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A DEBATE ABOUT Ireland’s maternity services, which has included both public and private care for many years, has kicked off in recent days.
The Rotunda Hospital is in a stand-off with the government and HSE over its decision to allow consultants on public-only contracts to do work for private patients on the grounds of the Rotunda, which is not allowed.
Professor Sean Daly, the master of the Rotunda, told the Oireachtas health committee this week that the practice was being allowed to happen as there is no private maternity option for women to avail of in Ireland.
Daly said private care is being allowed in the Rotunda because the hospital has long believed that women should have a choice.
He told the committee that he explained the situation to health minister Jennifer Carroll MacNeill when she came to the Rotunda last year, adding: “Suffice to say, she wasn’t happy.”
The master of the National Maternity Hospital, Prof Jennifer Walsh, has also weighed in and warned taking away a private option removes patient choice.
We asked our readers how they felt about maternity care in Ireland and what their experiences have been of public, semi-private and private care.
Our thanks to everyone who got in touch. Here’s what you told us.
One mother of three children said her youngest two were delivered by a private consultant while she chose to go semi-private for her first child.
“I chose fully private care for my subsequent children because I had multiple miscarriages after my first child, failed fertility and IVF treatment,” she said.
She felt her semi-private consultant for her first pregnancy “wouldn’t have been able to pick me out of a line-up”, adding: “I can only imagine what it is like in a severely overstretched public system where women are herded through like cattle.”
This mother said she understands the principle of what the government is trying to achieve in terms of keeping public hospitals for public patients, and also acknowledged that it is a privilege to be able to pay for private healthcare.
“I was so annoyed when I saw members of the Oireachtas Health Committee shrugging this off by saying ‘well, let the market provide the private care’. A total ‘let them eat cake’ attitude by (mostly) men discussing women’s healthcare.”
Another woman said the Rotunda Master Sean Daly is correct, stating that women need the choice.
Maternity cannot be compared to any other medical service. It can be very high-risk, and two lives are at stake.
This woman said she was in the public system with her first child and ended up having an emergency section three days after being induced.
“The public system is not good enough. You’re forgotten about… you’re constantly repeating yourself to the different doctor you see. I don’t think I had the same doctor once at any of my appointments. You get two scans early on and that’s it,” she said.
If she is having another baby, this woman said she will be going private, stating that she has “lost complete faith and trust in the public system and will not be taking that chance ever again”.
“I should have the right to make that choice,” she added.
While some mothers that got in touch with The Journal had complaints about the public system, some spoke of having a positive experience.
One Dublin woman said she was a public patient last year and availed of midwife-led care as her pregnancy was considered low risk.
“My waiting times for appointments were low, once a midwife even called my mobile to apologise that my appointment would be 15 minutes late as the clinic was running slightly behind,” she said.
She said concerns she had during pregnancy were escalated appropriately, including one concern that my bump was ‘small for dates’, and one concern about foetal position towards the end of pregnancy.
Giving birth to a healthy baby girl last August, she said she saw an obstetric doctor once during labour, when he “poked his head round the door and gave a thumbs up as he saw that my baby’s head had already emerged”.
“I acknowledge my privilege in that I have medical knowledge and would have been able to advocate for myself if needed, however this did not end up being necessary.
“I strongly believe that we can have faith in the public health system to deliver our precious babies, especially if care is delivered when and where it is most needed and not allocated based on ability to pay,” she said.
Another woman from Clare, who is currently pregnant, said she is currently in the public maternity system, stating that she chose to go public partly due to cost and because she had heard very positive stories from friends and family.
“There are certain aspects of maternity care that I feel could be much better,” she said, stating that each appointment she’s had, she is met with a new doctor or midwife that doesn’t seem to have her information to hand.
“This does not inspire confidence or security in me,” she said.
“I think that because private care is an option, there is less onus on the public system to improve areas that are lacking and gives the private system further incentive to offer better care,” she said.
