Michael Harty (Clare, Independent) | Oireachtas source

I do not think I will take 15 minutes, so Deputy Eamon Ryan will have a free run for the end of the debate.

The Maureen Harding Clark report on surgical symphysiotomy remains a very unsatisfactory report for many women. It covered a period of 50 years from 1940 to 1990 and was set up on the assumptions that symphysiotomy led to lifelong disability and was impelled by Catholic teaching on contraception and that Irish doctors were alone in the English-speaking world in using the procedure. However, the report found that the procedure for many women was non-injurious in the long term and medically appropriate and that patient consent was not necessary. These findings could not have been upheld if oral evidence had been taken. This also calls into question medical ethics. It is completely unacceptable that procedures would be carried out on anybody, even in 1940 to 1990, without obtaining consent or explaining the procedure.

The process of the procedure was very invasive and barbaric and was not a first option in allowing women to deliver their children. It certainly was not an option when caesarean section was freely available at the time. It was carried out because women were deemed to have pelvic disproportion, which is a small pelvis. This was a very difficult diagnosis to make up to the 1990s, certainly in the 1940s and 1950s. The procedure was carried out very often on first-time mothers who were not given a trial of labour and who could have had a caesarean section if their labour was not progressing. To use symphysiotomy in this regard was therefore completely unacceptable. Many procedures were carried out as an alternative to caesarean section, not because the women could not deliver the child.

The issue of consent is very important. Many women availing of this scheme did not know what procedure had been carried out. They were unaware that they had had symphysiotomies. This may have led to difficulty regarding the Maureen Harding Clark hearings. A total of 107 of the applicants were between 85 and 96 years of age at the time of application. These women could be forgiven for memory lapse and their ability to sustain a claim. Who would falsely claim redress for a procedure he or she did not experience?

The report relied on medical records, if they were available, going back many decades. Medical records going back 40 or 50 years were quite often not available, whether the survivors' GP records or their hospital records. They were subjected to an examination for evidence of a surgical scar, but this would not be absolute evidence of whether they had a symphysiotomy.

The scar was small and could have faded in time. It also relied on radiological evidence of the symphysis pubis gap being large, which would have been the case in many of those who would have had a symphysiotomy, but that may have healed over time and would not be absolute evidence that they did not have a symphysiotomy. Written evidence was taken but often discounted and no oral evidence was taken. The scheme applied an almost criminal standard of proof, beyond reasonable doubt, as opposed to the civil standard of proof, which would be on the balance of probability. Lack of consent or explanation of what had been performed was one of the inhibiting factors in this report and symphysiotomies were carried out before and during labour and even after a woman had had a caesarean section, to, in my view mistakenly, aid their next delivery. Of the 590 women who applied for inclusion in the scheme, 185 were excluded as they did not meet these criteria even though failing to meet them did not mean they had not undergone the procedure. Many were left to deliver their babies through a now traumatised, unstable pelvis adding to their labour and their pain. Thankfully, this procedure is no longer carried out in modern medical obstetrics. This report has many deficiencies. A major one was the failure to take oral evidence. If oral evidence had been taken, women could have outlined the mobility difficulties they had after the procedure, the pelvic instability they endured for many years, the urinary incontinence, the damage to their pelvic floor and the chronic pain they endured. Many lived a life of misery. The integrity of the 185 who did not meet these criteria has been called into question.

The procedure was not necessary and it led to poorer outcomes for baby and mother, when taking into account the availability of caesarean section. This is a crucial point. Infant mortality increased over and above what would have been available through caesarean section by having a symphysiotomy. It was a procedure that could damage the baby as well as the mother. The procedure was carried out in Ireland almost exclusively in hospitals which had a very strong Roman Catholic ethos in respect of fertility, contraception and particularly tubal ligation. This report has not brought closure to many people who went through this process, particularly the 185 who did not meet the criteria. They were assaulted, the procedure was unnecessary and their integrity has been called into question which is to be regretted.

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