The Master of the National Maternity Hospital has hit out at claims that pregnant women may manipulate doctors in order to obtain an abortion based on fabricated suicidal ideation.

Dr Rhona Mahony was addressing the first day of a three-day Oireachtas Health Committee hearing on the abortion legislation issue.

She told the Committee that legal protection was needed in situations where a pregnant women may die and treatment to save their lives may lead to a termination of pregnancy.

Dr Mahony stressed that if there was any chance in such circumstances that a baby might survive at the threshold of viability, every effort would be made to save the baby.

She said that in many cases where mothers have underlying serious medical disease and choose to continue their pregnancy, they know that they may die and in effect, they are choosing to risk their lives in order to reproduce.

However, she said some women, faced with a significant risk of their own mortality will not wish to continue their pregnancy in such circumstances. This led to doctors having to consider the degree of risk to a mother's life.

Dr Mahony said doctors must be able to make commonsense, sound decisions in these cases, based on medical circumstances and not on ideology. She stressed that doctors wanted to preserve life.

On the risk of suicide issue Dr Mahony said as a woman, she had been offended by some of the pejorative and judgemental statements made recently that woman might manipulate doctors in order to obtain a termination based on fabricated suicidal ideation.

She said psychiatrists were well capable of assessing suicide risk in these circumstances.

Dr Mahony said doctors did not underestimate the risk of women taking their own lives in pregnancy, although the number of such cases was small.

She said women who may be at risk of taking their own lives in such circumstances needed appropriate care, and in a small percentage of cases may require a termination.

Dr Mahony said around eight women per 100,000 maternities died each year in Ireland during pregnancy from causes directly or indirectly linked to the pregnancy or from unrelated causes.

She said in the 1992 X case judgement, it was not clear what exactly constituted a 'real and substantial risk to the life of the mother' in which abortion was permissible. Dr Mahony said doctors may rarely be certain that a pregnant woman will inevitably die as a result of her pregnancy.

"In addition, it is not clear whether or not the risk to life must be immediate or if it may be delayed... the critical question arises as to how a substantial risk of mortality is defined."

Dr Mahony said it was important that doctors and women get legal protection to allow for appropriate flexibility to make professional clinical decisions based on medical probability of risk to life, rather than certainty. "It is not clear to me that such legal protection currently exists."

Dr Mahony said she needed to know that she would not go to jail or her patient would not go to jail in the case of a complex medical decision being taken.

She said it can be impossible at times to distinguish with certainty the difference between risk to health and risk to life.

Rotunda Hospital Master Dr Sam Coulter Smith told the Committee that his hospital had five or six cases per year where an interruption of pregnancy would be required in order to save a mother's life. These cases would include where the mother had cancer or serious cardiac abnormalities.

He estimated that there would be up to 30 such terminations in Ireland each year.

He said most maternity hospitals would have between zero and three maternal deaths per year.

Dr Coulter Smith said there was a shortage of specialists to deal with pregnant women with mental health problems.

He said the incidence of suicide in pregnancy would be around one in half a million.

Dr Coulter Smith said it should be stressed that it is very rare for women who say they are suicidal in pregnancy to want a termination.

He said maternity services at present were barely coping with existing demands and there would be resource issues down the line for termination facilities to be provided under any new legislation.

Dr Coulter Smith said there needed to be flexibility in the new provisions to allow for developments in medical practice and to deal with a wide variety of clinical scenarios. He said the legislation needed to be short and there should be an appropriate appeals system.

He said conscientious objection should be the lesser issue where a mother's life is at risk in pregnancy.

'Abortion doesn't reduce suicide risk'