1. Wexford: a True Irish Experience
Dave Nelson

2. Wexford, Ireland Southeast “corner” of Ireland
Population: approximately 20,000
Small town feel with a nice main street
Excellent restaurant selection
Nice selection of shops in “downtown” Wexford

3. Wexford General Hospital

4. Senior House Officers and Registrars at Wexford General

5. Legality of Abortion in Ireland
Amendment 8 of the Constitution of Ireland discusses abortion
“The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.
This subsection shall not limit freedom to travel between the State and another state.
This subsection shall not limit freedom to obtain or make available, in the State, subject to such conditions as may be laid down by law, information relating to services lawfully available in another state.”

6. Relevance In Current Political Debate
This is a very relevant topic currently as there are ongoing discussions concerning repealing Amendment 8.
As a future OBGYN, this will be an important topic in my career.
Like the U.S. there are very passionate pro-life and pro-choice groups lobbying for and against Amendment 8 in Ireland.

7. Specifics of Abortion in Ireland
In the U.S., there are certainly differences in the legality of abortion from state to state, but in most instances, the mother may choose to carry or terminate an unwanted pregnancy.
In Ireland, abortion is strictly illegal, with very few exceptions.
Essentially, the only way that a provider is allowed to either induce a medical abortion, or perform a surgical abortion is if the mother’s safety is severely threatened by the continuation of pregnancy.
If the mother is contemplating suicide if she were not to receive a termination, this has been considered lawful grounds to grant the mother’s request.

8. Clinical Application of Abortion Laws
Physicians caring for women seeking a termination of their pregnancy without a threat to their well-being from the continuation of the pregnancy were previously not allowed to even discuss the topic.
In 1992, the 13th and 14th amendments were added to the constitution, and these explicitly protected a woman’s right to seek a termination in another country.
Prior to this modification of the legislature, physicians were not even allowed to inform the patient where she could have the termination done safely.

9. Thoughts on Abortion
Currently, those women seeking abortion will travel to the United Kingdom for either a medical or surgical termination.
However, this it is a costly endeavor for the woman, so if she cannot afford to go to the UK, she may choose to travel to a different country to undergo an abortion.
The problem with this scenario is that the practices employed in the other countries may not be safe for the mother.
It is clear that, if a woman desires a termination, she has options for doing so, and since that is the case, an argument in favor of repealing Amendment 8 is that by refusing to provide the woman with a termination in Ireland where the practices and facilities are regulated, the woman may be placed at undue risk by being forced to travel abroad for the termination.

10. Cervical Ectopic Pregnancy
The mother was an incredibly sweet young woman who had had a previous miscarriage. Her and her partner came into the early pregnancy assessment clinic because she had noticed some bleeding. One of the registrars I was working with performed an ultrasound, and we could see a heart beating, which is normally a very reassuring sign. Unfortunately for this couple, the embryo was implanted onto the mother’s cervix, instead of inside the uterus. This is a condition called a cervical ectopic pregnancy, and it is exceedingly rare at approximately 1 in 9000 deliveries. All ectopic pregnancies are not viable and can rupture, causing significant pain and bleeding for the mother. Unfortunately, cervical ectopic pregnancies are even more dangerous than other ectopic pregnancies. This is because the cervix has a very strong tendency to bleed, and cervical bleeding is notoriously difficult to stop. The bleeding can be so severe that a life-saving hysterectomy can sometimes be necessary.

11. Cervical Ectopic Pregnancy

12. The Culture of Midwifery
Midwives are actually employed at hospitals, and they triage patients who are coming in to rule out labor. If it is a low risk pregnancy, the woman will be seen by the physician once when she comes in, but if there are no complications, the physician will not see her again until the morning after the delivery. The physician is only called on if there is a problem, there is a need for an operative delivery or for a C-section. If it is a routine delivery, the midwife handles the entire labor.
There is also a prenatal care plan called the Domino Scheme in which the mother is seen initially by an obstetrician, and if she is cleared by the physician, the rest of her prenatal appointments are done with a midwife, with the exception of ultrasound visits (“Midwifery-led Clinics”).

13. Dublin and Wexford KUMC Students

14. Windy Day at the Cliffs of Moher

15. References
"Cervical Pregnancy". Uptodate.com. N.p., Web. 30 Mar
Constitution of Ireland (last amended June 2004) [Ireland],  1 July 1937, available at: March 2017]
"Induced Fetal Demise". Uptodate.com. N.p., Web. 30 Mar
"Medical Education, Training And Practice In Ireland". Medical Council Website. N.p., Web. 30 Mar
"Midwifery-Led Clinics". Nmh.ie. N.p., Web. 30 Mar