Public and private patients should get two ultrasounds to improve service, conference told
Not all anomalies are picked up by scans and not all detections result in better outcomes for the baby. However, medical staff, given the information, can greatly improve the pregnancy experience for parents. File photograph: Getty Images
Only seven out of 19 Irish maternity units in Ireland offer universal access to ultrasound scans, even though they can identify serious foetal abnormalities in early pregnancy, a conference has heard.
Dr Keelin O’Donoghue, consultant obstetrician at Cork University Maternity Hospital (CUMH), said basic antenatal care should provide two ultrasounds – an initial dating scan and a later mid-trimester anomaly scan at 21 to 22 weeks.
“That should be provided in all our maternity units and that should be available to public and private patients . . . it’s not impossible at all,” she told the International Children’s Palliative Care conference in Dublin on Friday.
However, according to a 2016 research paper, of which Dr O’Donoghue was a co-author, just seven of 19 (37 per cent), of maternity units in Ireland offered foetal anomaly ultrasounds to all pregnant women. Another seven offered them selectively, while five did not offer them at all. About 41,700, or almost two-thirds of pregnant women, receive anomaly scans.
The paper found that “substantial investment by health care policy makers is urgently needed”.
Dr O’Donoghue said not all anomalies are picked up by scans and not all detections result in better outcomes for the baby. However, medical staff, given the information, can greatly improve the pregnancy experience for parents.
“In Ireland there is no such thing as routine ultrasound,” she told the conference. Nor is there universal provision of initial dating scans.
Regarding decisions made by parents on whether to proceed with pregnancies when fatal foetal abnormalities are detected, Dr O’Donoghue said the debate on abortion does not help.
Parents make decisions on what to do on a number of factors, including the severity of the abnormality in question and quality of life for the baby, she said. Prior attitudes and beliefs as well as socio-economic factors can also come into play.
“We know that the way in which that information is communicated to parents is critically important in decision-making,” she said.
Terminations cannot be provided in Ireland, although information on them can be, subject to strict conditions.
“This is the public framework in which our patients live: termination of pregnancy remains unlawful in Ireland unless the life of the mother is threatened,” she said.
“And the choice to exercise your right to terminate a pregnancy [with a] fatal foetal abnormality is often subject to criticism, leaving women to face a very difficult choice in a context of secrets and lies. And there is no doubt that the current debate doesn’t help.”
The pro-choice argument, she said, fails to take into account the experience of those who choose to continue their pregnancies.
“On the other side, for those who end the pregnancy, we do need to have regard for those for whom continuing a very abnormal pregnancy could result in psychological damage for them and their whole family and recognise that for some of them, they have no choice but to travel abroad.”