Placing your trust in a medical professional for family planning is a significant decision. You rely on your GP or gynaecologist to guide you through the options, explain the risks, and perform procedures with the highest level of care. When an Intrauterine Device (IUD) or "coil" is inserted correctly, it is an effective form of contraception. However, when standard procedures are not followed, or warning signs are ignored, the physical and emotional impact can be devastating.
If you have suffered an injury due to a misplaced coil, a perforation of the womb, or a failure in follow-up care, it is natural to feel let down and unsure of where to turn. We understand that these injuries often result in invasive surgery, unplanned pregnancies, and significant distress. Our team is here to help you understand your legal position and investigate whether medical negligence played a part in your injury.
Overview of contraception care
Before discussing legal claims, it is helpful to understand the procedure involved. An Intrauterine Device (IUD), commonly referred to as a coil (such as the Mirena, Kyleena, or Copper coil), is a small, T-shaped contraceptive device. It is inserted through the cervix and into the womb (uterus) by a doctor or nurse. Its purpose is to prevent pregnancy for several years by releasing hormones or using copper to create an environment where fertilisation typically does not occur.
While generally considered safe, the insertion constitutes a medical procedure that requires specific training and care.
Why coil perforation and migration are specific medical concerns
A serious risk associated with IUDs is perforation. This happens when the device pushes through the wall of the womb. Once the wall is breached, the coil can migrate (move) into the abdominal cavity. This is a significant medical concern because a floating device can damage nearby organs, such as the bladder or bowel, and requires surgical removal. Timely detection is critical to preventing long-term damage.
Where negligence can arise in coil and contraception care
Every medical procedure carries some degree of risk. However, strictly defined protocols exist to minimise these risks. Negligence claims typically arise not because a risk existed, but because a specific error occurred that should have been avoided.
Failures in pre-insertion assessment
A safe procedure begins before the coil is even inserted. Your doctor must ensure you are a suitable candidate for the device. Failures here can include:
- Failure to check anatomy: Not performing a manual examination to determine the position and tilt of the womb before insertion.
- Inadequate screening: Failing to screen for existing infections or pregnancy, which would make insertion unsafe.
- Ignoring risk factors: Failing to take extra care with patients who have risk factors for perforation, such as those who are currently breastfeeding or have recently given birth (where the womb tissue may be softer), as highlighted in manufacturer guidelines like those for Mirena.
Errors during the insertion procedure
The insertion technique itself must meet a competent standard. Errors during the procedure that may lead to a claim include:
- Excessive force: Using poor technique or too much force, causing the device to pierce the uterine wall.
- ignoring patient pain: Failing to stop the procedure when the patient reports severe, abnormal pain that goes beyond expected discomfort.
- Lack of immediate checks: Failing to perform immediate checks (such as an ultrasound) if the insertion felt "wrong," difficult, or if the clinician was unsure of the placement.
Issues with consent and risk explanation
You have a right to make an informed decision about your body. A claim may be investigated if there were failures in the consent process, such as:
- Failure to inform: Not clearly explaining the specific risk of perforation to the patient before the procedure.
- Lack of alternatives: Failing to discuss alternative contraception options that might have been safer for your specific circumstances.
- Documentation failures: A complete lack of documented consent in your medical notes.
Delayed diagnosis of perforation or migration
Often, the negligence is not the perforation itself, but the failure to spot it afterwards. Delays in diagnosis can lead to more severe surgery. This includes:
- Dismissing symptoms: A doctor dismissing a patient's repeated reports of ongoing pain, bleeding, or discomfort following insertion.
- ignoring "missing threads": Failing to investigate when the retrieval strings (threads) cannot be felt during a check-up.
- Referral delays: Delays in referring the patient for an ultrasound or X-ray to locate a "lost" coil.
Failures in follow-up and referral
Post-procedure care is a vital part of the standard of care. Negligence can arise from:
- Lack of safety-netting: Failing to provide "safety-netting" advice,telling the patient exactly what warning signs to look for and when to return.
- Surgical delays: Delays in referring a patient to a specialist gynaecologist for surgical removal once it is known the device has migrated.
The consequences that tend to drive claim enquiries
When contraception care goes wrong, the impact on a patient's life is rarely just inconvenience. It often involves physical trauma and significant life changes.
Surgical removal and physical injury
If a coil perforates the womb and migrates into the abdomen, it cannot simply be pulled out. It usually requires keyhole surgery (laparoscopy) under general anaesthetic to retrieve. In severe cases where the device has embedded into the bowel or bladder, open surgery may be required, carrying risks of further infection and long recovery times.
Unplanned pregnancy and fertility concerns
If a coil has migrated, it is no longer providing contraception. This can lead to an unplanned pregnancy, which can be deeply distressing, particularly if the coil was chosen for medical reasons or to avoid further pregnancies. Furthermore, damage to the womb from perforation can sometimes have implications for future fertility.
Psychological impact and loss of confidence in care
We recognise that these injuries are not just physical. Many women experience significant anxiety, stress, and a loss of confidence in medical professionals. The trauma of an unplanned surgery or the fear associated with a "lost" device inside the body is a valid component of the suffering caused.
Standards, protocols and guidance relevant in Ireland
In Ireland, the standard of care is determined by comparing the treatment you received against what a competent group of medical professionals would have done in the same situation.
