Dr. Colm Henry:

The Deputy is absolutely right that the best time to make a decision is in advance, before any harm can ensue. In putting together this particular programme, we had to bear in mind that we did not want to alarm people who might, for example, have unstable epilepsy. We did not want them to stop taking their medications abruptly which could cause greater harm. The whole thrust of the programme was to ensure that they got the best and most expert advice, balancing the risks of changing or coming off medication against staying on medication which might harm a developing foetus. The bigger question to the Deputy refers is access to specialist care and advice. I presume she is not just interested in valproate but in other anticonvulsant drugs. Working with the epilepsy programme, led by Dr. Colin Doherty, we are developing a specific programme. We have now appointed two out of a planned six specialist nurses for pregnant women who are on anticonvulsant medication so that we can target them early with primary care and afford them the best advice. We want to ensure that their epilepsy remains stable because abrupt withdrawal can be quite harmful. We also want to make sure that they are on the safest possible medication at the safest dose.