Having a baby in Ireland ... Having a baby in Australia

Jennifer O’Connell: Babies die because of limited access to ultrasound in Ireland

I didn’t know what “no nasal bone” meant in practice, but I knew it was nothing good. Photograph: Getty Images

I didn’t know what “no nasal bone” meant in practice, but I knew it was nothing good. Photograph: Getty Images

 

“I’m sorry, but I’m just having a bit of trouble locating a nasal bone.”

Time slowed down when she said those words. Our bright and easy conversation dried up. My husband squeezed my hand.

“You’re having trouble locating it, or it’s not actually there?” I asked.

She didn’t answer. Instead, she suggested I go to the bathroom and get more comfortable.

On the combined statistics, my baby had a one-in-25 risk of an abnormality

Alone in the bright cubicle down the corridor, I wiped the gel off my newly rounded stomach and considered what might happen if I just stayed there, if I didn’t return to lie on the PVC chair in the dimly light room, and to my husband’s concerned, expectant face, and to those words that might mean nothing, or might change everything.

I didn’t know what “no nasal bone” meant in practice, but I knew it was nothing good.

The days that followed were a blur. There was an appointment with the consultant in foetal medicine, where he swiped through page after page on his computer screen and used words like “marker for chromosomal abnormality”.

On the combined statistics, my baby had a one-in-25 risk of an abnormality. Confusingly, on the missing nasal bone alone, the risk of nothing being wrong was one in 100. I had a CVS biopsy (to check for chromosomal abnormality) and turned my face away from the screen so I didn’t have to see the needle penetrate the placenta.

In the day afterwards, while I waited for the results, I bought the baby a hamsa hand necklace, an ancient Middle Eastern and north African symbol that was supposed to bring blessings and protection. I walked to a park overlooking Sydney harbour and sat on a bench while people threw sticks for their dogs and held the hamsa pendant tightly in my hand.

I was still holding it when the call came. I didn’t yet know for certain what I would do. As it happened, I never had to find out.

It was good news. A perfectly healthy little girl. Five months later, she was born with dark hair and dimples and a button nose.

No fear or anxiety

If I had been in Ireland during that pregnancy, I might never have had those days of fear and anxiety. Statistics published recently revealed that a foetal anomaly ultrasound at 20-22 weeks is offered universally to all women in only seven of Ireland’s 19 obstetric units. It is offered selectively to some women in a further seven. And in the remaining five units, it is not offered at all. Overall, fewer than two in every three women are given a foetal abnormality ultrasound and just less than one in two are given a first-trimester ultrasound.

If I had been having my daughter in Ireland instead of Australia, I might well have been spared the worry and the anxiety. I might not have been trusted with the information at all. And somehow, that would have been so much worse. Because even in the worst, darkest moments, I recognised that I was lucky: it was a privilege to be trusted to make the right decision for myself, for my family, for my child.

I suppose we’re numb to it all, resigned to being treated like an insentient, walking uterus

When the report Maternity Ultrasound in the Republic of Ireland 2016: A Review was published, the reaction was muted. There was no outcry, no fury, even though the Royal College of Obstetricians and Gynaecologists, the National Institute for Health and Clinical Excellence and even the Department of Health recommend the two-stage ultrasound approach.

I suppose we’re numb to it all, resigned to being treated like an insentient, walking uterus. We’re so used to being denied autonomy that being denied information doesn’t seem like such a big deal.

Information is power. In this country, mothers are not supposed to have power.

What’s the hold-up?

It is a big deal. In the words of the report: “Internationally, the widely accepted minimal schedule for antenatal ultrasound comprises two examinations; a dating ultrasound in the late first trimester, followed by a foetal anomaly scan, usually performed between 20-22 weeks’ gestation.”

If a foetal anomaly is detected at this stage, “planned delivery of the infant at the right time and in the correct place can be facilitated, thus enabling rapid access to appropriate neonatal intensive care, which may ultimately reduce neonatal morbidity and mortality. Diagnosis can also provide adequate time to psychologically prepare parents.”

That’s why the UCC professor of obstetrics and consultant obstetrician and gynaecologist Louise Kenny warned earlier this year that “babies will and do die as a direct result of a lack of access to ultrasound”.

I was one of the very lucky ones: chance fell on my side, and I didn’t have to find out

A clue to why there has been such a delay implementing the recommendations of the Department of Health – and why there has been no expansion in Irish maternity ultrasound services in the past decade – comes elsewhere in the report.

“Some major foetal anomalies are also detectable in the late first trimester and when diagnosed can facilitate parental choice with respect to continuing with or terminating the pregnancy.”

I still don’t know what I would have done. I was one of the very lucky ones: chance fell on my side, and I didn’t have to find out.

But there was comfort knowing that, if things had been different, the choice would have been mine – ours – to make.

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