Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I am sure the witnesses do not have to think too much about the last question.

The statistics provided by the Institute of Obstetricians and Gynaecologists indicate 36% of women attending ante-natal services in Ireland have no 20-week scan. Could the level of potential adverse events as a result of that lack of scanning be extrapolated? Perhaps the witnesses could discuss the professional difficulties doctors and midwives may encounter as a result of being presented with a disaster zone that could have perhaps been avoided. I think I am right in saying that Ireland has an increasing rate of neural tube defects. I could be wrong, but I read that at some stage. This is preventable in many cases with adequate pre-natal nutrition, such as sufficient folic acid consumption. As a community pharmacist, I am mindful that folic acid is one of the cheapest products available and that there is a lot misinformation around it. Before I took up my role as a Deputy I regularly encountered women who were taking whatever vitamins they had at home and using them up before they went out and bought new vitamins. I have worked in the most deprived parts of the country as well as in some of the most affluent parts. There is a huge lack of understanding throughout Irish society about adequate nutrition and preparedness for becoming pregnant, should one be so lucky for that to happen. It is all fine saying we can do a non-invasive tests, and I had one on my last child, but perhaps if the witnesses have the data with them, they could inform the committee of how we can avoid preventative birth defects.

My understanding is that the neural tube defect rate is climbing at a higher rate in Ireland than anywhere in the OECD. Free folic acid for everybody would be such a cheap measure. I know there are issues around safe upper limits because it is a water-soluble vitamin, so there are issues around how much one can take. I would like the witnesses' views on prevention rather than cure.

On post-natal depression and breastfeeding, I was privileged enough to be a private patient in the Coombe for my three children but on my last child, there was no private bed available and I was in a public ward. My first child had a birth defect which was discovered at the 20-week scan. I paid privately to see a paediatrician in advance of his birth because I knew that there would be a separation at birth and there would be an issue in terms of establishing breastfeeding when the child was in the intensive care unit and I was elsewhere. However, my understanding is that was only because I had the wherewithal to do that. For people in such circumstances, is there any similar system in place to address that? I was lucky enough to have a mother who is a nurse and lots of sisters to help me out but I felt that it was my own call. It all worked out but is there anything for public patients to address this issue, that is, support for women who are separated from their child at the point of birth to breast-feed?

Are there better pre-conception regimes in place in other countries and do the witnesses have any data regarding how this transfers to birth defect rates and mental health outcomes and breastfeeding outcomes for families?

On supports for public patients in the hospitals, maybe it is different in Cork and in other hospitals but I was handed what appeared to be a typed pink document and was told to go to a breastfeeding class but I had a caesarean section and could not walk. I was just handed this document and told to go to the class. I cannot remember if it was in the morning or in the afternoon. The last place a person wants to be is in a breastfeeding class with women with babies while one's own baby is in intensive care. I could not think of any worse place to be.

On the correlation between home births and breastfeeding, we were given a figure of 99.9% but I imagine we could drill down into that data more, that is, that women who choose a home birth are perhaps just more engaged with the whole birthing experience and that having a home birth means a person is more likely to breast-feed. I would like that correlation clarified.

On rural service users, we referred to the mastership model and clinical directors being appointed and to how birth defects do not happen only to people in risk situations. How can we say it is a good idea to have rural home births or rural units when we do not have adequate scanning? Are we going to end up with potential catastrophic incidences? I am all for it but if we do not have adequate scanning and things in place to prevent bad incidences at birth, how can we even consider people having babies far away from teaching hospitals and centres of excellence? I am concerned about it.

I was 30 years of age when I had my first child but the defect he had was more likely in teen pregnancies. If I had not had a 20-week scan and if I was in a rural hospital, my first child probably would not be alive. Is it realistic to expect that clinical directors and doctors could stand over units dispersed around the country when we do not even have the scanning in place? I hope the witnesses from AIMS might be able to straighten that out for me.

Someone mentioned there were no mother and baby units. What happens? Does the mother go into a psychiatric unit and the baby go somewhere else? I did not know this happened. Could this be spelled out for the committee because I was unaware of it and it is deeply concerning? God almighty, if a mother was on the edge already, then to take her baby away and put him or her somewhere else would definitely finish her off altogether.

In France, every unit has a perinatal psychologist. Have we any data about outcomes for families and mothers? If we had one, would we get better breastfeeding and better experiences for families?

On post-natal depression, I am a community pharmacist but I would like to hear the witnesses experience of this, which would be far greater than mine. However, I have come across women with post-natal depression but they are afraid to go to their GP or consultant because they do not want to be prescribed an antidepressant as they are concerned about breastfeeding. Their attitude is that they will suck it up and get through it because they are breastfeeding and that if they go to the doctor, they will be given medication and they are afraid of harming the baby. Is the lack of openness about this whole issue preventing women from going to their doctors or midwives?

My understanding was that public health nurses had to have a midwifery qualification but I am obviously wrong because the witnesses are shaking their heads. If we were to move towards having a midwife in a GP practice, would that get rid of the need to have public health nurses or are they two things that would work in tandem?