I thank the Minister of State for coming in for this debate. I have been asked by women and doctors in my constituency to outline the present situation in regard to epidural facilities in the Midland Health Board area. Pregnant women do not have the option of having an epidural at the time of their delivery.
We have, as I am sure the Minister knows, two maternity units in the Midland Health Board area, one in Portlaoise and one in Mullingar. The Minister for Health, in reply to one of my party colleagues in the other House, said last week that a limited epidural service is available in Portlaoise General Hospital and that he understood that the health board is investigating the possibility of providing a service in Mullingar. The Minister also stated that epidural services are available in the majority of maternity units in the country. Full or partial epidural services are available, according to the Minister, in 20 out of 23 units throughout the country. If the services are as limited as they are in Portlaoise then I suggest that such service is equivalent to no service at all.
One of the recommendations of the Commission on the Status of Women was that epidurals should be available on the basis of choice by the woman following consultation with her doctor and that all maternity hospitals and units should provide an adequate epidural service. In the Midland Health Board a number of years ago the maternity services were rationalised, with two units, one in Portlaoise and one in Mullingar, developed to provide a full range of obstetric services. I put it to the Minister that a full range of obstetric services should include the provision of an epidural service. This is a safe procedure, it is available to women in other regions in the country and I believe that the women in the Midlands are discriminated against because they are at present deprived of this service.
Obviously, the service can only be provided if the health board and the Minister are prepared to provide the resources to do this. I understand that the difficulty at the moment is the shortage of anaesthetists. Neither the faculty of anaesthetists nor the insurance companies that indemnify them recommend that anaesthetists provide such a service unless there is an anaesthetist solely dedicated to carry out this procedure. It is not possible to provide a service if these anaesthetists are also providing a 24 hour emergency service for general surgery and more than 66 hours a week of surgery commitment. There is a requirement that an anaesthetist would be available within three minutes for top ups, for adjusting dosages and in a case of an emergency. To do this the maternity units would need a consultant anaesthetist as well as junior staff.
Where an epidural service is available the demand has been shown to be there for it. Where the service is provided in any unit 20 per cent of women avail of it within a year. I noted in the Minister's reply last week that he said that a full or partial service is available in 20 of the 23 maternity units, but in many places, such as Limerick and Kilkenny, the service is available for private patients only. I am sure the Minister will agree that this is totally discriminatory and unacceptable. There is a limited service in Tralee and in Cork city. In Clonmel, epidurals are not available after midnight. Wexford seems to be the only hospital outside Dublin that is currently providing a full epidural service. I was going to suggest to the Minister, if he was here in person, that if by any chance he did become pregnant, he could rest assured that a full service would be available to him in Wexford Hospital. I appeal to the Minister to urgently consider the extension of this valuable service to hospitals in the Midland Health Board area. It is a procedure that should be available to all women.
