A GYNAECOLOGIST AND obstetrician has told a court he was “speechless” that a woman had a symphysiotomy carried out after a Caesarean.
Dr Peter Bowen-Simpkins made the comment before the court today when called as an expert witness in the case that the woman, who is retaining her anonymity, is taking against the Coombe hospital.
The case concluded today with an undisclosed settlement. It was brought by a woman who claimed there was no justification for the symphysiotomy that was performed on her in 1963.
The plaintiff released a statement this evening, saying:
I am a symphysiotomy survivor. I am glad it’s all over. I wish all survivors well. We can all learn from the past and move on.
She thanked her family and legal team, and Marie O’Connor of Survivors of Symphysiotomy.
Survivors of Symphysiotomy welcomed the settlement of the case after less than three days at hearing in the High Court.
Marie O’Connor, Chairperson of Survivors of Symphysiotomy, said:
“This settlement represents a signal victory for the plaintiff, her family, her legal team and our members.”
“With up to 200 such actions being taken by our members, Survivors of Symphysiotomy looks forward to a successful resolution of this issue, with judgements/settlements well in excess of the Government’s utterly inadequate scheme.”
Today’s outcome “vindicates those members who have maintained their legal actions” she added.
The case was before Justice Kevin Cross. The Coombe hospital denied all claims.
This is the first such case to be taken, but the group Survivors of Symphysiotomy are calling it a test case for women in these particular circumstances.
Opening the case this morning, the barrister for the defence raised concerns about evidence due to be given by expert Dr Peter Bowen-Simpkins.
Dr Bowen-Simpkins said he was a practising obstetrician from 1979 – 2004 and a gynaecologist from 1979 to the present day.
He was asked to read some obstetric charts before the court.
These included a letter of referral from Laois Co Hospital in 1962. Dr Bowen-Simpkins read out the letter, which said that it was the plaintiff’s first pregnancy, that she was of small stature and that she appeared to be clinically anaemic.
Dr Bowen-Simpkins said that anaemia was quite common in pregnancy.
Another piece of evidence was read out, dated 1963, which said that the woman was of small stature and also gave details of her blood group and that she was tested for syphilis, which Dr Bowen-Simpkins said is still done to all women in Europe and the US today.
The next entry said that the woman had a lower segment caesarean section, that a symphysiotomy was performed “on the way out”, and that there was a normal amount of bleeding.
The plaintiff was discharged on 25 June 1963 from hospital.
Dr Bowen-Simpkins said he had no criticism of the ceasarean section, calling it a “sensible decision”.
Asked about the symphysiotomy being carried out on a woman when the baby has been delivered by Caesarean section, he said: “I am speechless.”
Dr Bowen-Simpkins said that it seemed to be “most unjustifiable” to him and based on “conjecture”.
How a symphysiotomy works
A model of a pelvis and a baby were brought into the court to assist Dr Bowen-Simpkins in giving his evidence. Using that, he demonstrated the bony structure of the pelvis for the court, and how a symphysiotomy worked.
He told the court that to undertake a symphysiotomy, a scalpel or fixed blade was used, as if it wasn’t fixed then the blade could break.
A woman’s legs might be supported during the procedure, as they were not to be kept at more than 80 degrees or “damage” might occur.
Dr Bowen-Simpkins described what happened to the pelvis bone during a symphysiotomy:
Like opening a French window, or double doors. It just opens up the pelvis.
Later, he used the model to describe the different positions that a baby might lie in the womb, such as breech, and how this can affect the birth. He talked the court through the options for turning a baby in the womb, whether manually or through ventouse or forceps.
The issue of whether the woman had a contracted pelvis was also brought up in court. Her ‘contracted pelvis’ was referred to in a discharge letter after the birth.
Dr Bowen-Simpkins also told the court about about a condition called cephalopelvic disproportion (CPD) which he said can only be diagnosed if the baby and pelvis meet, that is: “when the woman is in labour”.
He agreed that this was diagnosed in the 1960s by clinical exam and x-ray.
Asked if in the case of a breech baby it was possible to diagnose CPD, he said “no, absolutely not”.
Dr Bowen-Simpkins was then questioned by the barrister for the plaintiff, with much of the discussion centring on the context of the time in 1960s Ireland when the symphysiotomy was carried out.