When Aoife O’Connell first became pregnant she knew she wanted continuity of care. She wanted to see the same medical professionals at appointments, during her labour and the birth of her child, and when she had her newborn in her hands. It was at this point she learned about a form of midwifery-led care called Domiciliary In and Out.
More commonly known as Domino, it is when a consistent team of midwives support women before, during and after birth, visiting the new mothers at home after an early discharge from hospital.
“I chose Domino because I could attend appointments close to home,” she says. “The appointments were always on time and five minutes from my house. The dedicated phone line was very useful, especially on a first pregnancy when everything was new.”
The Wicklow woman says she could not believe how wonderful the service was.
As someone who loves baths, she was “so grateful” she was able to use a birthing pool while in the hospital, adding that seeing the same faces was “so comforting”.
“It was quite calming and relaxing. It felt like you were in a different space and it [the birthing pool] made the pain much more manageable for me,” she adds.
O’Connell describes giving birth as “all encompassing”. When she had complications in the latter stage of labour, she was “never concerned”, even when her baby was brought to the neonatal intensive care unit (NICU).
Aoife O’Connell used a birthing pool in hospital: ‘It was quite calming and relaxing.’ Photograph: Enda O’Dowd
“The midwives were very calm and they were very encouraging. He wasn’t really breathing so he had to go to the NICU but again the midwives were really calm. They were clear there was an issue but they were also very clear that it was okay and it was being dealt with,” she says.
“They tried to find me a private room so I wasn’t around babies and mothers because the baby wasn’t with me. They got me a wheelchair and brought me down to the NICU. Overall, it was a really, really positive experience.”
Ten years of Ireland’s first maternity strategy: ‘If we were grading ourselves, I’d give us an 80’![Kilian McGrane, national programme director of the NWIHP. 'Once upon a time, [a hospital staff member] left and they automatically got replaced. That’s not the case any more.' Photograph: Gareth Chaney/Collins](https://www.europesays.com/ie/wp-content/uploads/2026/09/DQ4CFJYJIGGKQZ66N5GMEAMBC4.jpg)
Kilian McGrane, national programme director of the NWIHP. ‘Once upon a time, [a hospital staff member] left and they automatically got replaced. That’s not the case any more.’ Photograph: Gareth Chaney/Collins
At the heart of Ireland’s first maternity strategy, launched in 2016 in the wake of controversies and safety concerns, was a pledge to normalise birth, increase choice for women and standardise regional services.
More than a decade later, as the strategy comes to a conclusion, the National Women and Infants Health Programme (NWIHP), which is responsible for its implementation, says a lot has changed in that time.
Kilian McGrane, the NWIHP’s national programme director, says there has been an investment of €80 million over the lifetime of the strategy, including funding for gynaecology and abortion, among other things.
“There are now things that weren’t there. Individual units are no longer isolated, which is a hugely important thing. There are home-away-from-home rooms in all but five of the maternity units,” he says.
“The model of care wasn’t there a decade ago. The focus on quality and safety wasn’t there a decade ago. The guidelines were there but not in the way it is now, and there had been no investment.
“If we were grading ourselves, I’d give us an 80. We’re not claiming this is perfect. But what we are trying to say is there are very solid foundations in place now.”
The Irish Times has spoken to more than 20 women about their experiences of maternity care in the State, many of whom spoke about being dismissed and experiencing difficulties in accessing supports.
The words “choice” and “continuity of care” were regularly included in conversations, largely sparked by the gradual removal of private maternity options in the State due to the roll-out of the public-only consultant contract.
Private maternity care provided by public-contract consultants surfaced as an issue earlier this summer when Minister for Health Jennifer Carroll MacNeill clashed with the board of the Rotunda Hospital in Dublin.
The Minister threatened the hospital’s funding and indemnity if it refused to comply with the terms of the public-only contract as consultants were still treating private care while on public contracts.
The board of the hospital eventually backed down.
Already, two hospitals – Sligo University Hospital and Midland Regional Hospital Portlaoise – have ceased private maternity care.
The diminishing availability of this option was something raised by many of the women who contacted The Irish Times. A large proportion of those who say they sought private care say they did this due to a history of miscarriage or infertility.
