Two leading obstetricians have told an Oireachtas committee that pregnant women are exposed to an "unacceptable level of risk" due to the lack of availability of ultrasound scans.

Louise Kenny, Professor of Obstetrics at University College Cork, and Dr Peter Boylan, Chair of the Institute of Obstetricians and Gynaecologists, both expressed deep concerns at this morning's meeting of the Oireachtas Health Committee.

Dr Boylan said: "We wish to see all units have access to expert ultrasonography services for all pregnant women. At the moment there is a huge variation in availability of ultrasound for pregnant women around the country. 

"This has serious implications for the quality of care which can be given to women in pregnancy."

Adopting a similar tone, Prof Kenny, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital, said: "We once again reiterate the need for equal access for all women to standardised ultrasound services.

"At the current time, neither specialist ultrasound nor foetal medicine services are available to all pregnant women in the Republic of Ireland.

"Even in Cork University Maternity Hospital, a tertiary-level referral unit, where over 8,000 infants were born in 2016, we cannot provide second trimester foetal anomaly scanning for the majority of pregnant women attending for antenatal care.

"This issue remains unresolved in 2017 and exposes pregnant women attending CUMH, as well as their health care providers, to an unacceptable level of risk."

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Ireland has the lowest number of obstetricians and gynaecologists among the OECD countries and urgently needs to recruit a minimum of 100 extra maternity consultants, according to Prof Kenny and Dr Boylan.

Prof Kenny said that at a rate of 3.95 per 1,000 live births, Ireland has just over half the number of consultant obstetricians and gynaecologists as the UK for the same number of births.

On the issue of governance of maternity hospitals, Dr Boylan said: "The current governance model whereby maternity units around the country are integrated into the general hospitals is a failure. 

"Recent problems in Cork and Portlaoise are good examples of this. This has been demonstrated repeatedly over the past several years by well documented tragedies."

Representatives from the Health Service Executive, the Institute of Obstetricians and Gynaecologists and the Irish Nurses and Midwives Organisation are before the committee to discuss the National Maternity Health Strategy 2016-2026.

INMO Vice President Mary Leahy welcomed the new maternity strategy but stressed the need to increase the number of midwifery posts by 100 for each of the next four years.

She said the workforce is under serious pressure due to staffing resources and "there is a complete absence of workforce and manpower planning."

The INMO said there is a health service-wide issue with recruitment and retention of staff and this is the case within the midwifery area.

'Poor are disadvantaged across the board'

Dr Boylan later said that pregnant women outside Dublin who cannot afford to privately pay for ultrasound scans are disadvantaged.

Fine Gael TD Kate O'Connell asked the obstetricians what issues arise when pregnant women do not get a 20-week ultrasound scan. She also asked how many people pay for the scan and: "Is this a class issue?"

Dr Boylan said it is hard to say how many women pay for an ultrasound scan but acknowledged: "You are absolutely correct the poor are disadvantaged across the board and don't have access to the same sort of ultrasound services outside of Dublin. In the three Dublin maternity hospitals they do. There's no sort of distinction with regard to ability to pay." 

Prof Kenny said that in Cork "less than half the women are able to access the 20-week scan".

She said that a few years ago that figure was slightly better but cited the loss of staff and the fact that specialist staff have not been replaced as reasons for this decline. 

Prof Kenny said: "In Cork we are two-and-a-half hours by road from Dublin. If a baby is born with hypoplastic left heart; it needs to be assessed immediately after birth and transferred to specialist services.

"If that baby has been unidentified prior to birth because of the lack of the 20-22 week scan, that whole process has to take place ex-utero with a critically ill baby in an ambulance.

"That is the most disadvantaged start that child will have and will absolutely have an impact on its chances of survival. That is a devastating event for a family."

Earlier, Sinn Féin TD Louise O'Reilly pointed out that she asked the HSE about the availability of the 20 week scan.

"What they advised me initially that the scans are available to patients and listed a number of hospitals. They initially said they are routinely offered and provided but this is not the case. They revised their response and told me that they are available."

National Director of the HSE's Acute Hospitals Division Liam Woods said there are six sites where 20-22 week scans are available to all patients - Holles Street, the Coombe, the Rotunda, Galway, Cork University Hospital and with a slight variation the University Hospital Limerick "where it requires clinical decision."

Senator Alice Mary Higgins, interrupted and pointed out that we heard it was 50% of patients in Cork who get a 20-week scan.

Mr Woods said: "We can come back to you with precise current data if it is helpful."

He added: "As part of out overall strategy, we will have to look at the need to invest in this area of the service along with all others.

"I would expect the plan will set out our journey forward here and the investment requirement in terms of equipment and personnel."

He acknowledged "it is a deficiency and it is something that will have to be acknowledged in the plan."

Committee chairman Michael Harty asked what are the big inhibitors to the HSE providing such a basic part of obstetrics - a routine scan.

Mr Woods said: "the adequate availability of appropriate personnel and equipment would be our key challenges."

He spoke of the need for a workforce plan and how are to attract and attain appropriate personnel.

"The key deficiencies for us would relate to clinical and diagnostic personnel within the system and probably to a lesser extent equipment", he said.

Mr Harty pointed out that investment in ultrasound would have a huge knock-on saving in the future in that illness in unborn babies would be identified before they are delivered and it would prevent litigation.

Mr Woods said that the HSE Primary Care Services have invested in a range of externally provided ultrasound services from Letterkenny down to Tralee and along the west coast, and is providing direct access for GPs to ultrasound and is supporting hospitals that are struggling to deliver in terms of total volume and demand.