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As Ireland's first national maternity strategy concludes after a decade, the National Women and Infants Health Programme reports 80 million euro in investment and major reforms, but many women still report being dismissed and losing access to private maternity care.
Ireland's first national maternity strategy, launched in 2016 amid widespread controversies and safety concerns, has now reached the end of its 10-year lifespan, prompting a broad evaluation of what has been achieved and what remains unfinished.
At the heart of the strategy was a pledge to normalise birth, widen the choices available to women, and standardise regional maternity services across the country. The National Women and Infants Health Programme (NWIHP), which is responsible for implementing the strategy, reports that significant investment has flowed into the system during the decade, totalling approximately 80 million euro across gynaecology, abortion services, and a range of other maternity initiatives.
Kilian McGrane, the national programme director of the NWIHP, acknowledges that the transformation is not complete but argues that solid foundations have been laid for future progress. Individual maternity units, once isolated from one another, are now connected through national networks and shared standards. Home-away-from-home rooms, designed to provide a more comfortable and less clinical environment for labour and birth, have been introduced in all but five of the country's maternity units.
New models of care, including midwifery-led pathways that were not available a decade ago, have been rolled out across much of the country. A strengthened focus on quality and safety, supported by updated clinical guidelines and dedicated funding, has also been embedded into the system. According to McGrane, the way staff are managed has changed dramatically: departures no longer lead to automatic replacements without strategic consideration, and retention of experienced clinicians is now a priority.
He rates progress at roughly 80 out of 100, insisting that perfection is not being claimed but that the structural groundwork for ongoing improvement is firmly in place. One of the flagship models of care to emerge from the strategy is the Domiciliary In and Out scheme, more commonly known as Domino. Under this arrangement, a consistent team of midwives supports women throughout pregnancy, during labour, and after birth, including home visits following an early discharge from hospital.
Aoife O'Connell, from County Wicklow, chose the Domino pathway for her first pregnancy because it allowed her to attend appointments close to home. She describes the experience as overwhelmingly positive, noting that appointments always ran on time and were only minutes from her house, and that a dedicated phone line provided reassurance when everything felt new.
As someone who loves baths, she was particularly grateful to have access to a birthing pool in hospital, an option that helped her manage the pain of labour and created a calming environment. Seeing the same midwives at every stage was deeply comforting, and even when complications arose in the later stages of labour and her baby had to be admitted to the neonatal intensive care unit, she never felt abandoned.
The midwives remained calm, kept her informed, arranged a private room so she would not be surrounded by other mothers and newborns, and personally wheeled her down to the unit to be with her child. O'Connell describes giving birth as an all-encompassing experience and credits the consistency and compassion of her midwifery team with making a frightening situation feel safe and manageable.
However, the broader picture painted by women who have recently used Ireland's maternity services is more mixed. The Irish Times spoke to more than 20 women about their experiences, and many reported feeling dismissed or struggling to access the supports they needed. The words choice and continuity of care came up repeatedly, particularly as the gradual removal of private maternity options, driven by the rollout of the public-only consultant contract, has reshaped what is available.
The Minister for Health threatened hospital funding and indemnity if institutions refused to comply with the terms of the public-only contract, while some consultants continued to treat private patients while on public contracts. The diminishing availability of private care was a recurring concern among the women interviewed. A large proportion of those who actively sought private maternity care said they did so because of a history of miscarriage or infertility.
Feeling anxious and fearful during pregnancy, they believed that private status would guarantee additional scans and the ability to see the same clinician at every visit, sparing them the emotional toll of repeatedly retelling their stories of loss to new medics. Not all of these women held private health insurance; some saved substantial sums to pay out of pocket for private care because continuity of care mattered so deeply to them
Maternity Strategy Ireland NWIHP Domino Scheme Continuity Of Care
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