Dr. Anthony McCarthy:

The first question was about suicide being the leading cause. These confidential inquiries into maternal deaths report every three years. In the report for 2002-2005, suicide was definitely the leading cause. The numbers are small but the causes of maternal death are small. It might be two cardiac, one renal or one rupture of an aneurysm. In that report, suicide was the commonest cause and also in one of the subsequent reports. While there are very few suicidal cases, as members of the committee are probably aware, truthfully we also know that with many cases going to coroners' courts, in general with suicide, we also have to look at accidental deaths and open verdicts. We are all aware of women who almost certainly kill themselves in pregnancy but there is an open verdict. Very often a coroner is under huge pressure to do that. Those women have not been spoken about today but they are a real issue as well, believe me.
With regard to the management, I have certainly seen women in pregnancy who have seriously harmed themselves or have tried to kill themselves. As Professor Casey and Professor O'Keane have said, when treated they were better and wanted to keep the child. I have also seen women in pregnancy who did not threaten suicide but I knew a week later that they were no longer pregnant because they had gone to the UK. I have also seen women in pregnancy, particularly with a foetal abnormality, who had threatened suicide. In one case, she did not threaten me - I hate that pejorative word - but she was desperately seeking a termination of pregnancy. She had booked to have it in the UK a few days later. She was so desperate that she wanted it out now. Of course, under the current guidelines it felt much safer to say: "Well, you are booked to go to the UK. We're not going to do anything today." If the situation changes and she has that termination here, that may be a different issue. However, that will be for my obstetric colleagues to decide rather than me, because she will not be threatening, to use that awful pejorative again. That is an example of a very broad spectrum of people whom we see.