RTE "Prime Time Special" on Symphysiotomy, 18 February 2010
SEANAD REPORT: Extract from Irish Times article 25 February 2010 by Jimmy Walsh
Describing symphysiotomy as cruel and barbarous, David Norris (Ind) said he had been shocked to hear its use had been motivated by sectarian religious impulses. The practice had been ignored by the professional body. “Now we are sending it back to them. They are not fit to be charged with this [inquiry].” There should be a fully independent inquiry.
Speaking on the proposal for a constitutional amendment on children’s rights, Minister for Children Barry Andrews said attention had been drawn to the newly proposed article 42.4. “Some have suggested that any reduction in the threshold that allows for State intervention in the family should be resisted. This is construed as an attack on the integrity of the family . . . This was not the intention . . . The newly proposed 42.4 sets a new threshold, based on proportionality.”
The debate on the amendment would not be helped by the sensationalist approach of John Waters, Ciarán Cannon (FG) said. Waters recently wrote that the only equality provided by the amendment would be the equal right of all parents to have their children snatched by the State.
Alex White (Lab) said Waters’s contention was absurd.
Childbirth Operation Inquiry
Irish Times, Letters Feb 23, 2010
A strikingly uncritical review (Weekend Review, February 20th) of RTÉ Prime Time on symphysiotomy was nearly as shocking as the original programme.
The “simulation” in the programme came straight out of a low-budget gothic movie: evil masked male figure brandishing a scalpel dripping blood, and attended by subservient acolytes all of whom goggle pruriently at helpless women giving birth apparently without benefit of gas-and-air. Background voices which are mainly anonymous supply a commentary: “I was roaring with pain!” “It was a year before I could walk!” “It was sexual abuse!” And the punchline: “Someone should apologise to us all!” I was at first unable to connect this performance with Prime Time’s mention of the National Maternity Hospital in Dublin, where I spent a period as a pupil midwife in the late 1950s.
Symphysiotomy was indeed carried out there then, as a safer alternative to Caesarean section. Given the circumstances, Caesarean section was not always an option.
Irish midwifery was changing over rapidly from a domiciliary system in which most babies were delivered by district midwives in the family home, to a system which was to be entirely hospital-based, on the American model.
Our poorer patients usually came in without any preparation for childbirth, as ignorant of their own anatomy and physiology as of their rights, and terrified of hospitals, as places where people usually only went to die. If you had to go in, you got out again as quickly as you could, and never mind that English-trained nurse telling you that doing post-natal exercises would prevent bladder problems! Even worse, she wanted you to breast-feed the baby! Doctors then were not trained as now they are to communicate with patients, and this sometimes led to misunderstanding on both sides.
Case histories were often minimal – I am describing a very poor urban population missing out on the whole welfare and education scene, and light-years away from the year 2000. We did the best we could with what we had.
Of course it would be better to find out the truth. To evaluate symphysiotomy as an intervention professionally would probably not cost as much as the subsidy to a hotel or a golf-course, and it would even give valuable training and employment.
It would be good to have a factual analysis of this important topic instead of viewing a rant exercise. But it will take a lot to persuade me that maternity hospitals of 60 years ago were staffed entirely by sadistic puppets deliberately plotting to oppress and mutilate women.
If someone would prefer to think so, then that someone should apologise to us all! – Yours, etc,
HELENA KELLEHER KAHN,
Symphysiotomy is an 18th-century childbirth operation that effectively unhinges the pelvis by severing the pubic bones. The surgery was revived here in the mid-1940s for religious reasons and carried out, reportedly, without consent. More than 100 casualties survive today.
The Minister for Health has declined to accede to calls for an inquiry, most recently from the Joint Oireachtas Committee on Health.
Her refusal rests on advice supplied by the Institute of Obstetricians and Gynaecologists. Wrongly, the institute has led successive Ministers to believe that symphysiotomy was done out of medical necessity, that the surgery was a norm for obstructed labour until 1960, that results were “excellent” and complications “rare”.
