Joyce Fegan: Women 'go private' because they don't trust the maternity system

As another row over women's maternity care gets laid to rest, the pressing question is why do 25% of women giving birth in Ireland feel the need 'to go private' in the first place?

In the argument this week over consultants' private maternity care work, there was one voice always missing. The mother. The woman. The person giving birth. Photo: Sam Boal/Collins photos

At a 30-week antenatal visit with my lifelong GP, we got to discussing home births and hospital births. This much-loved man, whom a great deal of people trust with their life, paused his obstetric duties to say the following words: "Of all the journeys we take in life, the one through the birth canal is the most uncertain."

If you have a planned pregnancy, as soon as your period is even a whisper of a day late, the next thing on most women's minds is the safe delivery of their much-wanted baby.

For some, that might look like a home birth with their partner and children surrounding them in a dimly-lit birthing pool, for others that could be consistent midwife-led care in their local community with early hospital discharge or for others, it's choosing an obstetrician they'll see at each appointment, and who will, more or less, be guaranteed to be at their side, and in their corner, come delivery.

In an ideal world, where the State has a decades-long legacy of investing in maternity services, most women would feel safe enough to trust their country's maternity care system.

Bearing in mind, that just a few short years ago, in a post-Repeal Ireland, we had pregnant women holding up placards protesting outside maternity hospitals. 

During covid, a campaign group, Better Maternity Care, had to form, in order to lobby the Government, hospital boards and the HSE to allow partners in for all sorts of news. There was a smorgasbord of varying rules nationally, like centimetres-dilated stipulations before your partner was to be called for from their nearby street corner. The year was late 2021.

And then the following year, only 2022, we have an unholy row over the ownership of the new National Maternity Hospital. There were rumours of "religious interference" based on ownership of land, we had people quoting Vatican law in public discourse on the issue.

There was even a Fianna Fáil video of the inside of the National Maternity Hospital, where it was stated: "This hospital is well beyond its sell-by date". Taoiseach Micheál Martin also described our National Maternity Hospital building as "not fit for purpose" during that heated public debate.

You can hardly blame women for worrying about how the safe passage into the world for their child might be, and making well-considered personal healthcare plans, with all of this going on.

The absent voice

And like in those debates, about who could and couldn't attend a birth, who would or wouldn't hold a stake in our state-of-the-art new maternity hospital, and in the one this week over consultants' private maternity care work, there was one voice always missing. The mother. The woman. The person giving birth.

It was about boards of hospitals, politicians and obstetricians. The one constant in all of this, the woman giving birth, was the consistently absent voice in the debate.

In the National Maternity Survey 2025, 25% of the 3,354 participants chose private or semi-private care. That number varied across the 19 maternity hospitals. 

In Cork University Maternity Hospital, 27.8% of participants received some form of private care. In the National Maternity Hospital, 47.3% of participants received semi-private or private care. In University Hospital Kerry, 7.9% of the respondents received either semi or fully private care. 

Outside of the survey, it is about one in four women who opt for private care nationally, in various studies done over the last 10 to 15 years.

So if you become pregnant in Ireland in 2026, what are your care options? You can receive fully public care, semi-private or fully private. And within each of those three categories things vary widely.

Public System:

• In the public system, you can avail of the Domino (Domiciliary In and Out) scheme. It is midwife-led, and is only available in certain areas and to women with low-risk pregnancies. On this scheme, you can be discharged from hospital as soon as six to 12 hours after delivery and continue to receive midwife care in your home.
• Another option in the public system is midwife-led care in a hospital clinic or satellite clinic in your community, depending again on where you live. An obstetric team is also available and you stay in a public ward after delivery, with early discharge also possible.

Private System:

• The next choices available are either semi-private or fully private maternity care. With semi-private care you have a mix of hospital clinic visits and appointments with a consultant team. At delivery, the hospital manages your care with consultant oversight and post delivery, subject to availability, you can stay in a semi-private room.
• If you choose fully private care, you choose your own consultant, who you will get to meet at your appointments, and who will, unless they are on leave, most likely be at the delivery. After delivery, depending on how busy the hospital is, if you have access to a private room, it is not guaranteed, however.

In the National Maternity Hospital, semi-private consultancy fees are about €1,200, and single room accommodation will cost €1,000 if you have medical insurance. For fully private care, prices range from €2500 to €5000 "by arrangement with your chosen consultant".

In the Coombe, semi-private patients pay an antenatal fee of €750 on their consultant's visit, with a delivery fee of €381 or €571 for a caesarean section as listed on their website. For fully private care, "antenatal care fees vary between consultants", and prospective patients contact their preferred consultant directly from a directory of names and emails on their website.

Whereas in Cork, if you choose private care you contact your chosen obstetrician directly from their website, and have your antenatal appointments at their private clinic. Fees vary.

In yet another public debate concerning women's bodies, it was once again about contracts — can a doctor carry out private work in a public hospital, or within the terms of their work contract?

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Where women were included in the debate, there were undertones of ridicule once again, that they were seeing changes to private consultants' contracts as a removal of their choices, or worse, that it was a matter of "prestige".

Not some, but all women, want nothing more than the safe arrival of a healthy baby. Nothing more. And so a pressing question in all of this is not only how did a two-tier system develop, but why do 25% of women giving birth in Ireland feel the need "to go private" in the first place?

Some answers might include the following: 

• they feel they will be listened to, and cared for, accordingly; 
• if a c-section is inevitable they will know who is carrying out the abdominal surgery that they will have no time to recover from; 
• they worry about their job and the amount, and length, of hospital appointments they'll have to attend on their employer's time even before maternity leave begins; 
• they have experienced trauma and pregnancy is where they need to be listened to most; 
• or, they have complex medical needs and need complex maternity care.

It's a matter of trust for women, in a State that has so often failed them.

Our reproductive debates in Ireland have always centred on whether we trust women or not. This debate highlights how much women trust Ireland when it comes to their maternity care.