They were nervous and fearful about the pregnancy, they say, and believed being a private patient would result in an increased number of scans and being able to see the same clinicians, without having to repeat their tales of loss to medics at each appointment.
Not all of them had private health insurance. In some cases, they saved to pay for private care out of pocket because they felt so strongly about having continuity of care.
Rebecca’s story: ‘I honestly don’t know what I would’ve done without my private consultant’
Rebecca, which is not her real name, opted for semi-private care for her first two pregnancies, despite having private health insurance. A blend of private and public care, semi-private allows women to recover in smaller wards after birth, but they may be seen by different doctors throughout their pregnancy.
But when her second daughter was stillborn in May 2022, the trauma and grief of that loss led her to choose private care for her two subsequent pregnancies.
“It was so traumatic for us because, and I know it sounds silly, but I didn’t know it could happen at such a late stage. We had our induction day scheduled for two days later. I thought there was no way [she could have been stillborn] because she was coming in two days,” Rebecca says.
“I was speaking to different people and doctors every time and every day. Once I left the hospital without my baby, I had not one person to contact or to listen to me, or try to explain to me what happened.”
Because of the loss of her daughter, when she became pregnant with their third and fourth children, she had to be signed off from work early and began taking anxiety medication.
“I honestly don’t know what I would have done without my private consultant, and how I would have got through those two subsequent pregnancies. From that day forward he was by our side every step of the way, and literally on call no matter what time of the day,” she recalls.
“I could have as many appointments and scans as I wanted. I certainly wouldn’t have coped with a different consultant at every appointment or not having the comfort of being able to contact his secretary multiple times a week at some stages.”
But Rebecca is not the only individual who spoke to The Irish Times about the devastation of child loss.
Although many people perceive maternity hospitals to be happy places, not every story has a happy ending.
Sophie’s story: ‘I felt if I went in at 37 weeks she would have been here’
Sophie, which is not her real name, lost her first daughter just over a year ago. She had what she describes as a “textbook pregnancy”. She and her partner were “so excited” to discover they were having a little girl.
“Everything was perfect. I was absolutely fine. When I was 37 weeks I went in with high blood pressure. I went in and I got checked. Everything was fine,” she says.
She requested an elective Caesarean (C-section) birth because she did not want to go to full-term but was refused on clinical grounds, as she was not deemed high risk. Days before her due date, she realised her baby’s movements had stopped.
“I rang my partner. I said I was going to go in [to the hospital]. Straight away they put a monitor on and the room just went really quiet. They said there was no heartbeat,” she says.
“It felt like an out-of-body experience. I wasn’t looking at the screen because I knew there was something bad. He [her partner] was sitting at the end of my bed holding my hand and I could see the tears in his eyes.”
But that was only the beginning of a difficult road ahead. Because she was full-term, she had to deliver her baby. The 14 hours in labour were “horrendous”, she says.
“Normally when you’re giving birth, you’re going through all this pain knowing you’re going to hold your baby but I was doing it knowing she was gone,” she adds.
The doctors and nurses were “very good” and supportive of her during this time.
“I had three or four days with my baby. We were in a private room with my partner and a cold cot so we could have visitors,” she says.
Though Sophie has since learned that there was little that could have been done to save her baby, who died from a foetal-maternal haemorrhage, a condition where foetal blood cells cross the placental barrier and enter the mother’s blood circulation during pregnancy or delivery.
She still wishes her voice had been listened to when she had asked for an earlier delivery at around the 37-week mark.
“You have your mammy intuition; your gut feeling. I know they say they can’t just do whatever because you have a gut feeling but I just think there should be more flexibility,” she says.
“I felt if I went in at 37 weeks she would have been here. She passed at 39 weeks and five days.”
Claire O’Sullivan’s story: ‘I’m so grateful I was able to have a child’
Claire O’Sullivan: ‘You kind of catastrophise as a protective mechanism’
Not everyone has felt supported after a loss. Claire O’Sullivan had five miscarriages before the birth of her daughter in 2024.
Married in 2020, the now 40-year-old began trying for a baby with her now husband just before her wedding. The first three miscarriages were quite early in the pregnancies. The fourth required surgery.
