Professor Louise Kenny:

Perinatal mental health services are patchy at best. I have not seen any improvement in perinatal mental health provision in recent years. It is a very specialist area. All best practice recognises that a woman and a family's best chance of full recovery from an acute perinatal mental crisis is through the provision of specialist services in dedicated mother and baby units, to which we do not have adequate access nationwide. On a more worrying level, we do not have individual specialists in perinatal mental health at anywhere near what would be regarded as international norms. This is a fundamental problem and a matter of grave concern in an area that is woefully under-resourced. I have not seen any improvement in recent years in the provision of perinatal mental health services, a point with which my colleague would agree.

The accepted international norm for care pathways of ultrasound provision in pregnancy is a minimum of two scans, the first of which takes place at the end of the first trimester and the beginning of the second. The primary function of this scan is to confirm pregnancy, the location of the pregnancy and the number of babies involved. That is of clinical importance in dating the pregnancy, defining multiple pregnancy, which is a high-risk pregnancy, and also an extra-uterine pregnancy, which can be a life-threatening condition.

Following the first trimester scan, the next recommended minimal scan is a 20-week to 22-week scan, best performed at that time. That is a scan to screen for foetal development and foetal abnormality. As it is a screening scan, it cannot, by definition, be given to just selected proportions of the population, yet that is what we are doing. We are doing it specifically because we cannot give this scan to every one of the 8,000 women who present at Cork University Maternity Hospital, CUMH, for antenatal care every year. At present, we have adequate resources to provide that scan for approximately half of all women. Those who are not triaged to receive this scan can, if they are in a position to afford it, pay for a private scan. Accordingly, we have a two-tier health provision in terms of access to ultrasound and the poor are disadvantaged.

Clinically, we make the decision on the basis of those who are perceived to be at higher risk of having a baby or a pregnancy affected by a complication. Currently, we screen out those women who are of an older maternal age, those who have had a previous bad obstetric outcome and those who have a significant family history that would delineate them as being at risk. The majority of babies born with complex foetal abnormalities or significant neonatal conditions resulting from, for example, foetal growth restriction, are not born to women with any risk factors. In that kind of situation, we will miss the majority of babies born with problems.

If, for example, early foetal onset growth restriction or grave foetal abnormalities, such as hypoplastic left heart syndrome, which would be amenable to surgery, potentially ex-utero, are not picked up, it will increase the mortality from those conditions. Babies will and do die as a direct result of a lack of access to ultrasounds.