A little baby boom that's catching everyone out

The announcement that a sudden rush on its labour wards meant cancelling all elective gynaecologial procedures for three months…

The announcement that a sudden rush on its labour wards meant cancelling all elective gynaecologial procedures for three months at the National Maternity Hospital in Dublin stopped many people in their tracks.

Hadn't we thought the birth rate was slowing down? Only last week, for instance, the Eastern Health Board reported that live births in its terrain had fallen by almost 30 per cent between 1980 and 1996.

Now, however - and despite some earlier predictions - the stork is confounding things and it's not just a Dublin phenomenon.

No one is questioning that the numbers are smaller than in 1980 when a bumper crop of babies arrived: that year 74,064 babies were born, a 21.78 birth rate per 1,000 of population.

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Last year there were just 52,311 births, a 14.3 birth rate per thousand. But despite the figures, there's no disputing that midwives, nurses and doctors are being run off their feet in many maternity units throughout the State this year.

Dr Michael O'Dowd, consultant in obstetrics and gynaecology at Portiuncula Hospital in Ballinasloe, Co Galway, says: "There's definitely a little baby boom going on at the moment and it's catching everyone out."

And Dr O'Dowd's hospital, with an approximate birth rate of 4 per cent over last year, has been less affected than other areas in the Republic: Waterford and Limerick have experienced the most significant increases outside Dublin.

Dr Gerry Burke, consultant in obstetrics and gynaecology at the Regional Maternity Hospital, Limerick, says: "We've experienced an increase in the last three years of almost 20 per cent of births. We're heading for 3,900 this year or more, having had 3,300 or thereabouts three years ago. We believe it will increase and peak in 2007."

Waterford has experienced its largest increase during the past year. Dr Jack Gallagher, consultant obstetrician and gynaecologist at the city's Regional Hospital, says that up to the end of July there was a 10.4 per cent increase and "we expect that trend to continue until the end of the year."

A comparison of Central Statistics Office figures for the first quarters of this year and last reveals a massive increase of 31.6 per cent for Waterford. This represents 395 births during the first quarter of 1998 from 300 births during the same period in 1997.

The exact reasons for the increase nationally are unclear, but many doctors attribute it to the influence of the Celtic Tiger, an increase of returned emigrants in their child-bearing years, the acceptability of births outside marriage and an increase in the number of multiple births due to fertility treatments.

The demographics of the Irish population are also changing. "In 1979, the Pope visited Ireland and we had the highest number of births the next year. These people are beginning to reach their 20s and are having children. The average age of having a child is now 28," says Dr Burke.

He expects the trend to increase as boomers enter their prime child-bearing years.

Older women are also deciding to have children later in life, after pursuing a career. Many doctors are encountering women pregnant with their first child in their mid to late 30s.

Though increases are less dramatic in the midlands, north-east and north-west, there is still a small upswing in those areas. "We're still down on what we were in the late 1970s and 1980s," says Dr Jack Conway of Portlaoise General Hospital. However, he adds that there has been an upward trend in the last two years.

In Cavan, the birth rates are similar. Dr Louis Courtney of Cavan General Hospital says the reason "we're not mirroring the Dublin hospitals is because the rural population declined in the late 1970s and 1980s. The cities are taking it up." However, he adds: "I would expect that we'll be going up by the end of the year."

Sligo General Hospital's Dr Carthage Carroll says that only in the last year-and-a-half has it noticed a small increase of 2.3 per cent. " I suppose it's like all of these things, the economic success would help, with people returning, particularly from England. There's been no real change in contraceptive habits, so overall I suppose it's economic."

Birth rates in the west are very different from those elsewhere.

"In the west the figures have been relatively stable. However, locally we have experienced an increase of over 4 per cent in the last year," says Dr Michael O'Dowd from Portiuncula.

Dr Michael Mylotte of University College Hospital, Galway, believes the wide availability of family planning and sterilisation services in Galway has contributed to birth rate stability.

"It's rather amazing considering that in 25 years the population of Galway has trebled."

Many pregnancies today require more care than in the past, says Limerick's Dr Burke. "There's a big increase in the number of women having their first child and these are more complicated births requiring longer stays and more care."

Dr Burke attributes much of the overcrowding in urban labour wards to the percentage of first-time mothers. "It's over 50 per cent in Holles Street and 40 per cent in our hospital," he says.

Dr Burke believes that without proper planning by the Government, a major crisis will hit maternity wards, schools, and social services in the years to come. "I feel the Department of Health has to recognise that they have the demographic data and they must act. If we don't expand the maternity hospitals now, in three years' time there will be a really big problem. The hospitals are just about coping."

The population issue has been frequently discussed by Dr Garret FitzGerald in The Irish Times. In a February article, "New trends mean Irish society must be ready to hold the baby", he warned the Government: "It is only possible to say at this stage that pending further developments it would be unwise to base policy decisions on an assumption that our child population will fall by another 100,000, as projected in the medium-term programme."

A spokesman for the Department of Health and Children said it was working towards a resolution for overburdened maternity hospitals. "In recognising the additional service pressure in 1998, the Department have allocated £1 million extra funding to maternity hospitals, especially for obstetrics services. The Department are in discussions with the Department of Finance in relation to resource requirements for 1999 to give a quality obstetric service," he said.

"There are enormous implications for the health and educational services. We need more space in our labour wards and personnel," says Dr Burke.

Regarding staffing levels at maternity hospitals, the Department spokesman said it "is making preparations to study nursing needs, including midwives, for the coming years".

The Central Statistics Office forecasts a baby boom until 2005. As the Master of the Coombe Hospital in Dublin, Dr Michael Turner, said last month, this forecast would indicate that previous Department of Health projections, which were based on lower fertility rates and higher levels of emigration, were incorrect.