WE THOUGHT babies had gone out of fashion, with many couples delaying having children and few families having more than two or three. And the national birth rate has been dropping, has it not?
So it came as a surprise to many when Dr Peter Boylan, Master of the National Maternity Hospital, Holles Street, Dublin, revealed last week that his labour wards have seen a baby boom of 15 per cent between 1994 and 1996. How could this be?
The first explanation is human nature. During all the gloating over the Celtic Tiger, with its housing boom and falling unemployment, behind closed doors the Irish have found their own way of expressing confidence in the economy - they've been making babies like they're, well, going out of fashion.
In 1981, there were 72,158 births, but by 1994 the figure had fallen to 47,929. In 1995, there were 48,530 births, a modest increase of 600. The number rose again in 1996, to 50,358, topping the 50,000 mark for the first time since 1992.
It's not that families are getting bigger, but that more women - especially first-time and older mothers, and particularly in Dublin - are having babies. Behind the baby revival is the fact that women of child bearing age are remaining in Ireland and having babies here, rather than going abroad for jobs.
And while three quarters of babies are being born to married couples, CSO statistics show the proportion being born outside marriage - either to single parents or to parents in non marital relationships - breached the psychological barrier of 25 per cent for the first time in 1996.
In Dublin, the National Maternity Hospital (NMH) saw its birth numbers rise from 6,321 in 1994 to 7,275 in 1996, an increase of 15 per cent in two years, which is well above the national average and far higher than the other two Dublin maternity hospitals.
The baby boom has been felt to a lesser extent at the Rotunda, where birth numbers in the 1990s have hovered around the 5,500 mark. Its figures have increase by 5 per cent in just one year, from 5 595 in 1995 to 5,857 in 1996. Already in 1997, the Rotunda's figures are up 2.7 per cent on 1996, according to the hospital's Master, Dr Peter McKenna.
The Coombe, where annual birth numbers in the 1990s have been 6,500 on average, had 125 more babies born in 1996 than in 1995, and the upward trend is continuing. So far this year, there has been an increase of 150 on the same period last year.
However, the upward trends at the Coombe and the Rotunda are still modest compared to the dramatic upsurge at the NMH. What's behind the Holles Street figures?
One factor - and one which Dr Boylan doesn't volunteer, although he'll readily acknowledge it - is the unfortunate reality that the NMH's birth numbers plummeted in the late 1980s in the wake of the Dunne case, when the parents of a brain damaged child sued and the hospital was perceived by the public as being arrogantly non communicative. Between 1986 and 1989, births at Holles Street dropped from 7,512 to 6,375 as more women chose to have their babies at the Rotunda and the Coombe. Seen in this context, the NMH's figures in 1996 are merely a return to former levels.
While Dr Boylan would never admit it himself, some of his colleagues privately credit the Boylan Factor for the NMH's current popularity. His mastership, which began in 1991 and ends on December 31st, 1997, has been characterised by openness, accessibility and superb PR, not to mention the opening in 1992 of the plush Merrion Wing, a brilliant marketing tactic.
The hospital recognised that consumer expectations of health care were rising. As the decade began, socially aspiring, educated women - often in careers - were no longer happy with the institutional lino, the shared wards and the convent school style regime which their own mothers had accepted in maternity hospitals. They wanted hotel style accommodation, en suite bathrooms and privacy and were willing to pay extra for them.
No sooner had the Merrion Wing opened than the middle class mothers of Dublin's southside began competing for the privilege of staying in one of its 13 en suite private rooms, which are 100 per cent occupied 365 days a year The wing is so popular that 20 per cent of women who want to bed accommodated there have to accept a bed elsewhere in the hospital. Another 10 beds could be opened in the Merrion Wing tomorrow and they too would be 100 per cent occupied, although the Department of Health has opposed this development, says Dr Boylan. While the words "ensuite" carry weight on the property market, they also do so in the provision of maternity services.
Dr Boylan himself attributes his hospital's popularity to the economic boom, which has halted emigration and brought 1980s emigrants of child bearing age home to roost in Ireland.
He partly credits the NMH's position on the DART line for its attraction to growing numbers of women. And, for large numbers of working women concentrated in offices in south city area, Holles Street is seen as the most convenient location for ante natal care.
The financial and planning implications of the NMH's success have for the past 12 months put the hospital in a head to head battle for resources with the Department of Health. Dr Boylan denies that he chose this pre election time to go public. He insists that it was actually the Irish College of General Practitioners which through the Leinster Leader originally aired the hospital's financial problems because it is concerned about the consequent threatened closure of the hospital's Co Kildare ante natal clinic, which serves 550 women per year.
Dr Boylan, when contacted by The Irish Times last week, then revealed the whole picture, which is that the baby boom is stretching hospital resources to the point where it may have to start turning away expectant mothers.
Dr Peter McKenna, Master at the Rotunda, says that, as Government Departments come under pressure to cut spending in preparation for EMU, this is going to be passed down. The maternity services have been targeted as an area of savings, despite rising insurance rates and rising patient expectations.
Dr Michael Turner, Master of the Coombe Hospital, believes policy makers have yet to understand the demographic changes under way and the profound implications for all three Dublin maternity hospitals. He says while the number of births has risen throughout the State since 1994, the largest increases have been in Leinster, indicating a demoraphic drift from rural Ireland to CSO statistics show that in the first nine months of 1996 Leinster's birth rate outstripped the rest of the State, with 14.9 babies born per 1,000 population, compared to 13.4 in Connacht 13.9 in Munster and 14 for the Republic's Ulster counties.
The Coombe's own demographic analysis, contained in a confidential report, predicts an increased number of women requiring services, higher expectations in relation to the quality of care and an increasing proportion of first time mothers. Families will be smaller, but there will be more of them, so that the maternity hospitals will deal with higher proportions than ever before of first time mothers, who require more services, more time, have higher expectations and thus require more resources.
The Institute of Public Administration has projected national birth figures for 1996 to 2026.
Based on a scenario in which there is a moderate fall in fertility and low emigration, the annual birth total 25 years hence in 2021 will be 46,000, with an ever increasing proportion of babies born in Dublin.