Another woman from Dublin said there are so many excellent midwives and doctors involved in the public maternity system. “I believe it does them a disservice to subject them to a tiered healthcare model where some people who can afford private care are treated better than those who cannot,” she said.
One woman who had a baby four weeks ago said she had a very positive experience in the public system, stating that while she had private health insurance, she didn’t feel the need to go private.
All the staff went above and beyond, and she availed of the free mental health services, Reiki, breastfeeding and antenatal classes, which she said were very beneficial.
“I saw the same midwife for each of my check-ups, which was nice to have the familiarity,” she said.
One mother from Dublin, who has three children, said public and private care are worlds apart in her view.
“I am a strong advocate for good public healthcare, so I was adamant I would use it on my first; however, it was a litany of errors. At my 20-week scan the radiographer shushed me when I tried to ask a question about measurements, telling me the 20-week scan wasn’t for us but for ‘the hospital to see all was fine with baby’,” she said.
Throughout her pregnancy, she felt a lot was missed, and she was told conflicting things by the midwives, stating that many of them “belittled and scolded”.
For her second and third pregnancies, she sought private care “as I could not deal with so many different opinions”.
“In my experience private care trumps the public system every time, and it is concerning that the state who physically abused so many mothers in the past is now seeking to remove a mother’s choice about maternity care,” she said.
A mother from Kildare said she was a public patient in 2020 and a private patient three years later for her second pregnancy.
“As a public patient I never once felt as though I was being listened to. The wait times were always at least several hours, there was often no place to sit and when I was eventually seen it was as though I was on a countdown timer,” she said.
Again, this woman said she didn’t have the same doctor or midwife throughout her care, adding that she was made “feel like a nuisance”.
While I understand the staff are overworked and exhausted, that does not excuse the lack of empathy.
“I won’t discuss my experience of giving birth or the 24 hours that followed but just know that I left the hospital a shell of myself and with a severe mistrust of all medical professionals. I ended up attending several months of therapy and was diagnosed with postpartum PTSD,” she said.
For her second pregnancy, in private care, it was only positive, she said.
“My journey as a private patient was a dream. It healed a lot of the trauma and emotional wounds that I developed while being a public patient. I finally felt that my dignity had been restored,” she said.
This woman said the private fees she paid out were the “best money I have ever spent”, but she too acknowledged that she is in a privileged position, stating:
Until all maternity services are elevated to that standard, women deserve to have a choice.
One mother said that private care “was never about luxury or having a private room – it was about continuity of care, feeling heard, and having confidence in every stage of the process”.
She said from discussions with friends who went through the public system, the main difference she identified is that care can feel more fragmented, with fewer scans and less consistent contact with the same doctor.
“While I fully recognise that the standard of medical care in Ireland is high across both systems, I personally would have found that lack of continuity very difficult, particularly given the complications in my first pregnancy,” she said.
This mother said she strongly believes maternity hospitals should continue to offer private care, particularly outside Dublin where options are already limited.
While she said there can sometimes be a perception that private care is about extras, for her, it was about reassurance, close monitoring and a consistent relationship with her consultant.
Another woman from Dublin said one of her biggest regrets is not going private on her first baby. There were serious complications during birth, which required emergency surgery to be done by a specialist.
She said she wouldn’t have had her second baby unless she had the option of going private, adding that it is pretty disgraceful that someone has to pay thousands of euros or have good health insurance just to feel safe in Ireland’s maternity system.
One woman who got in touch said she was in the public system said on her first pregnancy in 2019, she started to feel very sick at about six weeks. At her 12-week appointment, she was vomiting more than 20 times per day and had lost a stone.
“At my visit, I told my midwife who asked me if I had scented candles in my house. When I replied that I did, she told me that was what was making me sick. She told me it would end soon as I was at the end of the first trimester,” she said.
She said the sickness never ended until the day she gave birth.
