'It's rewarding, but so emotionally draining': Star obstetrician Peter Boylan on a 40 year-career in women's healthcare
As one the most distinguished obstetricians in Ireland and an influential voice on women’s healthcare issues, Peter Boylan has been more than used to slings and arrows in his career.
Yet when he appeared on RTE’s live debates around the 8th Amendment referendum last May, speaking on behalf of the Yes side, even he was surprised when the Taoiseach accused No campaign’s speakers of personally targeting him.
The televised debates in the run-up to the referendum were emotive, and usually spilled over into a theatre of jeering, catcalling and hollering. Boylan says he wasn’t in the least bit perturbed.
“I’ve played a lot of sport, mostly rugby, and once you’re playing the man rather than the ball, you know they’re losing,” he says. “I’d expected some abuse and there was certainly some stuff from trolls, usually based in the US, which I completely ignore. But in a local environment, once they started going after me, I thought, ‘this is a really good sign. We’re winning’.”
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On the day in May 2018 that the Yes side won by an overwhelming majority, Boylan was invited to appear onstage at Dublin Castle with others who had campaigned.
“When I was brought onto the stage they were chanting my name, which on one level was scary but on another was an extraordinary experience,” he recalls. “Then Kay Burley interviewed me (for Sky News), which was another surreal experience.”
And, as the Yes side predicted, the sky hasn’t fallen in since the 8th Amendment was repealed last year and Irish hospitals and GPs began providing pregnancy termination services to Irish women.
“There were guidelines written, as there are for any new service and procedure, and there has been a lot of training going on,” Boylan reveals.
“The actual training for GPs is not particularly complicated as they are prescribing tablets – the counselling is more important, and doctors need training on the potential side-effects and so on. Once they start into the provision of the service, they become familiar with it quite quickly.
“Some people have complained that in some counties there aren’t GPs providing the service, but it’s a lot better than the previous situation,” he reasons. “As the service settles down, the GPs who have been reluctant and perhaps want to see how it’s going, will see that the sky hasn’t fallen in and that it’s working.
“What it means for healthcare providers and doctors is that they can now have an honest and open conversation about women when they’re trying to make up their minds in these situations,” Boylan adds. “No matter what decision they make, these women can now get support in their country without feeling like criminals.”
As a former chair of the Institute of Obstetricians and Gynaecologists, Boylan has seen time and time again how religious ideology, largely through the Eighth Amendment, has harmed the women of Ireland. And in speaking out, he’s not done yet.
In his book In The Shadow Of The Eighth: My Forty Years Working For Women’s Health in Ireland, he reveals that the site, owned by the Sisters of Charity, is still under religious control, and that the Vatican still hasn’t granted permission for the order to pull out from the maternity site at Elm Park, Dublin.
As the site is on ecclesiastical grounds, the Vatican will have to decide whether the Sisters of Charity can give up ownership of the land, despite the order announcing 30 months ago that it was ending its involvement in the St. Vincent’s Hospital Group. In 2017, Boylan was urged to resign over objections that he raised over the move of the facility. Not for the first time in his career, he feels a sense of vindication.
“Anything build on ecclesiastical grounds has to adhere to a Catholic ethos, it doesn’t matter who owns the building,” he explains. “I raised the whole thing about Catholic influence on practise in the new hospital over the years, and I was met with, ‘there’s no question of there being religious influence’, and I was accused of all sorts of telling fanciful tales. It turns out, though, that I’m absolutely right."
In Boylan’s book, he details a number of high-profile cases that were affected, directly in some instances, by the 8th Amendment (which recognised the life of an unborn foetus as equal to that of the woman carrying it). From the death of Savita Halappanaver to the X, Y and P cases, Boylan offers a comprehensive, insightful and often shocking social history of the country.
“If you take Miss Y and her Kafkaesque experience, you’ll see that it was certainly in the newspapers, but not really written down anywhere in any sequential way,” he notes, referring to the case where a rape victim had arrived as a refugee into Ireland, found out she was pregnant, and unsuccessfully sought to have an abortion in Ireland. “The story is long and complicated and it’s written so that people can understand the issues and the revelations.”
He notes that the case of Miss P was among one of the most tragic in his career, and was a prime example of how the 8th Amendment put medics in almost impossible situations.
In 2014, a pregnant woman in her 20s suffered catastrophic irreversible brain injury as a result of a cyst in her brain.
She had been receiving maternal somatic support in a hospital; although her next-of-kin wished for her life-support to be switched off, the medical stuff noted that this would violate the foetus’ right to life, citing the 8th Amendment. Her father appealed to the High Court for her life-support to be switched off.
“That was the most distressing experience of my entire career,” Boylan reflects. “What was happening was obscene. Her children were brought in to visit her just before Christmas, which was just inhumane. What effect would that have on a young child coming up to Christmas? It was just awful.”
In the telling of these stories, Boylan shows a particularly sensitive acumen when it comes to the patient. He cites a formative experience: “When I was a medical student, Kieran O’Driscoll was in charge of UCD and set us a task,” Boylan recalls.
“We had to sit with six women having their first baby, though the labour and birth. We then had to write an essay about the woman’s experience and mindset; not our experience. It was about trying to get inside the woman’s head to figure out the emotional impact of childbirth.
“It was the only time in one’s career that we got to sit with a woman throughout her labour and analyse the emotions of it all, and it had a huge impact on me.
Of the 6000-odd births he was present at, Boylan notes that most of them are a blur of relief and happiness and joy. Others stick in the mind for different reasons. In the epilogue of his book, Boylan recalls an instance where, following an uncomplicated pregnancy, a healthy woman’s labour was progressing normally. Minutes before birth, the foetal heart stopped, and the baby was still-born. A post-mortem examination did not provide any explanation.
“I will never forget my shock at seeing the foetal heart simply stop and the parents’ distress at losing their baby so abruptly and inexplicably,” Boylan writes.
“Ultimately, it’s an emotional rewarding specialty, but it’s also so emotionally draining,” he surmises.
“That particular baby, I still remember vividly, and that was 25 years ago. I still see it happening. That’s the stuff we never forget.”
In The Shadow Of The Eighth: My Forty Years Working For Women’s Health In Ireland by Peter Boylan is out now via Penguin Ireland.