“I had just lost my child and I woke up in the recovery room and the woman beside me, because there is no privacy, was naming her child and I was after losing mine. I shouldn’t have had to see something so joyous when it was the worst day of my life,” she says.
“There is no separation. You just sit in the waiting room with expectant mothers who are excited and want to speak to you. It was horrendous. I felt like an utter failure.”
The issue of women who recently experienced a baby loss or received bad news being placed in wards with pregnant women or those who have recently given birth is something that was flagged in the strategy as something that should not happen.
A decade later, however, some women still experience this situation. The HSE says staff try to avoid it as best they can, but the physical infrastructure of buildings can make that difficult.
For O’Sullivan, the grief was exacerbated by how lonely she felt at the time. She underwent the surgery in 2021, during the Covid pandemic, and her husband wasn’t allowed to be with her.
“They sent a bereavement midwife in to me. She gave me sunflower seeds, which was really odd to me. I had just lost my baby; I didn’t want sunflowers. But every other time it [miscarriage] happened, there was absolutely no support,” she says.
“It felt like the minute you weren’t pregnant any more, they didn’t care. Any support I ever got was in forums online where people talk. It’s like a dirty secret and it shouldn’t be.”
When pregnant with her daughter, who is now two years old, O’Sullivan says she was very anxious the whole time.
“You kind of catastrophise as a protective mechanism. That way if something bad does happen you can say you’d thought it through. I’m so grateful I was able to have a child; I know that’s not the case for everyone,” she says.
The support available after a negative outcome is not only something highlighted by the people who spoke to The Irish Times.
The State’s health services watchdog, the Health Information and Quality Authority, has carried out two surveys on national maternity experiences and one survey on maternity bereavement experience that highlighted a similar gap.
“Bereaved parents identified a need for better support after leaving hospital, particularly around grief, mental health and physical recovery,” the survey found.
“They wanted clearer communication, more consistent follow-up care, dedicated bereavement spaces within hospitals and greater recognition of the needs of partners and support people.”
Dr Clíona Murphy, consultant obstetrician and gynaecologist and clinical director of National Women and Infants Health Programme. Photograph: Tom Honan
Clíona Murphy, clinical director of NWIHP, says feedback to the programme has shown that bereavement care can be “variable” but that this is something they are taking steps to change.
“There wasn’t enough thought or training given to doctors or midwives. There’s been an awful lot of work done on bereavement standards, but it’s also been backed up by infrastructural improvements,” she says.
Fiona Sadlier’s story: A ‘draining’ IVF process before conceiving naturally 
Fiona Sadlier with her daughter Molly: ‘I’m so appreciative of the kids I have and the journey I’ve been on.’ Photograph: Edel O’Malley Photography
Fiona Sadlier underwent four rounds of IVF fertility treatment over four years, with none of them resulting in a pregnancy.
This, she says, was a devastating time in her life and a “really draining process”, though she knows she and her husband were lucky to have the option of fertility treatment.
“I wanted it so bad that I would have done anything in order to get it. I was putting more stress on myself the whole time. There were so many times when I thought this was not going to work for us. We would sit down after every transfer and have a cry and make a plan,” she says.
“We said we’d have a great life and come out the other side of it. We can figure out what would work for us. Adoption wasn’t really an option. We bought a dog in the middle of it and said the dog could be our child.”
And then, to their complete surprise, they conceived naturally.
“I didn’t believe it for a long time,” she says. “You thought this was going to be taken away. Once it got past a few months and I was able to settle into it, I loved being pregnant.”
Sadlier now has two children, both of whom were conceived naturally. Despite the lack of success with the fertility treatment, Sadlier doesn’t regret the money or time spent on it.
“It made me learn a large lesson. I learned so much about myself, I probably wouldn’t have gone through therapy. I’m so appreciative of the kids I have and the journey I’ve been on,” she says.
“For me and my husband’s relationship, it was good for us. Life has challenges; this was just one of ours.”
Maternity hospitals are busy at the best of times, but some of the women who spoke to The Irish Times say this made them feel unimportant when they needed help.
Some women say they didn’t feel listened to, or their pain was dismissed during labour and they were not given any pain relief or any explanation as to why it was being denied.
“The induction ward was nothing short of a conveyor belt,” says one woman, who says staff are overworked trying to care for all of the pregnant women.
