Dr. Mary McCaffrey:

I will deal first with the issue of pre-existing medical conditions. More and more women in the reproductive age group have pre-existing medical conditions who heretofore either may not have been alive or in a position to be pregnant. There are many women who had cardiac surgery as children who will already be under the care of a cardiologist. It is absolutely hard to believe that they would be managed anywhere other than at a tertiary referral unit. For example and as I mentioned in January, the Coombe Women's Hospital has a very specific clinic where it looks after medical problems in pregnancy. They liaise with various specialties. The question the Deputy is asking is whether we refer people on to centres with special expertise. Certainly I do and I am sure most colleagues do. Women are also very well informed now and women who have come from a clinic like that where they have been with a cardiologist since they were two or three years of age will be very well versed in the risks to them in terms of their pregnancy and will already know they need to be under specialist care.

On access to psychiatry at weekends, a woman who is pregnant is no different from any person who walks into an emergency unit at the weekend who is seriously ill, be it with a psychiatric illness or otherwise. Every unit that has a psychiatric service has 24-7 psychiatric care. Whether a person is male or female, pregnant or not, he or she is assessed. The service kicks in immediately as does the liaison team.

I am not sure what the right answer is to whether people should declare conscientious objections in advance. It would be disappointing if people were discriminated against and disadvantaged. The situation will be extremely rare.

With regard to training for new procedures, when I was collaborating around the country this was an issue brought up by a person who felt the institute and the Medical Council should ensure people were versed in the types of procedure and at what gestation one would do a surgical rather than medical procedure. It is really more about guidelines and ensuring everyone is appropriately trained to manage the situation. Managing a miscarriage is slightly different to managing what will be a live child after 12 weeks gestation. It is important to have guidelines that people are aware of. We see people back from the UK with complications from termination. This is in a country where people are trained. In the same hospitals in the UK, some will have operations and some will have medical procedures. It is important to have training, consistency and guidance for clinicians because there will be occasions where doctors will be employed who have never been exposed to these kinds of procedures before.