Dr. Méabh Ní Bhuinneáin:

The smaller units in this country are not small by international standards. In fact, there are no single-handed or dual-handed practices in operation at this time. All of the facilities are delivering more than 1,000 babies per annum and, in total, 20,000 mothers receive their care, including emergency care, in these units every year. Consultant-provided care is delivered in all 19 units on a 24-7 basis. There is a three-tier on-call system, involving a registrar, a senior house officer and a consultant. There are systems to support obstetric emergency provision in the cases to which Professor McAuliffe has alluded, where there is haemorrhage, bleeding, infection or uncontrollable high blood pressure and, in the case of complications of miscarriage, where a foetal heartbeat may still be present. There is the to provide that at this point in time.

The smaller units will be affected more by the logistics of implementing the services, but the networks and governance established through Medical Council best practice and ethical practice and through college governance will ensure a woman has access, regardless of which maternity unit she attends. For maternal survival, access to a unit that can save her life is essential. The timeliness of moving to a city unit and bypassing a rural unit could certainly confound maternal survival possibility.