Peter Fitzpatrick (Louth, Independent) | Oireachtas source

The importance of ultrasound for determining the gestational age of the unborn child and for protecting the life or health of the woman who is undergoing an abortion cannot be overstated, particularly in circumstances where there are concerns about dating the pregnancy or where there is an ectopic pregnancy. Dr. Peter Boylan, chairperson of the Institute of Obstetricians and Gynaecologists, explicitly informed the Joint Committee on Health on 19 September 2018, when it was discussing the clinical guidelines for the introduction of abortion services, that from nine to 12 weeks women will require hospital management which in turn raises the question of ultrasound as a dating mechanism.

According to Dr. Boylan’s testimony at the committee, figures can vary but in Scotland, for example, approximately 30% of women will require a scan for uncertain dates and the figure here will probably be similar. He also spoke about the risks of introducing a termination of pregnancy service without having adequate scanning facilities in place and noted current infrastructural deficits in the provision of access to ultrasound services during pregnancy in Ireland. This deficit raises very serious concerns with respect to the intention of the Minister for Health to have abortion services rolled out nationally as early as January of next year. These concerns were confirmed by Dr. John O’Brien, speaking on behalf of the Irish College of General Practitioners, ICGP, in reply to a question from Deputy Stephen Donnelly. Dr. Mary Favier of the ICGP also informed the committee that the evidence base on the need for ultrasound scanning is becoming clearer. Dr. Favier added that if ultrasound is required, rapid access to this facility, including the expert provision and interpretation of sonographs, will be a critical element of the pathway. In addition, a 24-hour helpline, staffed by appropriately trained clinical staff, will be required. Dr. Favier further noted that GPs have expressed concern regarding capacity and resourcing challenges in areas such as staffing, facilities and training, the potential lack of appropriate specialist support, the possibility of medical complications for patients, and a fear of litigation. All of these points underscore the necessity of introducing a legal obligation to perform an ultrasound for both the woman and her doctor. The taking of mifepristone and misoprostol, the so-called abortion pills, in the absence of an ultrasound can lead to potentially catastrophic blood loss for the woman concerned.

Confirmation of gestational age is also required for compliance with section 13 of the Bill, which deals with certification relating to early pregnancy, that is, prior to 12 weeks. This underscores the fact that ultrasound will become a routine part of care in this area.

In light of the experts' view of ultrasound as forming a key part of dating pregnancy and determining foetal age, it appears to be reckless in the extreme to even contemplate rolling out abortion services nationally in the face of such challenges in accessing ultrasound. It was a key concern of the Citizens’ Assembly in its ancillary recommendation that all pregnant women, regardless of geographical location or ability to pay, should have access to early scanning and testing. Amendment No. 44 seeks to ensure there is a clear framework in place regarding the duties on medical personnel to use ultrasound in a manner that is clear in law. The amendment offers clarity and certainty for medical personnel, which the Minister repeatedly insists he wants to be provided in the legislation. It also provides clarity and certainty for women and in no way restricts their access to termination of pregnancy.

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