“At every appointment throughout my whole pregnancy, I was dismissed and told it would end soon… By the time I gave birth, I was mentally and physically a shadow of my former self. There were times I thought I would die, I felt so horrendous all the time. I had no energy, no appetite,” she said.
For her second pregnancy, she decided to go private. In her first appointment she spoke about the sickness she had experienced during her previous pregnancy and was told she had hyperemesis graviadarum.
“For the first time, someone had acknowledged me and my sickness, which had not happened once in my previous pregnancy,” she said, adding that she was prescribed the drug Cariban.
“I took it every day until I gave birth. I truly believe it saved my life as I couldn’t have survived another pregnancy like my first one. I was still vomiting every day but at a much lesser rate, and it was manageable.
She paid her private consultant €3,000 in fees and paid around €50 a week for the Cariban tablets for the duration of her pregnancy. (It has since become available on the Drug Payment Scheme.)
“Some people choose private as they want a private room in the maternity hospitals, some want more regular scans, there were many reasons why people choose to go private. I chose to go private as I truly didn’t believe I would survive another pregnancy and we really wanted a sibling for our daughter,” she said.
This mother said she wished Ireland had an adequate public maternity system and that people didn’t have to pay huge sums of money to get the care they deserve while pregnant.
“Please do not take the option of private maternity care away from those of us who desperately need it,” she said.
Another woman said after giving birth and undergoing surgery, she was in extreme pain but said the ward she was on was very cramped. A nurse manager told her that if I wanted a better room she should have paid and gone private.
“I was in severe pain, unable to move properly after surgery, and desperate for support, yet one nurse told me she was too busy to help me with my baby and said that if I rang the bell she would not come. I cried every single day and night during my stay,” she said.
“While I understand maternity hospitals are under immense pressure, compassionate, safe and dignified maternity care should never depend on a woman’s ability to pay,” she said.
Another mother said she is a healthcare professional in the public sector, and after her baby died of a sudden and unexpected stillbirth, she opted to go privately with her other births.
“His death was no one’s fault. It was a rare complication of going overdue. However, I was highly anxious with my subsequent pregnancies.
Going private meant we could pick the consultant that we felt best met our needs. We saw the same doctor and nurse at every appointment and were hardly ever left waiting.
As the pregnancy progressed, her anxiety increased and her consultant offered more appointments than were clinically necessary, and she had his email in the event of any questions.
“He made a decision based purely on my anxiety to bring me in for an early delivery. I really felt heard and received excellent personalised care. I know I wouldn’t have received such personalised care in the public sector. I am in support of private maternity care for this reason,” she said.
“I think it’s disgraceful that the option of private care is being taken away from women. Women’s healthcare is already low down the priority list in Ireland; to now take the choice away from us, just sums up how out of touch government is with the people. I understand not everyone is fortunate enough to have the choice to go private, but the choice shouldn’t be taken away from those who can,” she added.
One woman, who has had seven miscarriages, said she was told by doctors in the public system that she would have to go through three miscarriages first before the hospital would do any tests to find out what might be going wrong.
“To expect a woman to endure that trauma over and over again is evil,” she said, stating that she chose to go private on her last pregnancy.
“A scan at 12 weeks and 20 weeks in the public system was not adequate, in my opinion, for my medical history nor my mental health given all I’d been through. The consultant I chose was absolutely amazing and ensured I was scanned every four weeks and the level of empathy and understanding he showed towards me and my husband was amazing,” she said.
I feel like yet again there are men in suits out there making decisions about women’s bodies that they are in no way qualified or entitled to do so and it makes me so angry.
One woman who has experienced multiple miscarriages said the difference between public and private is notable.
She said her experience of having a miscarriage as a private patient and as a public patient was vastly different.
This woman from Dublin said she considers herself lucky to have a choice between public and private, stating that everyone should have access to better care than the public system can offer, particularly in the cases of miscarriage.
“I don’t believe by removing private care options that the public system will be adequate to care for high-risk pregnancies in the manner in which they deserve, again a failing to women in Ireland,” she said.
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