Pregnancy and adverse outcomes


Sir, – I am in complete agreement with your columnist Jacky Jones in her declaration that “pregnancy is a normal event” (“Will the new standards for maternity services make a difference to women’s health?”, Second Opinion, January 23rd).

The women of Ireland may welcome the reminder of an insight that has been passed down by our forebears for millennia. Unfortunately for thousands of Irish couples every year, nature does not behave as benevolently as Dr Jones would expect in translating a “normal event” into a normal outcome.

There is no more frustrating aspect to the work carried out by those who provide pregnancy care than the inability to predict adverse pregnancy outcomes.

Dr Jones’s simplistic interpretation of the maternity strategy as cleanly stratifying women into “low risk”, “medium risk” and “high risk” as a means of determining which pregnancies can be managed without medical input ignores the most glaring truism in pregnancy: that the vast majority of adverse outcomes (foetal abnormalities, pregnancy loss, preterm birth, birth injury, haemorrhage) occur in pregnancies of “low-risk” women.

Dr Jones portrays an image of professionals who vie for control of pregnancy, a depiction that is at variance with the first-hand experience that I can offer of our maternity services, having worked in a maternity hospital almost every day of the last 20 years.

In that time I have never witnessed, not once, the inter-professional conflict that Dr Jones depicts. Obstetric care is impossible without highly skilled midwives, and our collaborative interdependence is a two-way street.

Dr Jones does all maternity service professionals and users of our service a grave disservice by suggesting otherwise.

I further suggest that your headline declaring “Pregnancy is a normal life event” is wholly insensitive to the thousands of Irish couples for whom the pursuit of a family has been anything but. – Yours, etc,



Rotunda Hospital,

Parnell Square, Dublin 1.