Symphysiotomy was never a norm, however. Ireland is the only country in the developed world where symphysiotomy was widely practised during the 20th century.
More than 1,000 of these operations were performed here from 1944 to 1984.
The surgery left babies dead or damaged and mothers with genital and pelvic injuries, persistent wounds and other infections; and sexual, marital and family difficulties. Many report decades of depression, impaired mobility, incontinence and chronic pain.
Symphysiotomy was a blatant abuse of authority and of medicine, one that showed a callous and cavalier disregard for mothers and babies.
For the Minister to persist in refusing an independent inquiry into this mutilating operation is to make a mockery of patient safety and to deny these women justice.
Like other victims of institutional abuse, they, too, are entitled to truth, validation, redress and closure. – Yours, etc,
Director Assoc for the Healing of Institutional Abuse;
Feminist Open Forum;
PHILOMENA CANNING RGN
TCD Gender and Women’s Studies;
Dr DOLORES DOOLEY;
Author The God Squad;
MARY GILLESSAN RGN RM;
Chair, Assoc for Improvements in the Maternity Services Ireland;
Prof KATHLEEN LYNCH,
UCD Equality Studies;
Dr JOAN MCCARTHY
UCC School of Nursing and Midwifery;
Dr MARY MCAULIFFE
UCD Women’s Studies;
Director, National Women’s Council of Ireland;
Dr JACQUELINE MORRISSEY;
Dr JO MURPHY-LAWLESS,
TCD School of Nursing and Midwifery;
MAIRE ÚNA NÍ BHEAGLAOICH,
Gluaiseacht an Phobail;
CAOIMHGHÍN Ó CAOLÁIN TD,
Author Emergency: Irish Hospitals in Chaos;
Dr KATHERINE O’DONNELL,
UCD Women’s Studies;
JAN O’SULLIVAN TD;
Sen PHIL PRENDERGAST;
Director HOPE Project;
Feminist Open Forum;
ARTHUR MORGAN TD;
Dr ERNESTO VASQUEZ DEL AGUILA,
UCD Women’s Studies
C/o Rathdown Road,
Phibsboro, Dublin 7.
Profession Must Get More Professional
Irish Times, February 23, 2010
MEDICAL MATTERS: It’s time for doctors to get their act together, writes MUIRIS HOUSTON
LAST WEEK’S Prime Time report on symphysiotomies made for uncomfortable viewing. Apart from the unethical procedures revealed, it was also a reminder of Michael Neary’s warped Caesarean hysterectomy practices. Indeed, the disgraced gynaecologist made a cameo appearance, suggesting the symphysiotomy victims were motivated by compensation rather than suffering.
Such behaviours cause despair for the vast majority of medical professionals. But they also help drive the effort to redefine medical professionalism. In 2005, the Royal College of Physicians (RCP) came up with a useful definition, when it said that medical professionalism “signifies a set of values, behaviours and relationships that underpins the trust the public (and patients) have in doctors. Medical professionalism is a set of values, . . . doctors are committed to integrity, compassion, altruism, continuous improvement and a working partnership with members of the wider healthcare team”.
The RCP said these values should form the basis for a moral contract between the medical profession and society. And it called for the partnership between patient and doctor to be based on mutual respect, individual responsibility and appropriate accountability.
Last week was also the occasion of the 85th Abraham Colles lecture at the Royal College of Surgeons in Ireland. Dr Michael Brennan, a RCSI graduate and president of the staff of the famous Mayo Clinic, spoke passionately about professionalism. He suggested that certain episodes involving the inappropriate behaviour of doctors had undermined the “compact” between society and medicine.
As an educator, he emphasised the development of “the professional self” in students; the internalisation of the values and virtues of medicine as a calling. In the past, this supposedly occurred by osmosis, part of a student’s informal curriculum. Now, it is formally taught, but there is also recognition that a “hidden” curriculum, based on how students interpret what they see, also exists.
