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No Confusion

IRISH DOCTORS SAY NO CONFUSION IN SAVING MOTHER'S LIVES

In the past few months some of Ireland's most experienced Obstetricians and Gynaecologists have come forward to say that they will always intervene to save a mother if a life-threatening condition arises in pregnancy.

While some of have expressed a desire for legal clarity, all have stated that women are safe in Ireland under the present Medical Guidelines.

    

Top obstetrician, Dr Sam Coulter-Smith Master of the Rotunda told a major conference of doctors in April 2013 that an intervention that is required to save a mother's life in pregnancy should not be called an abortion.

I think that is an important one because we are talking about a termination of pregnancy, bringing a pregnancy to a conclusion in order to save a mothers life - I don't think we should call that an abortion,

 said Dr Coulter Smith, who is master of Ireland's busiest maternity hospital.

He said that he was required to make such interventions four times last year, stressing they should not be called abortions.

"I think we should find another term for it," he continued. 

I think labelling a woman who has had an wanted pregnancy who has some sort of illness where we have to terminate that pregnancy, calling that an abortion, I think is wrong. It may seem like a small point but I think from the mother's point of view, I think it is hugely important.

Dr Coulter-Smith made his remarks at the Irish Medical Organisation's conference during a session entitled 'Medical Ethical issues from the Beginning to the End of Life'.

He added that for Irish Obstetricians in "these are situations where delivery of the baby has to be expatiated ...it is important to stress that absolutely all efforts are made to save the baby, the foetus, in all situations".

He also added that suicide should not be included as a grounds for abortion in any legislation. "Most people accept that termination is not treatment for suicide ideation," he told the medical audience.

Incredibly, the Irish Independent reported his remarks the following day under the headline: 'I carried out four abortions in past year to save lives, says doctor'

An irate-sounding Dr Coulter-Smith told the Today with Pat Kenny Show on RTE that morning that the headline was factually incorrect and irresponsible.


News in the Journal re Sam Coulter Smiths comments



Professor Fionnuala McAuliffe who is spokesperson for the Institute of Obstetricians and Gynaecologists has said that doctors do intervene to save the life of a pregnant woman, even if it means the loss of a baby and that there was "no evidence they [doctors] are letting people die".

She said obstetricians believed they had the freedom to intervene to save a woman's life, even if it meant the loss of the unborn baby.


Dr John Monaghan on Newstalk: The whole thing has become very inflamed. We cannot at this stage judge what the true medical facts were. I cannot see how legislation would have influenced this particular scenario. In the light of the [Medical Council] guidelines I quoted to you a few minutes ago, it would be legitimate under the current regulation that a doctor would intervene to deliver the baby in the situation where the mother has become septic. To me as a clinician that would fit in with those guidelines. So I am not sure how legislation could deal with this particular case as I understand it.


Dr Rhona O'Mahoney of Holles Street told Newstalk that "women can be assured that if they need treatment, they will get it in this country. The standard of care if very high. If a termination of pregnancy is indicated to save her life, that termination will be done. They can rest assured that that is the case. Thats how things stand at the moment."


Dr Sam Coulter-Smith, master of the Rotunda Hospital in Dublin and consultant in obstetrics and gynaecology, said he sees no evidence of confusion in medical ranks in Ireland over whether or not a woman can have an abortion if her life is at risk.

He said it would be preferable to have legislation to bring clarity, but he said that in his experience he has not seen confusion among doctors on whether a woman is entitled to an abortion on clinical grounds.

“No. Not in relation to where a mother’s health is at risk,” he told the Independent.

Dr Coulter-Smith is also clinical professor of obstetrics and gynaecology at the Royal College of Surgeons in Dublin and has headed the Rotunda for the last three and a half years.


Medical Council President Professor Kieran Murphy told the Irish Times that its current guidelines on abortion were decided in 2009 and reflect the current legal position.

Prof Murphy said the guidelines were prepared after extensive consultation with the public and the profession.

He added that the guidelines are as accessible and as straightforward as possible and had received a plain English recognition mark.

Psychiatrist Dr Siobhán Barry said that an assessment of a woman for suicide risk would typically look at how she previously dealt with life’s reversals. Any suggestion that a woman would think of ending her life “out of the blue” because of an unwanted pregnancy was misplaced, she said.

“The risk is being portrayed as overwhelming or of sudden onset when clearly the person involved will generally have a track record,” she said.

