Around 36% (23,300) of women who attended antenatal services in Ireland last year did not receive a foetal anomaly ultrasound, a leading professor of Obstetrics has told a Dáil committee.

Professor of Obstetrics at UCC and Consultant Obstetrician at Cork University Maternity Hospital Louise Kenny said we are providing "inadequate care" to mothers and babies, "which impacts upon clinical outcomes, sometimes with devastating consequences."

She is before the Oireachtas Health Committee.

Usually performed between 19-22 weeks' gestation, the main purpose of the fetal anomaly scan is to screen for structural foetal abnormalities to facilitate prenatal diagnosis of a wide-range of conditions.

Professor Kenny said: "Without nationwide access to anomaly scans, we continue to provide inadequate or inappropriate care to mothers and babies, which impacts upon clinical outcomes, sometimes with devastating consequences." 

She cited the example of babies with undiagnosed structural anomalies such as cardiac defects being born outside centres of paediatric surgery and will require emergency ex-utero transfer to Dublin immediately after birth. 

"For some babies, this will significantly decrease their chance of survival. In other cases, an absence of ultrasound means that the opportunity of in utero foetal therapy will be missed and babies will die of potentially treatable conditions."

She added: "A lack of ultrasound also has detrimental effects on maternal health.

"Women will continue to have unnecessary caesarean sections and other interventions for infants who cannot survive.

"Families will continue to be deprived of prenatal palliative care, to enable them to prepare for their baby's death. Obstetricians will continue to deal with unexpectedly bad outcomes at sometimes extremely complicated deliveries.

"We are expected to explain to parents how a major anomaly, normally clearly visible on routine ultrasound, was not diagnosed and to assist parents in dealing with the aftermath of a traumatic delivery and either unexpected bereavement or unanticipated illness or disability."

She added: "Overall in 2016, 23,300 or 36% of women attending antenatal services in Ireland did not receive a foetal anomaly ultrasound. 

"The fundamental issue underpinning why some hospitals can provide this scan and others cannot is one of governance.

"In maternity hospitals without ring-fenced budgets and robust independent governance, women's healthcare competes with other clinical priorities and international experience demonstrates that it is always the first to be cut."

Fine Gael Senator Colm Burke asked what needs to be done in order to make sure the service is available so that every woman has access to this facility.

Professor Kenny said that "the number of consultant obstetricians and gynaecologists in Ireland is at the lowest in the top OECD countries, sitting somewhere around 3.6 per 10,000 deliveries.

"We have a high birth rate so it's even lower when you correct for birth rate."

"I think that we need to appoint another 100 consultants to bring us up to international norms", she said.

She said: "It's well-known that Ireland trains some of the best doctors in the world and they currently staff the units of Australia, New Zealand the UK, Canada and America.

"We would love to bring some of our trainees home. Currently they will not come home because of a divisive contract, because the working conditions are appalling and because they will be better serviced in other countries.

"With regard to the questions around anomaly scans. I would argue strongly that this isn't an unsolvable problem.

"We do not need to find expensive and career radiographers, which are not plentiful in Ireland, we can actually train our midwives to a very high standard to perform foetal anomaly scanning."

"There is a recognised diploma in Dublin. It takes two years but within three months of that training, midwives on that course, they can perform routine first trimester scans."

Chair of the Institute of Obstetricians Peter Boylan said: "We need to employ ten new consultants per year for the next ten years plus replacements for those who retire".

He said there are enough trainees coming through if the jobs were attractive enough in Ireland.

He cited the example of a job between between the Rotunda Hospital and Drogheda as a consultant.

"There were no applicants for that job. That is astonishing."