The performance of medical students, and increasingly qualified doctors, in areas such as interpersonal skills, communication skills and professionalism is now formally assessed. And professionalism is actively taught: at NUI Galway medical professionalism is given a substantial 20 per cent of curricular time in each of the five undergraduate years.
The 12 learning outcomes of the new curriculum include five that relate directly to the development of a new health professional; graduates must be able to demonstrate a full range of communication skills and professional behaviours in all areas. (Declaration of interest: I teach medical professionalism at NUIG.)
What are the challenges in maintaining professionalism? Autonomy, protected by generations of doctors, may suggest protectionism rather than excellence to society. There is a need for selflessness and discipline in working with others and following procedures. But a good doctor needs to get used to uncertainty. Experience and knowledge form the basis of such judgments. But you cannot measure wisdom, and so such decisions may appear to lack transparency to an outside observer.
One of the most important aims of professionalism is securing trust. The only way to achieve this is in partnership with patients, supporting them in making decisions about their care. Teamwork, too, is crucial – Dr Brennan referred to it as “the nexus of quality and professionalism”.
But he also reflected on the US healthcare crisis. Financial gain for individual doctors and physician self-interest were contributing to the blocking reforms. But at least they are negotiating, unlike here in the Republic where reform is being carried out by decree, not discussion.
Rather than shrink away under the harsh light of investigation into inappropriate behaviour by a few, it is time for doctors to renegotiate a contract with society based on trust. It’s time for partnership, not conspiracy.
Group Calls for Cowen to Dismiss Harney
Irish Times, February 20, 2010 by Eithne Donnelan and Lorna Siggin
TAOISEACH BRIAN Cowen was yesterday urged to dismiss Minister for Health Mary Harney from Cabinet over her refusal to set up an inquiry into why symphysiotomies were performed on hundreds of Irish women up to the 1980s.
The “brutal” surgical procedure to permanently widen the pelvis was performed on nearly 1,500 women as they gave birth, leaving many of them incontinent and in pain.
Speaking in Ballinasloe later yesterday, Ms Harney said the practice, which was discontinued 27 years ago, appeared very barbaric, but she saw no role for the Government in holding an inquiry. It could be a matter for the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians, she said.
“It was replaced to a large extent by Caesarean section, and now up to 25 per cent of all births in Ireland are done through Caesarean section,” she said.
The Department of Health’s chief medical officer was concerned about the rising number of sections, she said, and discussions were being held with the institute on the issue.
Survivors of Symphysiotomy (SOS), the support group for women who underwent the procedure, says the claim that the procedure was accepted practice in emergency situations between the 1950 and 1980s is a myth. They say it had largely been replaced by Caesarean section in the developed world, except in Ireland.The SOS group feels what happened to them amounted to abuse and that Ms Harney is allowing it be covered up by not holding an inquiry.
Kathleen Naughton, from Duleek, Co Meath, who underwent the procedure at Our Lady of Lourdes Hospital, Drogheda, in 1977, said yesterday she hasn’t walked right since the procedure 33 years ago. “If Minister Harney was in my body even for one day we would have the review the next day,” she said.
Colm MacGeehin, solicitor for the women, said claims by the Government that symphysiotomy was a necessary operation in its day and few complications resulted were a lie. It was used, he claimed, to ensure women could continue to have children whereas a Caesarean section might limit that.
RTÉ’s Prime Time programme, which focused on symphysiotomies on Thursday night, claimed medical records indicated the former Drogheda obstetrician Dr Michael Neary, who was struck off the medical register in 2003 over unnecessarily removing the wombs of 10 patients, had carried out the symphysiotomy procedure on at least one patient. However, Dr Neary, on the programme, denied this and asked if it was “the smell of money” that was now causing women to seek an inquiry.
Symphysiotomy A True Horror Story
Prime Time Special: Brutal Practice RTÉ1, Thursday
Irish Times, Weekend Review, 20 February 2010 by Anne Marie Hourihane (TV Review)
Paul Maguire’s report on the history of symphysiotomy in Ireland was profoundly upsetting – a history of savagery which then turned into news. Symphysiotomy, the cutting of a woman’s pelvis into two to facilitate the delivery of her baby, was discontinued in the developed world in the early part of the 20th century. Symphysiotomy was reintroduced here in 1944. Unbelievably, it continued in Our Lady of Lourdes Hospital, Drogheda until 1982.
