Are victims of Symphysiotomy being ignored?

Survivors of Symphysiotomy- Photo Credit- Demotix
Holly Lenny investigates symphysiotomy in Ireland to uncover why compensation for its victims is being delayed as many die without justice, allowing the State to win the battle.


A Symphysiotomy procedure- Photo Credit- Embryology
A Symphysiotomy procedure- Photo Credit- Embryology

Ireland does not exactly have an ideal track record when it comes to women’s rights, especially reproductive rights. In the past four years, there have been many issues brought to light whereby women have suffered life-altering abuse at the hands of the Irish State.

Women, who involuntarily underwent a procedure called symphysiotomy, are the latest victims who are currently attempting their fight for justice. The goal is that the Irish Government acknowledges and takes responsibly for what unjustly happened to these women.

Symphysiotomy is a procedure that is undertaken during childbirth to increase the size of a woman’s pelvis up to 3.5 centimetres to allow a natural birth. During the procedure the cartilage where the pubic bone fuses is separated, creating the necessary space for the baby’s head to pass through the birth canal.

Improvements to delivery methods changed in the 20th century in the West and the Caesarean section was preferred in comparison to symphysiotomy, as it was deemed a safer method of delivery if complications transpired. It was only in Sub-Saharan Africa that symphysiotomy was a credited procedure due to poor sanitation and access to medical care.

However, in Catholic countries, especially Ireland, symphysiotomy continued to be practised and according to the Walsh Report, up until 1992 many times, due to the ban on contraceptives and sterilisation. Professor Oonagh Walsh, a Senior Research Fellow in Medical History at University College Cork, was commissioned by the Chief Medical Officer in the Department of Health to draft a report on the practice of symphysiotomy in Ireland.

It was two-part report, submitted in May 2013. In the Walsh Report it stated that many of the symphysiotomy procedures were “medically acceptable”.

Of the documented 1,500 women who underwent symphysiotomy, many were unaware that it was actually carried out on them by their doctor. Right up to the 1980s, a Caesarean section was carried out followed by a symphysiotomy, which according to doctors makes no medical sense.

In 1956 John Chasser Moir, the Professor for Obstetrics and Gynecology in Oxford, questioned why “such wanton wastage of human life is a thing to be condoned or explained away in the name of religion?” In regard to symphysiotomy being used in the United Kingdom, he stated it would never be used as common practice again.

Contrastingly, Professor Kenneth Björklund, of the Karolinska Institute in Sweden, has a different view in regard to his research on symphysiotomy. “If valid conclusions can be drawn from 100 years of retrospective studies, there is considerable evidence to support a reinstatement of symphysiotomy in the obstetric arsenal, for the benefit of women in obstructed labour and their offspring.”

In 2011, solicitor Ernest Cantillon and his team represented an Irish woman in the High Court, Dublin. In July 2006 the woman gave birth to her son but during the birth he suffered shoulder dystocia and became trapped in the birth canal. Although the doctors previously knew this would occur and a Caesarean section should have taken place, they allowed the natural birth. A symphysiotomy took place and as a result left the mother in a critical position and led to her son being born with cerebral palsy.

Even though the HSE denied outright liability, they fought the case and lost. The HSE admitted full responsibility and the boy was awarded a six-figure sum.

The side effects of symphysiotomy have been devastating for its victims: incontinence, bowel complications, severe pain, depression, and difficulty walking, are just a few. In a Prime Time documentary by Paul Maguire in February 2010, victims and gynaecologists highlighted the reality of symphysiotomy. Matilda Behan, who gave birth in Holles Street Maternity Hospital, Dublin, described the surgery: “It was like someone was sawing a board. It was nearly a year before I could walk properly.” She was left “totally incontinent” from the day she had the operation.

Olivia Kearney is another Irish victim of symphysiotomy who received compensation for what was done to her, yet it was cut from €450,000 to €325,000 in the Supreme Court. In April 2013, Sinn Féin Health spokesperson Caoimhghín Ó Caoláin introduced a private member’s bill that would lift the Statute of Limitations for victims of symphysiotomy for only one year.

