Serious risk to health is a crucial reason to vote Yes on repeal

‘YOUR health is your wealth” as my grandmother used to say back in the day, but health can be subjective. For the woman with multiple sclerosis, health may be walking her children to school or doing her own shopping. For the man with epilepsy it may mean being seizure free long enough to allow him to drive a car safely and maintain his independence. To the teenager with bipolar disease it may be the ability to stay in the community for care and continue in schooling.

For those of us in a health bubble who have no major, medical illnesses it can be difficult to quantify what is meant by a serious risk to health. As a working obstetrician, I know what serious risk is. I have met women who expect one thing (a healthy happy pregnancy) and end with another (a stay in intensive care, a major bleed, a clot in their lung, an infection due to pregnancy) so it tends to put everything into perspective. I am grateful for my health and for the health of my family and friends, but respectful of how things can change in an instant.

What exactly does serious risk to physical or mental health mean? It means the woman with kidney disease who now requires dialysis. Prior to pregnancy she may have attended a hospital once a year, now it’s three to four times a week. Life must continue during dialysis – children brought to school, husband going to work, GAA training organised, projects completed, but she must ask others to help or do.

Serious risk to physical health means the woman with diabetes who is unable to control the changes in her sugars brought on by a pregnancy. Her eyes can be affected by the fluctuating levels of sugar and despite advances in treatment her vision is deteriorating and she is going blind.

Serious risk to physical health means that a woman who has waited for a liver transplant and been lucky enough to win that lottery, who has waited a couple of years to ensure she was safe for pregnancy and now faces concerns that her transplant is unexpectedly being affected by her pregnancy.

Serious risk to mental health is the woman who has gathered together multiple boxes of paracetamol and drafted a letter to her family. Serious risk to mental health is the woman with schizophrenia or bipolar disease whose medications may have been changed to more pregnancy-friendly versions, or stopped against advice in a misguided attempt to protect her pregnancy. She is now so unwell that she cannot distinguish between reality and the world of her mind.

Serious risk to health is the previously healthy woman whose waters have broken too early and where risks must be balanced between birth and infection. Serious risk to health is the previously healthy woman who has a problem with the afterbirth resulting in persistent bleeding, requiring multiple blood transfusions.

IN 2013, 365 women in the Republic of Ireland had a severe complication in pregnancy. For the clear majority of women these occurred in the third trimester of pregnancy, after six months when the foetus is viable outside the womb.

Relevant clinicians would be involved in the discussion with the woman and her partner and delivery may be recommended with the support required to maintain safety and care. The birth would be

A woman may need to end a pregnancy but I can’t yet do anything. There may be a serious risk to her health, but there is not substantial risk to her life

that most appropriate to individual circumstances and appropriate intensive, medical, surgical and neonatal care provided. The aim is a healthy mother and healthy baby.

Very occasionally, a serious risk to the mother’s physical or mental health will occur in the first or second trimester, before viability. Risk to health and potentially to her life are high, the chances of continuing pregnancy to viability without meeting these risks are increasingly small. It’s an incredibly difficult situation. To maximise appropriate management all appropriate clinical staff are drawn in to assess and discuss.

I have been the doctor in this situation where a woman will face the facts that her health and potentially her life are at risk and she may need to end a pregnancy. Her partner will hold her hand and cry with her but agree. Her mother will talk about how much she wanted a grandchild, but how she wants a healthy daughter more.

There will be intense sadness in this unwanted situation, but a small nugget of hope that should health be maintained that there may be potential in the future for another chance. And I will then have to explain gently that I cannot yet do anything.

There may be a serious risk to her health, but there is not a real and substantial risk to her life, which can only be averted by ending her pregnancy. She may be too ill to travel to another jurisdiction. And we must wait.

As a working obstetrician, the Eighth means that I can’t give a woman the help and support she needs at the most desperately dark time of her life.

We need to vote Yes on May 25 so that obstetricians have the space and capacity to provide proper support and care for women and her family when her health is put at serious risk by a pregnancy.