The hospital will close in something over a week with the tragic loss of 300 jobs. Booked-in mothers have been sent into orbit but most will be facilitated at the Coombe or the National Maternity Hospital.
There are terrible stories of personal loss hidden behind these newspaper headlines. But the fact that Nama closed the hospital demonstrates that we shouldn’t rely on private interests to deliver basic health care.
There are many reasons for this, not least the nature of the healthcare which is delivered. Private maternity care will always serve private interests more than those of the public. That is why the loss of Mount Carmel should prompt the urgent question: Will this single tier health system we’re promised be public for all — or private for all?
Mount Carmel Hospital was the brainchild of Archbishop John Charles Mc Quaid following a visit to the headquarters of the Little Company of Mary in Rome in 1949. Three nuns left Milford House in Limerick and set themselves up in Dublin, opening the hospital in Rathgar just a year later.
The private maternity hospital was a runaway success despite the fact that, as Sr. Brigid Canning wrote in a parish booklet, “Many patients were apprehensive about having their confinements taken care of by religious sisters. Some felt they would not be given any pain-relieving drugs.”
This was certainly not the case. The hospital, which moved to a fabulous building in 1960, provided a heady mixture of Catholicism, as this was the first maternity care in Dublin provided by an order of nuns, and exclusivity, as this was the only private maternity hospital in Ireland.
Growing up in the 1960s and 1970s in the south county Dublin power-base created by Mc Quaid around UCD and RTÉ, I was in the zone of Mount Carmel hospital. My husband was born there as were all my friends. I wasn’t, because I was Protestant and a Protestant labour is a very different procedure to a Catholic one. Protestant babies are born through the ear canal. Oh yes. It’s a fact.
So thank God, Mc Quaid and a solid middle-class income for Mount Carmel! Here Catholic ladies could have their babies far away from the corrupting influences of the city, tended carefully by Mary’s Little Company which has a vocation to “stand with Mary at the foot of the cross in Calvary, interceding for the sick and dying of the whole world”.
Some of us might suggest that Calvary is an appropriate image in a maternity hospital. But why did the Sisters open and maintain a private hospital providing services you couldn’t get if you didn’t pay?
I don’t see the Gospel message in that. Nor do I see fairness or justice in a system of maternity care which ranges from steerage, which I have experienced shuffling along a wooden bench in the bowels of the National Maternity Hospital, to First Class with a view of the park in Mount Carmel.
When I graduated to the private wing of the National Maternity Hospital a consultant told me he thought I was getting a basic service but the public wards were made even worse because the State had a vested interest in people buying private health insurance.
I got a strong sense of this “Ascent of Man” approach to maternity services, which started with endless visits to maternity hospitals as a cub reporter. One mission involved tracking down newly-delivered mothers. I started in the large wards of a Dublin teaching hospital where one poor woman tried to run away from me, only to be followed by intrepid yours truly with her tape recorder. I reached the zenith when I entered the flower-strewn boudoir of a private room at Mount Carmel.
There wasn’t a baby in sight. And that is the crux of the issue. Private maternity services are provided to the paying client, who is the mother, not the baby. Mount Carmel Hospital has never been designated a “Baby Friendly Hospital” according to international criteria, despite the advantage it has with an exclusively middle-class client base. It has been the last to change its policy of keeping mothers and babies separate so that mothers can “rest” in direct opposition to the “rooming in” policy favoured by WHO for successful bonding and breast-feeding.
Krysia Lynch of the lobby group for maternity services, AIMS Ireland, talked to one Mount Carmel mother who said she was “physically man-handled” out of the nursery when she went to see her baby. Among all the messages of keen regret at the hospital’s closing on the Internet, one woman speaks of being “almost forced” to put her newborn baby in a room with 10 other newborns on his first night. As Krysia Lynch says: “There was still the culture that if you wanted to go out to dinner with your husband and without the baby the day after the birth, they would facilitate that.”
She stresses that the independence of Mount Carmel was important to many women who were able to get exactly the kind of delivery they wanted with some superb consultants. However the fact remains that the “He who pays the piper” model of healthcare has immediate and obvious effects on the kind of care which is offered. And in maternity care, it is offered to the mother, not her baby.
Further, it is offered to the mother by a consultant rather than a midwife and this results in more instrumental deliveries and a higher rate of Caesarian section. Mount Carmel had the second highest Caesarian rate in the country — 36.1% — after St Luke’s, Kilkenny, in a survey published last year.
In a recent Trinity College Dublin study, Deirdre Murphy and Tom Fahey found a Caesarian rate of 34.4% in private patients as against 22.5% in public patients in the same Dublin hospital. The biggest difference was in rates of scheduled Caesarian section in mothers who had already had a baby which were twice as high in private patients.
Murphy and Fahey concluded that the differential could not be accounted for by medical or obstetric risk differences and suggested that the women might be influenced by the choice obstetricians would make for themselves. This is often a scheduled Caesarian, wholly controlled by the consultant and far from optimal for mother or baby.
“One would expect that every woman, irrespective of funding source, is managed in a way that results in the best possible outcome for mother and baby”, they conclude. One would indeed. But if we rely on private maternity care led by consultants, and fail to invest in midwife-led public care which puts mothers and babies first that is not going to happen.