In over five years’ practice in the UK, Dr Barry never once saw a case of a woman who had terminated her pregnancy on the basis that she wasn’t able to cope, she said. Later, when working at the Coombe for 12 years, she said she saw “very few” women in a state of suicidal crisis.



From Hindu Times: The president-elect of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), Gynaecologist Hema Divakar, has commented on the actions of the physicians in Galway who treated Savita Halappanavaar. She said that had they aborted the child, as has been suggested in the outcry since her tragic death, it may have been equally dangerous to her.

Although the facts of the case are not clear yet, she said that “based on information in the media, in that situation of septicaemia, if the doctors had meddled with the live baby, Savita would have died two days earlier.”

Top Indian expert says abortion would not have saved Savita's lifeThe president-elect of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) , Gynaecologist Hema Divakar, has commented on the actions of the physicians in Galway who treated Savita Halappanavaar. She said that had they aborted the child, as has been suggested in the outcry since her tragic death, it may have been equally dangerous to her.

Although the facts of the case are not clear yet, she said that “based on information in the media, in that situation of septicaemia, if the doctors had meddled with the live baby, Savita would have died two days earlier.”

Dr. Divakar's assertions were printed in the Indian paper The Hindu. The case has received a lot of public attention in India where the most prominent immediate reaction was to criticise the hospital's decision not to intervene to terminate Ms. Halapanavaar's pregnancy, by medical or surgical means.

Dr. Divakar disputed the now widely made assertion that abortion could have saved her life. Giving her opinion, she said that “Delay or refusal to terminate the pregnancy does not in itself seem to be the cause of death. Even if the law permitted it, it is not as if her life would have been saved because of termination,”

She said that it seems from the available information that “Severe septicaemia with disseminated intravascular coagulation (DIC), a life-threatening bleeding disorder which is a complication of sepsis which leads to major organ damage and loss of the mother’s blood due to severe infection, was the cause of death in Savita’s case." She added that "it is a sequence which cannot be reversed just by terminating the pregnancy.”

Dr. Divakar said that when infection requires aggressive treatment [at 17 weeks gestation] "the usual practice is to meddle the least until the mother is stable."

"This appears to be the actions taken by Savita's doctors," she said.


Letter from Doctors Cork / Kerry

One of Cork's most senior emergency doctors is among almost 20 medics who have written to TD's to voice concerns about the proposed legislation on abortion. 

Both Dr Stephen Cusack of Cork University Hospital's emergency department and the hospital's oncology registrar Dr Alan O'Shea have signed a letter being sent to politicians by doctors from Cork and Kerry. 

The letter was published on Evening Echo Thursday, June 27, 2013, under the following title, Abortion Plea: 

In the interests of the wellbeing of our patients, we feel compelled to make this statement regarding the proposed legislation for abortion as a medical intervention for suicidal ideation.

As practicing doctors, we all know that there is no evidence to support abortion as a solution for this or any other psychological symptom. 

Psychiatrists are virtually unanimous on this point, and obstetricians agree that this lack of evidence presents a dilemma for their members.  

Any changes to medical practice should be based on good scientific and clinical evidence. 

Ireland, with one of the lowest maternal mortality rates in the world, is among the safest countries in the world for maternal care. 

This legislation, if passed will allow doctors to engage in practices which are not evidence-based and will undoubtedly affect the standard of care given to pregnant women, who deserve to be treated in line with best practice, as well as with support and compassion from the entire medical community.  


Signed by 40 doctors from Cork and Kerry including the following from Cork:  

  • Dr Brendan Crowley, GP 
  • Dr Ann Denise Kiely, GP
  • Dr Audrey Russell, GP 
  • Dr Helena O'Regan, GP 
  • Dr Siobhán Crowley, GP 
  • Prof Stephen Cusack, 
  • Professor of Emergency Medicine (Cork University Hospital) 
  • Dr Shane Hurley, GP Dr Helen Barrow, GP 
  • Dr Alan O'Shea, Oncology Registrar (Cork University Hospital) 
  • Dr Rachel Quigley, GP Dr Fiona Kelly, GP 
  • Dr Fionnula Murphy, GP 
  • Dr Emma Tobin, GP Dr Bríd O'Brien, GP Trainee
  • Dr Yvonne Nunan, GP 
  • Dr Attracta O'Carroll Burns, GP Dr Olivia Barry, GP

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