Dr. Rhona Mahony:

It is important to note that we generally work as a team and if there is a complex medical issue, consultants and trainees work together and, generally, consultants have a really big input when a patient is unwell or where there are complex clinical issues, so I would like to think that it is very rare that a trainee would find themselves on their own in this context. We generally work very hard to work as teams but there is a broader issue regarding training. It is not just the chilling effect of the eighth amendment. There are broader issues relating to obstetrics, recruitment into training and attrition rates.

That is because obstetrics is very high risk. We have long hours. It is a surgical specialty. Complications can arise, not necessarily due to somebody's fault, but they can arise unpredictably and they can be very profound.

In terms of adverse outcome, our specialty experiences maternal death, the death of baby or a baby who is very damaged and has cerebral palsy. These are very high-risk stakes. For some young people, these kinds of outcomes will make them wish not to practise in obstetric medicine. On top of that, it is quite punitive to practice in Ireland. We have a good deal of regulation, which is a good thing but, at the same time, if there is an adverse outcome, one can face into a High Court litigation, a civil litigation, or a Medical Council hearing. Perhaps one of the most difficult aspects is the fact that Medical Council hearings or other cases are covered in the media, and that is very difficult when one lives in a country with a population of 4.7 million and one sees one's name regarding a case or very intimate details of cases being published.

Ireland is a little different with respect to women and women's health regarding the intimate details about women, particularly in the area of termination of pregnancy, that find their way into the newspapers. At times I have been quite shocked at the level of the detail because it makes women readily identifiable. Also, we do not tend to see similar reporting with respect to men, for example, having prostate surgery. There is a bias there. That can frighten young doctors. Certainly when we see cases like the Y case or other very high-profile cases, no doctor wants to find himself or herself as part of the next media sensation. We never want to be part of an adverse outcome, but they will happen because our specialty is very high risk, and even though we do our very best, we will have complications and adverse outcomes. Ireland is a punitive place in which to practise medicine, and that puts some of our young people off doing so.