About 2-3 per cent of pregnancies involve a congenital abnormality, of which about 15 per cent are life-limiting, or potentially so. Major congenital abnormality is the main cause of death in about one-quarter of the 250 or so stillbirths that occur in Ireland each year.
Diagnosis of foetal abnormality typically occurs at the 11-13 week scan, or later at the second trimester anomaly scan at 20-22 weeks.
Since the law changed at the start of this month, a woman who discovers her baby has a fatal foetal abnormality would be given the option of continuing the pregnancy with perinatal palliative care, or terminating it. Foetal medicine specialists and other doctors would be involved in these discussions.
The woman would be given access to “value-neutral” information about termination of pregnancy, written in plain language.
If either the parents, or the doctors treating her, were uncertain about the prognosis of the pregnancy, a second opinion would be sought within a few days.
The law on providing terminations in the case of fatal foetal abnormalities is set out in Section 11 of the Health (Regulation of Termination of Pregnancy) Act 2018, passed by the Oireachtas last month.
This section, dealing with a “condition likely to lead to death of foetus”, states that a termination may be carried out where two medical practitioners, having examined a pregnant woman, “are of the reasonable opinion formed in good faith” that the foetus is affected by a condition that is likely to lead to its death either before, or within 28 days of, birth.
‘Relevant speciality’
One of the two certifying medical practitioners has to be an obstetrician, while the other has to have “a relevant speciality”.
The two doctors have to certify their opinion before the procedure carried out by the obstetrician among them. (It is possible that the second medical practitioner is also an obstetrician and that person could also carry out the procedure.)
Where a pregnant woman is refused a termination under any of the provisions of the Act, she has a right to seek a review of the doctors' decision by the Health Service Executive.
The termination is performed surgically, after administration of an abortion pill. Counselling and bereavement support would be provided to the woman.
The Coombe, a voluntary hospital with its own board, is the only one of the three big Dublin maternity units that has not yet started taking referrals for women seeking abortions. In a statement issued on December 31st, a day before the legislation come into force, the hospital said it was fully committed to providing abortion services under new legislation.
“To ensure the provision of safe, high-quality, sensitive and compassionate care to women, these services will be provided when the board and management of the hospital are satisfied that the necessary resources have been put in place.
“In this context, these services will not be available on 1st January, 2019.”
Notified
The hospital said it had notified the Department of Health and the HSE of its stance.
It is not entirely clear therefore what level of service is available for women living in the Coombe’s catchment area. They may seek a referral through the MyOptions helpline but will be sent to another hospital in the region.
However, while the other two Dublin hospitals, the National Maternity Hospital and the Rotunda Hospital, are operating the service, they are only accepting referrals from their respective catchment areas. The HSE disputes their right to limit provision in this way.
The introduction of piecemeal services on January 1st will result in geographic inequity, difficult clinical choices and missed deadlines for early abortions
Obstetricians from the Coombe were prominent in warning late last year that Minister for Health Simon Harris was rushing the introduction of the measure to meet the January 1st deadline.
A letter published in The Irish Times on December 22nd, and co-signed by Master of the Coombe Dr Sharon Sheehan, claimed the new service would be "disjointed and inadequately resourced" if it went ahead at the start of January.
“The introduction of piecemeal services on January 1st will result in geographic inequity, difficult clinical choices and missed deadlines for early abortions,” the letter warned.
“Although abortions have taken place in our maternity units under current legislation to save the life of the mother, there is little or no expertise in surgical abortion (which is different in important respects to the surgical treatment of miscarriage) and no experience in feticide in the country.”
