'I do not want to wait until she's dying before I intervene'

Existing rules do not help in assessing when a risk to health becomes a risk to life, says the Master of the National Maternity Hospital at Holles Street, writes SHEILA WAYMAN

The Master of the National Maternity Hospital is a woman under pressure. When I arrive at the agreed time for an interview, I am told at the front desk of the antiquated building on Holles Street that there are others waiting ahead of me. The “others” sitting in the small entrance hall waiting for Dr Rhona Mahony include a significant one – the Minister for State at the Department of Health, Alex White.

When Dr Mahony arrives about 10 minutes later to greet White, an apologetic secretary says that she is not sure how long I’ll have to wait as the master also has to go down to theatre.

Being the head obstetrician at a hospital with 700 staff and where about 27 babies are born each day is an onerous responsibility. She wears the stress lightly, although with the country convulsed over the death of Savita Halappanavar and the issues arising from that, everybody working at the coalface of the maternity services must be particularly deeply affected.

Mahony is concerned that neither Medical Council guidelines nor legislation address situations where the degree of risk to a woman’s life, if a pregnancy continues, may be difficult to assess.

“If we think is a woman is going to die, we can terminate the pregnancy – and we do – and there are no issues surrounding that,” she explains.

“But there are areas where we are not sure how to quantify the risk to life, and indeed the risk to health, and there is an overlap between the two – when does the risk to health become a risk to life?

“It can be difficult in practice to make a clinical distinction between threat to life and threat to health, therefore there is a degree of legal uncertainty.”

Doctors need to be able to exercise professional judgment without fear of prosecution, she stresses, “and at the heart of all of this is our wish to look after women the best way we can”.

For instance, more women with serious underlying diseases, such as congenital heart disease, or significant chest or liver disease are now, thanks to improved healthcare, living to an age when they may become pregnant. But the extra burden of pregnancy can significantly impair health and pose a significant risk of mortality.

“When she comes in at 12 weeks gestation she may be very well but I am looking at the effect of this pregnancy as it progresses,” says Mahony, who does not believe it is clear exactly when, in such a case, she is permitted to intervene.