Woman (76) appeals symphysiotomy ruling

An appeal over the rejection of a woman’s claim that an unjustified symphysiotomy was performed on her in a Dublin hospital in 1963, days before her first baby was born, has opened at the Court of Appeal.

The appeal by the 76-year-old is seen as a test case for actions over symphysiotomy, a procedure involving breaking the pelvis to facilitate easier delivery during birth.

Her counsel, Ciaran Craven SC, disputed there was adequate evidence in this case of such disproportion between the size of the woman’s pelvis and the baby’s head to justify the medical view it was inappropriate to try labour before proceeding to symphysiotomy.

He said the evidence did not establish symphysiotomy was a “generally approved” practice in 1963 and did not support the courts being “sanguine” about the effects of the procedure.

Emily Egan SC, for the hospital, argued a 1963 practice cannot be viewed “through 2016 spectacles” and the evidence was this symphysiotomy arose from a medical view that vaginal delivery was not possible.

If the three Dublin teaching hospitals were practising this procedure on a limited basis in 1963, that was evidence of a reputable body of opinion practising it, she said.

The procedure was not embraced with “unbridled enthusiasm” and was thought appropriate only in rare and exceptional circumstances, she said.

Adverse effects

In her action, the woman claimed an unjustified symphysiotomy was performed when the hospital incorrectly believed she was 12 days overdue on her first baby.

She said she felt “split in two” afterwards and has suffered lifelong pain, incontinence and depression as a result.

The hospital denied the claims and disputed the procedure results in significant adverse effects.

In the High Court last May, Mr Justice Kevin Cross found the practice in 1963 of prophylactic symphysiotomy - performed without any trial of labour based on a view that normal delivery would not be reasonably possible - "was not a practice without justification".

He found the procedure had adverse effects on the woman, including mental health consequences, but accepted it was “hotly disputed” the procedure generally caused adverse effects.

The appeal, before Mr Justice Michael Peart, Ms Justice Mary Irvine and Mr Justice Michael Hanna, is expected to conclude on Wednesday.