Only seven months later, in November 2013, the decision was repealed and James Reilly, the Minister for Health, appointed Judge Yvonne Murphy to implement an ex-gratia redress scheme. This meant compensation would be given although recognition of any liability would be ignored, often seen as a less successful route than formal litigation. On the petition website of Survivors of Symphysiotomy, they stated: “The Irish Government is now shamefully bent on shafting these survivors, under the disguise of ‘redress’ – still refusing to lift an unfair Statute of Limitations that blocks some survivors from accessing the courts.”

An ex-gratia scheme would be somewhat similar to that of the victims of the Magdalene Laundries, compensation received but no responsibility taken by the Irish Government for what these women endured. Solicitor Ernest Cantillon said: “It is offensive at this stage that the State does not have the good grace to give them a legally enforceable right to seek compensation in a fair amount to be determined by the courts.”

Many of the hospitals that symphysiotomy was carried out in are private hospitals and there is no guarantee they will contribute to such a scheme. Clare Daly, a TD with the United Left Alliance, believes that ”women are entitled to have a full declaration that this practice was not best practice at the time, that the medical profession should have known and that they are entitled to full compensation for the butchery that they have experienced, not some sort of redress board, whereby the responsibility of the medical establishment is minimised”.

Survivors of Symphysiotomy- Photo Credit- Demotix
Survivors of Symphysiotomy- Photo Credit- Demotix

The simple question everyone wants answered is why the delay for these women. Ernest Cantillon said the Government “felt it might leave them open to a claim that there was an unlawfully favouring of one group of victims over another. I think such a claim would likely fail, but I think this was the worry. There was also a fear that it might create a precedent that would be shoved in their face as it were by the next group of victims who were experiencing Statute of Limitations difficulties.”

Survivors of Symphysiotomy and Patient Focus are two organisations helping victims fight for justice. Bridget Dorothy from Patient Focus said: “These women were damaged without consent. We are here to support and give advice to women, not to do the decision making.”

As the delays continue with Judge Murphy’s deliberations, the urgency to address the issue becomes ever more important because for many of the victims time is no longer on their side. “When these women die, their fight for justice and compensation dies with them,” said Bridget Dorothy. Ernest Cantwell agreed. “Yes. Under current law, except for Hepatitis C victims, claims for general damages die with the death of a victim.”

Clare Daly said: “I don’t believe symphysiotomy is being addressed correctly in Ireland.” Not only are mistakes in the past being swept under the carpet but in the present too. “Ireland is not as safe as they would make out and in fact within the overall figures there is a disproportionate amount of non-Irish born women who suffer fatalities in childbirth which needs to be investigated.”

There is always the concern about the ratio of men to women involved in this case that prompts the question, is it a reason for this issue not being taken seriously enough. Clare Daly responded: “Possibly, although I think it is an issue of economics rather then gender. The health service is being monopolised by vested interest at the top of the medical profession, to the detriment of all individuals, men and woman.”

Ernest Cantillon felt the same. “I think it is a case of a Government trying, in a bumbling way, to get a victims’ group off their back. Instead of doing so in a generous way, they are penny pinching and doing more harm.”

As the years pass and these victims age well into their seventies and eighties, the figures of the deceased are rising, allowing the Government to buy itself more time. There are supposedly around 300 survivors of symphysiotomy but according to Bridget Dorothy from Patient Focus, “every now and then we get a phone call from a family member to say someone has died”.

As time goes on there are still no sufficient answers and, as stated by Ernest Cantillon: “The problem is they have no rights. Whatever rights they had have been taken from them by the Statute of Limitations.”

Judge Yvonne Murphy is due to deliver her deliberations in March 2014. Only time will tell whether lady justice’s scales will deliver a legitimate and fair verdict.

Under the Irish Constitution, entitlement to fair procedures is a right of an Irish citizen. “The person making the decision that affects you should not be biased or appear to be biased. You must be given an adequate opportunity to present your case. You must be informed of the matter and you must be given a chance to comment on the material put forward by the other side.”

These victims of symphysiotomy are being silenced as their numbers dwindle, with for many their dying wish for justice going unheard.

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