'I do not want to wait until she's dying before I intervene'
“Do I have to wait until she is unwell, critically ill – at what stage can I make provision to offer her good, sensible healthcare? I do not want to wait until she is dying before I intervene, I want to protect her. I take into account her wishes as well.”
To say that women in Ireland never choose to terminate their pregnancy to safeguard their own health is inaccurate, she says. Some, who feel the risk of pregnancy is too great, will travel to a different jurisdiction to terminate it – before the risk to their life is closer to an “almost certainty” that permits termination here.
“These are not common cases but they do exist and I think one needs to make provision for that.”
Asked for her view of abortion on demand, Mahony says that is a decision for the people of Ireland. She regards situations where there is a threat to the mother’s health and life as being an obstetric decision, but that abortion on demand is a “social decision”. She believes there is a readiness in Irish society now for debate on termination in cases where the foetus is not viable.
Witnessing the public fall-out from the Galway case, Mahony also believes that people need to be reassured that any death of a woman in a maternity hospital, a “catastrophic, devastating event”, is always taken extremely seriously and investigated appropriately.
Nine women have died in Holles Street hospital since 2003, which is in line with the national figure of eight maternal deaths for every 100,000 births, and includes non-obstetric causes.
A death must be reported to the coroner who, after a post-mortem, will either decide an inquiry is not necessary or will, in the public interest, hold an inquest, which the family can attend. Medical staff explain what happened and can then be questioned through the coroner by families, who can also be legally represented.
At the same time the hospital will also closely examine all the circumstances surrounding a death, to see what lessons can be learned.
One problem, says Mahony, is that the hospital does not get the post-mortem results until after the inquest is held, because it is important that is done independently. However families sometimes think there is a big cover up, she says, because the hospital is unable to give them findings from the post-mortem.
“That is very difficult for us because you really want to tell the family everything.”
Irish maternity hospitals are also involved in an UK initiative under which a report on maternal deaths is produced and shared every three years. These are anonymous accounts, she explains, to avoid legal problems and to allow “a very honest appraisal of why a woman died”, in the hope of avoiding a similar case in the future.