Paul Maguire told this horror story with great seriousness and care, whether talking to the victims of symphysiotomy about their continuing pain, incontinence and difficulty walking, or revealing the blistering criticism that international obstetricians levelled at Irish obstetricians during the 1950s.
The programme implied that symphysiotomy was a symptom of the misogynistic Catholic medicine that pertained in Ireland at that time, although this link was not really explained. Enough, perhaps, that Mary Borg underwent it when she was delivering her baby at the age of 14.
Most of the women who had symphysiotomy seemed to have been young and pretty at the time. They also seem to have been, on the evidence here – although this was never explicitly said – working class.
There was no rational reason for modern symphysiotomy. It was not about the safe delivery of a baby – it had a high infant mortality rate – but about punishing the young and fertile. Records at Our Lady of Lourdes revealed something called an “on the way out” symphysiotomy, which was performed after a Caesarean section. In other words, it was performed when the baby was already out of the woman’s body. This was chilling viewing.
And a remark by Dr Michael Neary about the injured women – “Is it the smell of the money that’s getting to them?” – was so offensive as to be almost unbroadcastable. However, it is right that it was broadcast, because it was highly informative.
Inquiry Sought Into Operations
Irish Times, February 19, 2010 by Eithne Donnellan Health Correspondent
The Taoiseach Brian Cowen was today urged to dismiss health minister Mary Harney from Cabinet over her refusal to set up an inquiry into why symphysiotomies were performed on hundreds of Irish women up to the 1980s.
The "brutal" surgical procedure to permanently widen the pelvis by sawing it in two was performed on nearly 1,500 women as they gave birth, leaving many of them in pain and incontinent all their lives. Many were not asked for their consent or told what was going to happen to them before being held down for the procedure.
Survivors of Symphysiotomy (SOS), the support group for women who underwent the procedure, say claims that the procedure was accepted practice in emergency situations between the 1950s and 1980s are a myth.
They say it had largely been replaced by Caesarean section in the developed world, except in Ireland, at that time.
A promised review of the practice by former health minister Micheál Martin in 2003 never took place as there was no agreement on who would conduct the review.
Since then Ms Harney has, according to SOS, been "stonewalling" their attempts to have an inquiry established. The all part Oireachtas health committee wrote to her seeking a review last year and gave her the names of four people who could possibly undertake such a review, to no avail.
The SOS group feel what happened to them amounted to abuse and that Ms Harney is allowing it to be covered up by not holding an inquiry, and therefore should resign or be dismissed from Cabinet.
Kathleen Naughton from Duleek, Co Meath, who underwent the procedure at Our Lady of Lourdes Hospital, Drogheda, in 1977 told a press conference in Dublin this morning: "If Minister Harney was in my body even for one day we would have the review the next day".
Colm MacGeehin, solicitor for the women, said what happened his clients was one of the worst medical scandals in Irish history. Claims by the Government, he said, that symphysiotomy was a necessary operation in its day and that few complications resulted were a lie.
It was used, he claimed, to ensure women could continue to have several children whereas a Caesarean section would limit the number of children they could bear.
The women cannot take an action for damages unless the statute of limitations is set aside, he added.
Furthermore he said claims that the women have been provided with adequate support services is untrue.
The Department of Health said today that Ms Harney has concluded, based on full consideration of all the facts and on the advice available to her, including that of the chief medical officer that it would not be productive now to initiate a review.
"The purpose of conducting a review of health policy or medical practice is primarily to examine past events so as to improve care for patients. In the case of symphysiotomy, the practice is now extremely rare in Ireland, having been superseded by Caesarean section since the early 1980s," it said.
It added that the HSE will continue to monitor and oversee the provision of necessary support services for women who underwent the symphysiotomy procedure.