Mr. Peter Thompson:

If we talk about late diagnosis, some conditions only present late. The other case that I described in the papers, microcephaly, whereby the brain is not growing normally, usually only presents after 24 weeks. Even if a woman has a history of having a previous baby with this, in many cases she has a 1:4 chance of having another baby affected in the same way. We would have to scan those women all the way through their pregnancy. Sometimes the head size appears normal until they get as far as 28 or 32 weeks and suddenly it becomes apparent that the baby has microcephaly. That is important.

With regard to foetal awareness and pain, the Royal College of Obstetricians and Gynaecologists has studied the literature on this, and regularly comes out with definitions of it. Last time it said the evidence that the foetus can and does experience pain is less compelling and accordingly the benefit of administering analgesia is less evident while the risk of the practicalities of so doing remain. On the basis of first do no harm, prior to the procedure described in this report, analgesia is no longer considered necessary from the perspective of foetal pain or awareness. The previous report had suggested that we should give analgesia to the foetus in case the foetus felt pain. After that it suggested that it was not necessary. I am not an expert on foetal pain but that is the Royal College of Obstetricians and Gynaecologists' position.

I think Irish women are greatly disadvantaged. In the UK, not long ago, there was, and there still is, a shortage of sonographers and many units stopped doing 20 week scans. We have had to train up many of our midwives who perform ultrasound scans to get a new cohort of professionals to do this. It should be something that is available to everyone. Ultrasound depends on how large the woman is, in women who are overweight the views are less good. Women are often brought back for a second look. We talked about doing it between 18 and 22 weeks but if we do it at 18 weeks we have to bring back a greater proportion of women for a second look and we end up doing more scans overall. That is why most people settle for around 20 weeks as their best evidence.