Breda O’Brien: Why did so many women say they had symphysiotomies?

Sensationalist consensus may overlook one third of applicants who never had procedure

An established narrative is virtually impossible to shift. On Tuesday, November 22nd, Judge Maureen Harding Clark published a meticulously researched report on the ex gratia payment scheme for symphysiotomy. On Wednesday November 23rd, the RTÉ website published a report of an interview with Dr Peter Boylan on Today with Seán O'Rourke.

The website report of the show (not the show itself) says: “The symphysiotomy procedure involved cutting the pelvic bone to create more space during childbirth. Long-term effects for most women included impaired walking, chronic pain and incontinence.”

However, neither of those two statements are true. Symphysiotomy does not involve cutting the pelvic bone; that is a different procedure, called a pubiotomy. Symphysiotomy involves separating fibrous cartilage with a scalpel.

Nor does medical evidence support, according to Judge Harding Clark’s report, that symphysiotomy results in “impaired walking, chronic pain and incontinence” for “most women”.

The radio show itself was attempting to set the record straight. It is profoundly ironic that the report of the show perpetuates two of the most egregious myths.

Judge Harding Clark’s report makes for extremely disturbing reading. For example, many of the applicants use almost the same words in their accounts. The report contains two pages of phrases that recur again and again. It states that “there was a strong suspicion that symptoms described reflected the injuries complained of by the successful plaintiff in the High and Supreme Court judgments of Kearney v McQuillan”.

Describe in detail

The accounts by the women repeatedly said that they would never forget the sound of the saw, which some described in detail. “Some applicants recalled actually seeing the doctor taking out the saw which was sometimes described as a hacksaw or an electric saw or a saw with a wooden handle.”

Except that a saw is never used in symphysiotomy, and never has been. After numbing the area, scalpels are used to make an incision in the fibrous cartilage of the pelvis, which allows it to widen sufficiently to allow the baby to be born. A pubiotomy involves sawing of bones. Among the applicants, only one pubiotomy was verified, even though this procedure is the easiest to identify as X-rays provide irrefutable evidence. Accidental injury to bone can occur in symphysiotomy when an inexperienced doctor fails to incise correctly, but nothing comparable to pubiotomy and there would be no sound comparable to sawing.

Judge Harding Clark is clear that some women experienced great trauma, long-term injury and psychological damage.

But medical experts proved that a third of those who made applications, including some very vociferous and active campaigners, had never had the procedure at all.

Other applicants claimed to have had it in hospitals that were not yet built, or to have had it carried out by doctors who were not there, and “in several statements the applicant claimed being held down by nuns (in hospitals where there were no nuns) while she was being ‘assaulted’.”

It is eerily reminiscent of Nora Wall, who was accused, convicted and jailed for allegedly holding down a child while Paul McCabe raped a victim. Nora Wall was subsequently cleared of all wrongdoing, as was Paul McCabe. But reasons why such an utterly egregious miscarriage of justice were allowed to happen have never been properly investigated, and never will be.

Atmosphere

However, the atmosphere of the time fuelled by media made it plausible that a religious sister could do such a thing.

Similarly, the media ignored scholarly reports that challenged the narrative of innocent women brutalised by unfeeling medical people in thrall to the Catholic Church, even though symphysiotomies were also carried out in Protestant hospitals.

This is despite the fact that many of the women went on to have four or five normal births afterward. No journalist investigated how that could happen if they were destroyed for life.

Judge Harding Clark suggests that the possibility of financial payment had influenced “suggestible women and their family members into self- serving adoption and embracing of the experiences described by others or in the media and created psychosomatic conditions”.

The role played by the medical profession in this will not face serious scrutiny or censure. And as usual, the legal profession cleaned up, earning a total of €2,079,921.Will all this be discussed in our so-called post-truth society? I have great sympathy for elderly women who had traumatic births and were convinced a symphysiotomy was to blame, but what about much younger women who jumped on the bandwagon?

The cultural consensus now dictates that if someone identifies as something, even in this case as a victim of a procedure that they never had, to query their experience is akin to abusing them brutally.

I fear this has led us to where emotive narratives, like the one that was established about symphysiotomy, can never, ever, truly be dislodged once they have taken a hold on the public imagination. The dispassionate, impeccably researched truth will always lose out to the sensational and shrill alternative.