Symphysiotomy should never have been carried out, Supreme Court finds

A 60-YEAR-OLD woman wept at the Supreme Court yesterday after it upheld a High Court finding that a symphysiotomy procedure carried out on her just after she had her only baby at age 18 was “entirely unjustified” and “deeply flawed”.

The five-judge court said the procedure should never have been carried out on Olivia Kearney in 1969 when she was unconscious and anaesthetised, but reduced the general damages awarded to her by Mr Justice Sean Ryan from €450,000 to €325,000.

It did so after finding the injuries suffered, while very serious, were not of a scale to justify an award at the highest scale of general damages. That finding did not reflect in any way on Ms Kearney’s “understated” testimony on what she suffered, the court stressed.

The “entire fault” for what happened to her lay with the obstetrician who carried out the procedure, the late Dr Gerard Connolly, “and no one else”, it ruled.

The procedure “was wrong, even by the standards of the time” and there was “no rationale for it”, said Mr Justice John MacMenamin, with whose judgment the other judges agreed. It was “unfathomable” by today’s standards and even by those of 1969 had “no justification whatever”.

Ms Kearney, Castlebellingham, Co Louth, wept as the findings were outlined and said afterwards she was “delighted” with the Supreme and High Court outcomes. Her case that she was subjected to “a wholly unnecessary and unjustified symphysiotomy following the already safe delivery of my only child” had been “fully vindicated” and, while the physical pain continued, she was looking to get on with the rest of her life.

“This was never about the money,” she said. “The vindication is the most important thing.”

Ms Kearney’s son was delivered by Caesarean section at Our Lady of Lourdes Hospital in Drogheda on October 19th, 1969. The symphysiotomy was carried out afterwards. A procedure dating back to the 18th century to enlarge the pelvis, it left her in such a condition that she could not get out of bed to see the baby until six days later, when she was taken in a wheelchair to see him.

She did not know she had had a symphysiotomy until nearly 33 years later in 2002, when she heard a radio discussion in which women described their experiences following such operations.

As a result of the procedure, Ms Kearney suffered profound ongoing pain and later suffered continuous back pain, incontinence and depression. Before the radio broadcast she had thought she was “going mad”, not knowing why she had pain. After she learned what had happened and read her medical file, she experienced profound shock.

She had hoped for a large family but, after the procedure, could not bear the prospect of future pregnancies.

Mr Justice MacMenamin yesterday delivered the Supreme Court’s judgment which unanimously rejected the appeal by the Medical Missionaries of Mary, as owner of the Lourdes Hospital in 1969, against the High Court finding that it was liable for the injuries suffered, but agreed to reduce the amount of damages.

He rejected the defendant’s argument that it was not liable on grounds the procedure was medically and ethically justified at the time by reference to the thinking of clinicians who shared Dr Connolly’s views on symphysiotomy.

Symphysiotomy was first developed in the 18th century to deal with a situation where the baby’s head was too large to pass through the mother’s pelvis to allow birth, he noted. Its popularity waned in the early 19th century but interest in it was later revived in some quarters, including some Irish hospitals. Dr Connolly was “a strong adherent” of a school of thinking among some obstetricians whose views held sway in some Dublin teaching hospitals and other maternity units, including the Lourdes Hospital, which observed a Roman Catholic ethos.

Their view was that a risk of disproportion between a baby’s head and the mother’s pelvis during a pregnancy could lead to a woman considering Caesarean sections in later pregnancies. As this would lead after multiple pregnancies to repeated incisions and scars, they were concerned women might consider artificial contraception.

Evidence was given to the High Court that the procedure ceased to be used in the National Maternity Hospital in the mid-1960s and in Drogheda by 1971. It was “entirely unwarranted”, “lacked any objective medical basis” and was “deeply and fundamentally flawed”, he said.