We look closely at manufacturer guidelines (such as the leaflets and clinical instructions provided by the Health Products Regulatory Authority (HPRA) for devices like Mirena or Kyleena). We also examine standard GP and gynaecology protocols. For example, if a manufacturer explicitly states that extra caution is required for breastfeeding mothers, and a GP proceeds without that caution, this may be evidence of a breach of duty.
When a poor outcome is not necessarily negligence
It is important to be transparent: not every perforation or failed coil is due to negligence.
There is a difference between a Known Risk and an Avoidable Error. Perforation is a known, albeit rare, risk of the procedure (roughly 1 in 1,000 insertions). It can happen even when the doctor does everything right.
However, negligence typically arises when:
- The risk occurred because the doctor deviated from the proper technique.
- The perforation occurred, but the doctor failed to spot it reasonably quickly, causing you further harm.
To succeed in a claim, we must establish three things:
- Duty of Care: The doctor owed you a duty of care (standard in all doctor-patient relationships).
- Breach of Duty: The doctor made an error that no reasonably competent doctor would have made.
- Causation: That specific error directly caused your injury (e.g., the need for surgery or the unwanted pregnancy).
Time limits in contraception negligence cases
In Ireland, the Statute of Limitations for medical negligence is generally two years. However, the start date for this two-year period is crucial.
It starts from the "date of knowledge."
With coil perforations, you may not know the injury occurred at the time of insertion. It might be months or even years later when an ultrasound reveals the device has moved. The two-year clock typically begins from the date you discovered the injury, or the date you should reasonably have known about it.
Because these dates can be legally complex, it is vital to seek legal advice as soon as you suspect an issue.
Evidence and documentation that usually matters
If we proceed with an investigation into your care, we will need to gather a comprehensive picture of what happened. The following documents are typically essential:
- GP and family planning clinic notes: detailing the assessment, the insertion procedure, and any immediate comments made.
- Hospital records and operation notes: specifically if you required surgery to remove the device.
- Imaging reports: Copies of Ultrasounds, X-rays, or CT scans that pinpoint the location of the displaced coil.
- Consent forms: Any paperwork you signed, including information leaflets you were given (or not given).
- A personal timeline: Your own written account of your symptoms, pain levels, and dates of appointments.
What an investigation typically focuses on
When our legal team assesses a potential claim, we look at the case through a forensic lens to determine if the standard of care was breached.
- Whether the procedure was suitable for the patient: Did the clinician check if it was safe to proceed? Did they ignore contraindications (reasons not to perform the procedure) like a tilted womb or recent childbirth?
- Whether the technique met the required standard: Does the evidence suggest the insertion was difficult or forced? Was the clinician experienced enough to perform the procedure?
- Whether warning signs were acted upon promptly: When you returned complaining of pain or inability to feel the threads, did the doctor investigate thoroughly, or were you sent home without a scan?
FAQs
What if I cannot feel the coil threads?
Not feeling the threads does not always mean perforation; they may have simply curled up inside the cervix. However, it is a key warning sign. You should see your GP immediately. If your GP dismisses this without checking or referring you for a scan, and the coil has migrated, this may be considered negligence.
Can a perforation be missed at the time of insertion?
Yes, this is common. A "silent" perforation may occur with little immediate pain. However, negligence may be involved if the insertion was notably difficult and the doctor failed to perform safety checks despite the difficulty.
Does the Injuries Resolution Board handle medical negligence claims?
Generally, the Injuries Resolution Board (formerly PIAB) does not assess complex medical negligence claims where liability (fault) is contested. Most medical negligence cases require a specific authorisation to bypass the Board and proceed through the courts. We guide you through this procedural step.
What if the procedure was done in a private clinic versus a public hospital?
The legal process is similar, but the defendant differs. In a public hospital, the State Claims Agency usually handles the defence. In a private clinic, we deal with the doctor’s private medical indemnity insurer. We have extensive experience dealing with both.
How long do I have to start a claim if the injury was discovered years later?
You generally have two years from the date you found out about the injury (the Date of Knowledge). If the perforation happened three years ago but was only found on a scan last month, your time limit likely starts from last month.
What should happen if I experience severe pain during insertion?
The standard of care dictates that if a patient experiences severe or abnormal pain, the procedure should be stopped immediately. Continuing despite severe distress can be deemed negligent.
Why Michael Boylan LLP?
At Michael Boylan LLP, we understand that discussing women’s health issues and contraception failures can be difficult. You need a legal team that combines sharp legal expertise with a sensitive, human approach.
Specialist focus on medical negligence litigation
We are not a general practice; we are specialists. Our firm is dedicated to medical negligence and personal injury litigation. We have a deep understanding of the medical protocols surrounding gynaecology and family planning, allowing us to identify errors that generalist solicitors might miss.
An empathetic, evidence-led approach to women's health issues
We believe in listening to women. Too often, patients report that their pain was dismissed or their concerns ignored. We validate your experience by investigating the medical evidence thoroughly, using independent medical experts to build a robust case.
Initial case assessment
We offer a structured approach to investigating your claim. We will review your story, help obtain your medical records, and provide an honest assessment of whether you have a viable case for negligence. Our goal is to provide you with answers and, where appropriate, the compensation required to aid your recovery.
Get in touch for expert legal advice
If you have suffered an injury due to an IUD perforation, migration, or poor gynaecological care, please contact our specialist team. We are here to listen to your experience and advise you on the best path forward.
Contact Michael Boylan LLP today to arrange an initial consultation.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
