Court rejects woman’s appeal over ‘unjustified’ symphysiotomy

A woman’s claim there was “no justification whatsoever” for a symphysiotomy carried out on her in a Dublin maternity hospital in 1963, has been unanimously rejected by the Court of Appeal.

The procedure on the woman, who was 24 at the time, took place 12 days before her first baby was born.

Now aged 77, the woman was in court with supporters and clearly upset by the outcome.

Hers is regarded as a test case for about 30 other actions over symphysiotomies but the court stressed each must be decided on its own particular circumstances.

While another woman obtained €350,000 damages over a symphysiotomy, that case was very different as the baby was delivered before the symphysiotomy was performed and there was an absence of indications justifying the procedure, Ms Justice Mary Irvine said.

In this case, clinicians believed there was a “high probability” of obstructed labour and the symphysiotomy was peformed to avoid that.

Legal sources believe the judgment will have adverse implications for similar cases concerning the procedure, carried out rarely from the mid 1940s to mid 1960s in the three Dublin maternity hospitals to address “disproportion” (where the baby is considered likely to be too big to pass through the mother’s pelvis).

Symphysiotomy was sometimes performed to address disproportion rather than a Caesarean section. It involved partly cutting fibres joining the pubic bones to increase pelvic capacity with a view to facilitating vaginal delivery.

The woman claimed her antenatal symphysiotomy, done without a trial of labour, was done without her knowledge, was unjustified and she suffered lifelong consequences, including incontinence, back pain and mental health difficulties.

The High Court accepted she suffered physical and psychological difficulties caused or contributed to by the symphysiotomy but rejected her claim it was done without any justification.

Dismissing her appeal, Ms Justice Irvine, with whom Mr Justice Michael Peart and Mr Justice Michael Hanna agreed, said this type of symphysiotomy has long since been abandoned “for good reason”. Assessed by present day standards and where women here can better control their own fertility, it would be considered “inherently defective”.

The “mechanics of labour” were not as well understood in 1963 as now but even by the late 1960s, there was much greater understanding about a mother’s ability to deliver a baby which appeared disproportionately large for her pelvis.

By 1963 standards, and the woman’s “very particular” circumstances, there was credible evidence she had not established this symphysiotomy could never, in any circumstances, have been justified.

There was evidence a “reasonable and respectable” body of clinicians of like expertise to the hospital master who performed the symphysiotomy would have approved of his decision and no evidence of deviation from a “general and approved” practice.

She dismissed the woman’s case disproportion could not have been diagnosed without trying labour. In the rare case where it was considered that providing more room within the pelvis - achieved by symphysiotomy - would allow the baby be delivered vaginally, the procedure “would have met with general approval”, she also found.

Symphysiotomy was considered in 1963 as a “relatively benign” procedure with no significant adverse consequences for mothers and “significant benefits” for mother and baby. It was seen as rendering a mother capable of vaginal delivery thus protecting her from mortality and other risks attached to Caesarean section, the likely alternative intervention for obstructed labour.

While evidence showed just one maternal death due to a section at this hospital between 1957-63, there was evidence sections, and particularly repeat ones, carried a “not insignificant” risk of mortality.

While antenatal symphysiotomoy was not universally approved of in the decade preceding 1963, even some critics advised it had benefits, she said.

With passage of time, advances in medical knowledge and greater follow up of patients who had symphysiotomies, those views “have long since been abandoned if not discredited”.

The court also granted the hospital’s cross-appeal against the High Court finding the two year time limit for bringing the case had expired. Costs issues will be decided later.