Concern over partial abortion procedures

The Master of the Rotunda Maternity Hospital acted out of concern for both patients and the reputation of Irish maternity services when he wrote to health officials warning about the growing trend of women diagnosed with fatal foetal abnormalities returning to Ireland to give birth to stillborn babies after undergoing a partial abortion procedure in the UK.

Speaking to the Irish Examiner, Dr Sam Coulter-Smith said he raised the issue with Department of Health’s chief medical officer, Dr Tony Holohan, because he was concerned that women were “having an intervention in one jurisdiction” before travelling back to Ireland for the baby’s delivery.

“The chance of something going wrong is small, but the impact is very high,” Dr Coulter-Smith said.

The fallout was “multi-factorial” he said, impacting on the patient “physically, emotionally, psychologically and financially”, especially when they had to travel for treatment, which he said was “very sad and very difficult”.

But there were also potential ramifications for the Irish health service.

“There is the risk of reputational damage to the Irish health service and to the Irish maternity services and it’s just one more thing to go wrong,” Dr Coulter-Smith said.

The Irish maternity service has had a torrid time in recent years with a number of high-profile cases where pregnant women died while in hospital care.

Last week a jury in the inquest into the death of 29-year-old Dhara Kivlehan returned a verdict of medical misadventure.

Ms Kivlehan died of multiple organ failure in 2010, a week after an emergency caesarean section.

Dr Holohan has said he is “very concerned about the patient safety implications” of the issue raised by Dr Coulter-Smith. He said a meeting took place between Dr Coulter-Smith and health officials to discuss the matters raised.

A statement from the health department said: “The Chief Medical Officer has taken initial soundings which appear to indicate that this practice has not been identified in every maternity service in Ireland. However, it is too early to say that it is confined to the Rotunda. The Chief Medical Officer intends to communicate with the Institute of Obstetrics and Gynaecology and the National Clinical Programme for Obstetrics to establish the further extent if any of the practice.”

Dr Coulter-Smith said yesterday he was upset his letter was leaked — it was reported on RTE’s Prime Time programme — because he “hadn’t had the chance to complete the conversation” with the department. He said the matter was “still under discussion”.

The matter raised involves women travelling to the UK for the first step in a two-part termination procedure, the first part of which involves the administration of an injection to stop the heart of the foetus once the women has passed the 22 week point of her pregnancy.

The woman is then given drugs to induce the birth and asked to return to the hospital at an appointed time for the second step, the delivery of the baby. Dr Coulter-Smith said women are returning to Ireland for the second step.

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