Dr. Adrienne Foran:

Like all areas of staffing, there probably could be more but if one looks at opiate, methadone and heroin abuse, the cohort of women involved is small - about 100 per year - and one whole-time equivalent for that small group is probably about right. However, if we had a community-based drug liaison midwife and Justin Gleeson had the support of another colleague, we could probably identify the more subtle exposures, particularly to alcohol, earlier and get those patients into the system. What we are presenting here and what we know about is probably only the tip of the iceberg. What Deputy Byrne is seeing in the community probably reflects better what is really going on. The Deputy is absolutely right that these are not easy babies to bring home. They withdraw for months if not years, they do not sleep very well and get terrible nappy rash. They are not easy babies to care for. We rely very heavily on the foster care system. The committee will see from our report that regarding the 14 babies mentioned, there were 19 interim care orders. We had one horrific case where a mum was booked in for a C-section for medical reasons. When she realised that a C-section would mean that would not have access to drugs for five days, she went off the rails. When she presented the baby was in severe trouble because she did not stick to the programme because she was worried about being kept in hospital for five days. If we had continuity of care through another colleague for Justin Gleeson who could cover weekends and out-of-hours, we could stop those few who escape. Such patients are very fragile and they feel very guilty. We cannot be judgmental because addiction is a complex issue. The judgmental attitude has gone and that has helped a lot but if we ask these women to abstain throughout their pregnancy, it falls apart.