Professor Richard Greene:

The question was why we did not have a proper reporting system. Deputy Billy Kelleher asked it. There are a number of things going on and sometimes people get mixed up about exactly what is happening. The majority of our statistics with respect to perinatal mortality, that is, babies who die during pregnancy or in the first week after pregnancy, are provided officially through the birth registration form which goes to the CSO and what was the ESRI but is now incorporated into the hospital pricing office in the HSE. That is where the information comes from. The national perinatal centre was set up to look at perinatal health. It collects data directly from hospitals on a voluntary basis. The information collected is not just on babies but also mothers. The centre is also involved in maternal death inquiries. There are always issues in respect of this kind of information. While I know that it is not kosher today, it absolutely gets to the point to look at maternal deaths. A maternal death inquiry is a confidential evidence-based inquiry which adopts what is considered internationally to be the appropriate approach. It is based on the English system. We pick up about two and a half to three times the number of maternal deaths found in the official statistics. There are reasons for this which we have pointed out in many of the reports in the past few years. In fact, we have started to work with the CSO on that issue in order that we can both ensure we are getting the appropriate numbers.

The centre takes data on babies who, sadly, die. As a practising obstetrician, I note that this is an area that is extraordinarily difficult in terms of management and very pressing and devastating for patients with life-long effects. It also has an effect on us as staff. It is an area that is extraordinarily sad and difficult, but it is also an extraordinary area in which to practise as we can have a great effect in helping people through it.

When a baby dies in a hospital, the report on the event is a completed audit form. It is not just that a baby died but it takes in information about the pregnancy, the mother, time of death and any clinical information on the baby that is available. This allows us to look at perinatal death and the causes.

Every one of these babies and their families are extraordinarily important. It is also important to remember, however, that annually in this country about 450 babies die. Up to 150 of those are associated with congenital anomalies which puts them at a slightly higher risk. The others are associated with many causes, some of which are difficult to detect. One we are now beginning to learn about is that some babies do not grow as well in the womb which accounts for 50% of the normally formed babies who die during pregnancy or around the time of delivery.

We are interested in more than just numbers. We go behind the numbers to find out what happened. One issue associated with one of the reports on Portlaoise was over numbers. There was an issue between the numbers from the CSO, the ESRI and ours. Statistically, it depends on what definition one takes. This country’s perinatal mortality rate for all babies over 500g is just over six per 1,000. That equates to a not insignificant number in total. It is as good as, or better, than most of our European counterparts and internationally significantly better than some very wealthy countries. Norway and other Scandinavian countries are held up as being so much better than us. They quote a figure of about two per 1,000 which makes us look bad. However, if we take the same definition they use, then our rate comes in at 2.1 per 1,000.

We are good at what we do but we still have a significant number of families affected every year by perinatal loss. Sometimes, unfortunately, families and potential parents are not aware of that. I do not believe we will ever completely stop this but we can reduce the numbers. To do that requires investment by us academically and by the health services. That requires society to decide that this is important.

The comparison I drew last week, which may be interesting to the committee, concerned road traffic accidents. There is rarely a day when one turns on the radio that one will not hear about road traffic accidents from the Road Safety Authority, and appropriately so. There are 160 to 180 deaths per year on the roads. Up to 450 babies die. We need to have an understanding of exactly what is going on.

The reporting system we have is adequate. Where it falls down is sometimes around definitions. It could be assisted by having a full-time committed officer to collect and produce this information annually. Like many tasks in our health service, many of us are doing this in addition to our full-time jobs.