The inquiry investigated if the Catholic ethos was responsible for the high hysterectomy rate, writes Eithne Donnellan
The Lourdes maternity hospital was founded in 1939 by the Medical Missionaries of Mary. Its owners, according to Judge Maureen Harding Clark's report, set out to provide the best medical care to the people of Drogheda in a Catholic setting and to train doctors and nurses for the missions in Africa.
Its Catholic ethos meant that as time moved on and other hospitals began to provide female sterilisation, it did not.
The report said, however, that there was a "very strong suspicion" that a number of hysterectomies were carried out because of the hospital's ethos. The suggestion is that women were having their wombs taken out to ensure they would not have any more children, given that the alternative of tubal ligation was not permitted.
The Medical Missionaries of Mary objected to this finding, saying it was "incumbent on the inquiry to draw its conclusions on more than mere suspicions".
It pointed out to the inquiry that many other hospitals in the State had the same ethos, yet its rates of peripartum hysterectomy (a hysterectomy within six weeks of delivery) was not at the same level as at the Lourdes hospital. The inquiry looked at this.
It "particularly checked" the figures at Airmount in Waterford, as it was a hospital owned also by the Medical Missionaries of Mary and managed according to the same religious ethos. This hospital was established in 1952 and in 1995 it was closed and subsumed into Waterford Regional Hospital.
"For total deliveries in the region of 61,929 from 1970 to 2003, there were 6,309 Caesarean sections and 21 hysterectomies, ie one hysterectomy for every 2,949 deliveries and one hysterectomy for every 300 Caesarean sections," it said.
The rate in the Lourdes hospital was one peripartum hysterectomy for every 282 deliveries and one Caesarean hysterectomy (a hysterectomy at the same time as a Caesarean section) for every 37 Caesarean sections between 1974 and 1998.
The inquiry also looked at the hysterectomy rates at Portiuncula Hospital in Ballinalsoe which was run by the Franciscan Missionaries and which again had an ethos similar to that which prevailed at the Lourdes.
The Portiuncula maternity unit was slightly smaller than the one at the Lourdes hospital but for its 60,787 deliveries between 1970 and 2003 (it was taken over by the Western Health Board in 2001), there were 6,603 Caesarean sections and 26 hysterectomies; ie one for every 2,338 deliveries and one for every 254 Caesarean sections. Both Airmount and Portiuncula had significantly lower rates of hysterectomy.
The report said "a very major difference" between them and the Lourdes hospital was that they had a system in place whereby no obstetric hysterectomy would be carried out by one consultant without first seeking the second opinion and if possible the assistance of another consultant.