospital. He maintained the practice of symphysiotomy for decades after even the main Dublin Catholic maternity hospitals had abandoned it.
Ms Kearney had sued the Medical Missionaries of Mary, who owned the hospital until 1997. They sought to have her action struck out on the basis that there was an inexcusable delay in bringing it before the courts, which was such as to severely prejudice their right to a fair hearing. Ms Justice Anne Dunne ruled in their favour and against Ms Kearney.
During the hearing, the nuns had denied everything, even that a symphysiotomy had taken place. Ms Justice Dunne, however, found to the contrary. She further stated that "it would be no exaggeration to say that she [Olivia Kearney] has been left with a legacy of problems including pain, which could not but have had a significant adverse effect on many aspects of her life." The judge also expressed "the utmost sympathy for the plight in which she now finds herself."
Nonetheless, given that Dr Connolly was deceased, as were many of the other staff members involved in Olivia Kearney's care, the judge ruled that it would be unjust to ask the nuns to defend themselves in court. She consequently dismissed the case against them.
The issue of how to deal with people injured as a result of actions which took place in the past remains a difficult one. The judgment above is very in keeping with the courts' view that distance of time can prejudice a fair hearing. A number of cases, including some against disgraced obstetrician Michael Neary, were thrown out on similar grounds.
It is now clear that a political rather than a legal solution should be found in these cases. It is right and proper that the Government acknowledged the damage done to the victims of Michael Neary by establishing both a full inquiry and a compensation scheme.
The victims of symphysiotomy deserve no less.