Soaring tensions about maternity hospital matched by falling birth rates

An irony in the row over the planned move of the National Maternity Hospital (NMH) is that obstetrics is one of the few areas in Irish medicine where business is declining.

There were more than 10,000 fewer births in Irish maternity hospitals last year than in 2012, figures provided by the Health Service Executive show.

The drop would have been even more dramatic were it not for a pandemic “bounce” in births last year – a rise that may prove temporary. Between 2012 and 2020, total annual births were down by 13,664, or almost 20 per cent.

At its most basic, births are falling because fewer women are having fewer babies, and those doing so are having them later in life. The reasons for this phenomenon could do with further exploration.

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Eighteen of the 19 maternity units saw their figures drop and one, the renamed Tipperary University Hospital, now handles fewer than 1,000 births a year, an extremely low number by international standards.

The NMH is one of the units most affected by the drop in demand. The number of births there fell from 9,142 in 2012 to a low of 7,353 in 2020, before recovering slightly to 7,692 last year. According to former master Dr Peter Boylan, now the arch-opponent of the hospital's move from Holles Street to the St Vincent's, campus, birth numbers are back at levels last seen in 1994.

Numbers have fallen despite the closure during this period of the private maternity unit at Mount Carmel in south Dublin.

In 2012, the NMH was the busiest maternity unit in the country; by last year, it handled fewer births than the Rotunda Hospital and the Coombe also in Dublin and was just ahead of Cork University Hospital.

In contrast, the Rotunda saw births rise marginally over the period, from 9,046 in 2012 to 9,147 last year. Again, the reasons are not clear, but the hospital’s catchment area stretches to the north and west of the city, where population growth has been greatest.

Obstetrics, of course, is not the only business of a maternity hospital but it is the main one. The fall in births means there is less pressure on maternity units, though many remain overcrowded – just like the rest of the health service.

Grand plans

The plan to relocate the three Dublin maternity hospitals to new locations dates back to the Celtic Tiger era, when births, and grandiose plans for expansion, were soaring.

All three Dublin maternity hospitals are in substandard buildings, and it is hard to make a redevelopment case for one ahead of the others. The Rotunda, after all, is the oldest maternity hospital in the world.

The NMH succeeded in getting to the front of the queue about a decade ago. This was shortly after leading figures in the hospital lent their support to then minister for health James Reilly’s plans to reform abortion laws. Dr Reilly had not attended to any of the detail of the plan to move the hospital to St Vincent’s and, as the world knows, this has unravelled painfully over the last six years.

The NMH building is so old it was mentioned in Ulysses. It is a warren of corridors, nooks and crannies. In one part of the building, women can share a ward with up to 13 others, their beds separated only by thin curtains. Elsewhere, spacious hotel-standard accommodation is available for paying private clients in the Merrion Wing. There's even a private fertility clinic next door, staffed by the same doctors working in the public hospital.

The new hospital, if it goes ahead at St Vincent’s, will offer single rooms to all mothers. Emergency ICU treatment will be available for women just across the corridor in the adult hospital.

This is the standard of 21st-century healthcare any country should aspire to, but it could just as easily apply to a move of the Rotunda to a greenfield site as to the relocation of the NMH.