Ending of private maternity care in public hospitals 'means new models must be examined'

AIMS Ireland spokeswoman Krysia Lynch: 'We know that a lot of people who are very low-risk in Ireland sign up with private obstetricians, that is a mis-match in terms of skill base. Very low-risk births are better taken care of by midwives whose expertise is in normality.'

An open debate is needed on the implications of ending private maternity care in public and voluntary hospitals, advocacy group AIMS Ireland has urged.

The call follows Cabinet approval of a new contract for hospital doctors which will see private care phased out of these hospitals by 2025, including private and semi-private obstetric care.

New figures from South/SouthWest Hospital Group show 17% of births
at Cork University Maternity Hospital are private.

At University Hospital Waterford, 14.5% of births are private, 10% of births at University Hospital Kerry are private, and Tipperary UH 8% are private.

Figures supplied by University Maternity Hospital Limerick show last year, 24% of births were private — which means more than 1,000 births out of a total of 4,314 deliveries. 

AIMS Ireland spokeswoman Krysia Lynch said the change would affect women, hospitals and could impact how the maternity strategy is applied. 

“I do welcome the phasing-out. However, I would like to see some other mechanism for the delivery of private obstetric care, in the same way that I would like to see a mechanism for the delivery of private midwifery care,” she said.

“Perhaps we need to look at new models. In the same way we can look at offering public birthing centres for low-risk care. We need to review all of this.” 

Pregnancy choices can be “complex” she said. “You might choose private because you know you are going to have a Caesarean birth — there’s a wide variety of reasons that might be the case, including peri-natal mental health reasons,” she said.

“There are women who have elevated risks, and they want their obstetrician to liaise perhaps with another consultant in an acute hospital.” 

Low-risk pregnancies account for most births. “In the UK, widespread private practice does not exist like this, there you would only be seen by an obstetrician if there is something really wrong with you,” she said.

“We know that a lot of people who are very low-risk in Ireland sign up with private obstetricians, that is a mis-match in terms of skill base. Very low-risk births are better taken care of by midwives whose expertise is in normality.” 

One obstetrician, who did not wish to be named, said it was considered strange in Ireland for obstetricians not to offer private births.

The pathway offers “continuity of care” and is another choice for women, this doctor said.

However, they added: “Would the woman really choose this if she had other good choices, a midwifery team, community care with midwives pre- and post-birth ? Like everything about public and private, do we make the public option so unattractive that people go to the other?” 

The new contract will remove the inequity of doctors hired since 2012 being paid one-third less than colleagues hired previously. The financial incentive to bridge that gap by offering private births could drop then, the doctor said, pointing out gynaecology can still be done in private clinics.

“The work many of us do is high-risk and fairly thankless,” they said. “And in the case of obstetrics and gynaecology, you will not complete your career without inquests, courts and litigation, with accompanying media scrutiny. It is not an attractive job.”