Dr. Sam Coulter-Smith:

With regard to the lack of intensive care facilities, I agree that head 1 must be broadened to include the general hospitals as some of our sickest patients will be in those institutions. It is absolutely correct that there are three specialist perinatal psychiatrists, all of them based in Dublin. This is a very restricted pool of professionals in this area. Not only are we under-resourced from a maternity services point of view, the mental health support of those maternity services is also under-resourced. It is something that must be addressed.

I have nothing to add to what Dr. Mahony said about decriminalisation in head 19.

To return to a question I missed earlier, I was asked if I was aware of any intervention in a case of suicidality. I am not.

There was reference to the Californian experience. I do not have any knowledge of that or of what legislation was introduced which might have led to that change.

We have talked in detail about the consultant-patient ratio. Our midwife-patient ratio is also approximately half of what it should be. The internationally recognised appropriate ratio of midwives to patients should be between 1:25 and 1:30. In our hospital at present it is approximately 1:50. That is in a situation where, at our peak levels of activity, there were 42 deliveries in a 24-hour period last December. That was delivered from nine labour ward rooms. One cannot imagine the level of activity and the risk associated with trying to put that level of activity through an extraordinarily busy labour ward. It is not a matter for this setting, but I should point out that the safety of the services we provide is down to the skill, dedication, hard work, missing meals and missing breaks of our extraordinarily talented and gifted midwives. We owe a huge debt of gratitude to that group, mainly women although there are some men.

In terms of Professor Crown's point about how often this situation occurs, I agree that suicidality in pregnancy is extraordinarily rare. Most obstetricians will go through their entire working life and not encounter this situation. However, it is important that if a woman's life is deemed to be at risk, she has access to the appropriate psychiatric care. If termination of pregnancy is deemed to be appropriate in that situation, that is fine. We will get involved and we will do that. However, it is important that gestation is not covered by that element of the legislation, and that leaves this open.