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Column Don’t just blame the Catholic Church for symphysiotomies – blame the doctors

Catholic fundamentalism goes some way towards explaining the mid-set of obstetricians who performed the barbaric surgery, but it is not the entire story, writes Ruadhán Mac Aodháin.

OVER THE PAST seven days, the campaign for justice for survivors of symphysiotomy made national news as the Survivors of Symphysiotomy organisation and their members went on television, radio and appeared before the Oireachtas to tell their stories.

Unquestionably, Theresa Devoy’s account on Tonight with Vincent Browne last Tuesday evening of her abuse at the hands of medical practitioners in St Luke’s Hospital Kilkenny captured the public’s attention. Theresa’s story brought home the true horrors of this barbaric and destructive operation whereby she was allowed to remain in labour for four days, begged to see a doctor, ignored, finally operated upon and awoke, unable to move.

Symphysiotomy is a childbirth operation that severs one of the main pelvic joints, sundering the pubic bones and unhinging the pelvis. The operation never succeeded in gaining acceptance from the medical profession and was seen as a surgery of last resort, to be done only in an emergency. By the 1920s in England, Caesarean section was well established as the norm for difficult births; and by the end of the 1930s, Irish obstetricians had caught up with their English colleagues––and the rest of the world–– in this area of practice.

The National Maternity Hospital revived symphysiotomy in 1944, and the surgery quickly spread to the Coombe. The operation bordered on clandestine, with no information given to patients before or after surgery. No case of informed consent exists. Control of women’s reproductive health appeared to be the goal: obstetricians were hostile to family planning for ideological reasons.

Believing that repeat C-sections would inevitably lead to women to opt for fewer children, obstetricians arbitrarily revived this mutilating surgery without any concern, seemingly, for the damage wrought by the operation on their patients, damage amply described in the medical literature. The injuries sustained vary, but most of the women were left with truly horrific injuries, including life-long pain, walking difficulties and incontinence.

Symphysiotomy continued long after the Church’s influence had diminished

Much has been written in the media about symphysiotomy, its consequences for survivors, and, most of all, the role played by Catholic ideology and the Church in this particular institutional abuse. While Catholic fundamentalism goes some way towards explaining the mind-set of obstetricians, it is not the entire story.

The practice of performing symphysiotomy without consent continued until the late 1980s, a long time after the Church’s influence had diminished. Survivor testimony strongly suggests that hospitals, such as our Lady of Lourdes in Drogheda, performed this brutal procedure for training purposes. Irish hospitals, such as the National Maternity Hospital, had sought to establish themselves internationally as medical training centres since the 1940s. For hospitals, such as the Lourdes, bent on perfecting the surgery for missionary hospitals and clinics in Africa and elsewhere, symphysiotomy was a triple whammy, offering clinical material – patients’ bodies – for experimentation and training, as well as ensuring women would not have to address the issue of birth control.

The fact that doctors there continued to perform symphysiotomies on young mothers covertly right into the 1980s, ignoring the destructive effects of the surgery and exercising this policy of pelvis cutting without consent, in the full knowledge that C-sections were the obstetrical norm for difficult births, beggars belief.

The many failures of the Walsh Report

Members of the Survivors of Symphysiotomy campaign group outside the Oireachtas last week. (Photo: Sasko Lazarov/Photocall Ireland)

Issues such as medical training, obstetric power and regulatory failure, which are at the heart of the history of symphysiotomy, have been largely ignored in the recently leaked Walsh Report. The Walsh Report, commissioned by the Department of Health without reference to survivors of symphysiotomy, has effectively sought to justify the procedure in 95 per cent of cases, and blame the Catholic Church for the others, those done in the aftermath of Caesarean section.

There are many false conclusions reached in this most defective and distorted work. Firstly, the claim that symphysiotomy was carried out in emergencies is inaccurate and untrue. It is clear from patient records, theatre reports and the accounts of survivors themselves that symphysiotomy was an elective and planned operation. If the author, Oonagh Walsh, had factored survivors into her study, she would have been unable to reach this wrong conclusion. Instead of interviewing 150 key witnesses (survivors), the author selected data derived from proponents of this destructive surgical practice.

Conveniently, the Walsh Report blames Catholic law, claiming that obstetricians carried out the operation to avoid the supposed dangers of repeat C-sections that were alleged to be unavoidable due to the non-availability of contraceptives.This argument is as defective as it is tortuous. Repeat C-sections were practised from the 1940s onwards by other doctors in Ireland, as in other countries, without difficulty; and family size was falling by then, with or without the aid of contraceptives. More fundamentally, as underlined in Kearney v McQuillan, and contrary to what the Walsh Report implies, the issue of family planning was for the mother, not the doctor, to decide.

The Walsh Report fundamentally fails to address the core issue of patient consent, which was neither sought nor given. The carrying out of surgery without consent has been unlawful for over one hundred years. A doctor who performs an act of surgery without consent commits an assault, for which he is liable in damages. The right to determine what shall be done with one’s body is a fundamental right. Patients were denied their right to refuse surgery: these operations were therefore illegal. They also breached women’s constitutional and human rights.

Why the statute of limitations should be lifted for the survivors

The findings of the Walsh report lie four-square with the myths that have been spun about symphysiotomy since 1999 by the Department of Health,which has allowed itself to be captured by the Institute of Obstetricians and Gynaecologists on this issue. For over a decade, the two bodies have denied, delayed and obfuscated, stymying survivors’ campaign for truth and justice. Successive Ministers for Health have refused to initiate an independent inquiry, while the Institute of Obstetricians has issued statements which included the benefits of symphysiotomy.

Last Wednesday Survivors of Symphysiotomy (SoS) met the Oireachtas Committee on Justice, looking for the statute of limitations to be lifted to gain access to the courts. For many survivors, the justice system administered by our courts is their only option if they wish to hold their abusers to account.

The primary obstacle facing survivors in accessing our courts are time-based procedural issues under the statute of limitations and arguments around delay. An inherent defect in our legal system is the absence of discretion in cases, such as these, where justice demands that plaintiffs be allowed to bypass the statute of limitations. This is particularly problematic for victims of institutional abuse, who may be unable to to come to terms with it within the time frame demanded by statute. The Oireachtas temporarily lifted the statute of limitations in 2000 to allow child abuse victims in residential institutions to initiate legal actions. SoS is now seeking the same legislative intervention.

As the Department of Health has signally failed these women, it is up to our TDs and Senators to to take responsibility. Further delay in this matter is unthinkable, given the advanced age of most survivors. If the Oireachtas implements this relatively simple legislation to amend the statute and allow these women access to our courts, the truth of this ghastly chapter in the history of institutional abuse in Ireland may yet be told.

Ruadhán Mac Aodháin is a practising barrister and adviser to Survivors of Symphysiotomy. Ruadhán has acted in a number of major constitutional cases including Pearse Doherty’s successful by-election challenge against the Government of Ireland in 2010 and most recently the Referendum Commission case.

Read the draft Walsh report in full here >

Column: Symphysiotomy was seen as a gateway to childbearing without limits >

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