About 95 per cent of parents whose babies are diagnosed with Down syndrome at the Rotunda Hospital in Dublin choose to have an abortion, according to the master of the hospital.
Prof Fergal Malone says the Rotunda strives to be non-directive in its counselling to affected parents. “The 95 per cent who choose to travel do reach that decision themselves. We very much do not advocate for termination,” he said. “The reality is that the vast majority choose to terminate. I don’t have a view on whether that is the right thing. We don’t advocate for it, that is just the lived experience.”
Although the risk of Down syndrome can be identified as early as nine weeks into pregnancy, confirmation of the diagnosis usually takes about 12 weeks, which is the cut-off for most terminations under Irish legislation introduced in 2019.
Down syndrome, unless accompanied by another life-limiting condition, is not a fatal foetal anomaly under the legislation, so affected women seeking a termination after 12 weeks have to travel abroad for the procedure.
According to Down Syndrome Ireland, one baby with Down syndrome is born out of every 444 births. The Rotunda said in 2018 that between 20 and 25 babies with Down Syndrome were born in the hospital every year.
The Rotunda currently carries out about 30 to 40 terminations a year involving a fatal foetal anomaly. In another 20 to 30 cases the foetal anomaly does not meet the criteria under the legislation and the women involved travel abroad for a termination.
Prof Malone says the “paternalistic” requirement in termination legislation for women to wait three days before going ahead with the procedure should be removed.
“I don’t think I can come up with any other example of healthcare – not transplantation or cancer surgery, for example – where we require someone to go through an informed consent process with a doctor and is then required to go away and come back in three days to reaffirm their consent.”
While figures show about 5,000 women who had initial consultations about a termination with a GP over a three-year period did not go ahead with the procedure, Prof Malone says miscarriage is a more likely explanation than a change of mind for many of these cases.
Prof Malone, who completes a seven-year term as master at the end of December, is critical of an “expectation of perfection” in maternity care: “There are a certain number of stillbirths every year, a certain number of babies born with cerebral palsy, even when care is correct. If that is thrown back on ‘that midwife messed up, that doctor didn’t do X’, that’s a problem.”
Although the Government plans to move the Rotunda to Connolly hospital, he believes there is no prospect of this happening for 20 years, and suggests that decision could be revisited.
In the interim, the State’s busiest maternity hospital is building a new critical-care wing on its city centre site. To make way for this, women visiting outpatient services will be seen off-campus, in a building purchased by the HSE for the hospital.
With more women delaying having babies and greater access to fertility treatments, more than a quarter of mothers delivering at the Rotunda are now aged over 35, he says.
Earlier this year, there was controversy over the selection of Prof Sean Daly as the next master of the Rotunda, ahead of two other women professors in the hospital. Defending the selection of his successor, Prof Malone says the appointment was handled “completely in compliance” with the standards in place.