Dr. Rhona Mahony:

On the question of maternal mortality and morbidity, we monitor those issues very closely. Indeed, the three Dublin maternity hospitals have been producing annual clinical reports for decades. In the case of the Rotunda, in fact, it probably has been done for more than 100 years or even 200 years. In addition to the year-to-year information, we can also plot the trends. At the moment, the maternal mortality rate is somewhere between eight and ten per 100,000, which compares very favourably with statistics internationally. In the United States, for example, where a much larger proportion of GDP is spent on the health budget, the maternal mortality rate is 17 per 100,000. In the United Kingdom, the rate is ten to 12 per 100,000, with similar rates in France and throughout Europe. In the Scandinavian countries, the rate is six to eight. We have, therefore, very low maternal mortality, although there are small differences there. Some 99% of maternal deaths occur in the developing world where mortality rates can be as high as 350 per 100,000 in any one country, which is a staggering figure.

In terms of maternal morbidity, approximately two women in every 1,000 pregnancies will have a very severe morbidity issue. These include massive obstetric haemorrhages, clots, venous thromboembolic disease, uterine rupture, etc. We have a list of very severe morbidities and we keep a record of their incidence nationally in conjunction with the National Perinatal Epidemiology Centre, NPEC, at University College Cork. Again, we can see certain trends from these data. If I were to comment on one such trend, it would be the rise in cases of haemorrhage. That is what worries me most as Master of the National Maternity Hospital, in particular the increasing incidence of postpartum haemorrhage. The other striking trend in terms of maternal morbidity is the increase in maternal age and maternal obesity, both of which have a significant impact on delivery and risk.