Dr. Rhona Mahony:

I really believe this is where clinicians and their patients need flexibility to look at the implications of health issues during pregnancy. Some women come into pregnancy with conditions of cystic fibrosis or portal hypertension and there may be a significant risk of that woman dying because of the additional physiological burden of pregnancy. Similarly, women can become ill during pregnancy and we need to interrupt the pregnancy prior to foetal viability. Once foetal viability is achieved, we can deliver a baby because of either maternal or foetal disease, and as I said, we do that all the time. A total of 2% of deliveries in this country occur early before term because a woman or baby is ill and we can deliver before term. It is prior to viability that the problem arises when we do not have the option of delivering a woman's baby. In those cases, we have to look at the risks to that woman and that is where clinicians need flexibility. I do not think it is appropriate that we somehow have to wait until a woman is at a substantial risk of dying because how does one define that? As I said, what is a substantial risk? Is it 5%, 10% or 50%? What of the woman's view? If I say to a women that she has a 10% chance of dying but I am okay with that, she might disagree with that and say: "Well, doctor, I am not okay with that." This is real-life medicine. We cannot predict the clinical course all the time with exact precision. We have clinical evidence, likelihoods and probabilities. Therefore, what clinicians and their patients require is flexibility.