Another says: “Mothers should be able to focus on recovering and bonding with their babies, not navigating overcrowded wards and capacity shortages.”
Staffing is one of the “biggest challenges”, says the NWIHP’s Kilian McGrane.
Kilian McGrane, national programme director of the NWIHP. ‘Once upon a time, [a hospital staff member] left and they automatically got replaced. That’s not the case any more.’ Photograph: Gareth Chaney/Collins
“The funded posts are very good overall but the actual numbers on the ground are quite challenging. We’ve invested in about 360 midwives. But you don’t see the net effect of that on the ground because the turnover is so high,” he says.
“The current rate of maternity and sick leave is between 15 and up to 20 per cent in some of the maternity units.”
McGrane says financial controls in place in three of the six HSE regions are having a “material impact on the ground”.
“Once upon a time, someone left and they automatically got replaced. That’s not the case any more.”
Yael Margalit’s story: A ‘calm’ home birth using a birthing pool
Yael Margalit knew she always wanted a home birth
These busy, bustling atmospheres are one of the reasons why Yael Margalit (37) says she always wanted a home birth.
She acknowledges that there is a “time and place for medical intervention” but says she is aware of research that suggests people who attempt to give birth at home have a better birthing experience.
“There is more support and the less medical intervention in those contexts give a better birthing outcome. I felt I was going to get that at a home birth,” she says.
She contacted the now defunct Private Midwives Ireland and paid for a midwife to support her to deliver her baby at home in 2024.
“Everything felt calm,” she says, and she was able to use the birthing pool and had a “lot of downtime”.
Yael Margalit (37) was able to use a birthing pool during her home birth
However, the option for private home births is now no longer available. Last summer, Private Midwives Ireland closed following an inability to obtain insurance.
Consequently, home births are now only available through 23 self-employed community midwives who work through the HSE, in a system with stricter eligibility criteria.
Home births are also not available in the midwest region through the HSE after this service was suspended in 2022 following the death of Laura Liston, who died after giving birth to her son at her home in Limerick.
But McGrane believes that despite the absence of services in the midwest and the gradual removal of private maternity care, there has been an increase in choice made available to expectant mothers.
“We now have midwifery-led care across all of the units, which wasn’t available when we launched the strategy,” he adds.
There might be an increase in midwife-led care, but there are still only two midwife units in the State, the same number there were when the strategy was launched.
Angela Dunne, the national lead midwife at NWIHP, said this recommendation stalled due to “infrastructure restrictions and a lack of capital investment”.
“We have put in place, alongside birth units, home-away-from-home units in 14 maternity units. They’re non-clinical, nice environments for women to give birth in. The five units that don’t, the reason is we just don’t have space,” says Dunne.
The focus of the strategy isn’t only on labour and birth.
In recognition of the fact that a woman’s needs don’t end as soon as their baby is born, the State has developed nine postnatal hubs across the State, with plans for there to be a total of 13.
Niamh Lynders’s story: ‘The healthcare assistant was so supportive on my first night trying to establish breastfeeding’
When Niamh Lynders gave birth to her daughter in October 2024, all she wanted was to be able to breastfeed her baby.
“There was a healthcare assistant on the ward on my first night trying to establish breastfeeding. She told me to get back into bed and [give it] some time. She was so good at supporting me,” she says.
“I was very conscious I hadn’t established breastfeeding. I wanted to stay another night so more support [could] be established. They let me.”
Lynders, who is based in north Dublin, notes there is a “postcode lottery” when it comes to accessing postnatal supports, but says she had a “great experience”.
“There’s a public health nursing service and lactation consultants in Dublin. There was a time when I was over in Spain and emailed them when I had a problem with breastfeeding and they got back to me within 24 hours,” she says.
“Community midwives came out on day two when I was discharged. They offered me multiple visits after.”
Amy Rose Hart’s story: ‘The public health nurse was fantastic but the scheduled checks wind up at four months’
In Donegal, Amy Rose Hart feels the services after birth still leave a lot to be desired.
She recently was visited by her “fantastic” public health nurse at her home. Towards the end, she was asked the “usual, brief set of postnatal depression-related questions: had I any anxiety or intrusive thoughts, was I feeling down, and so on”.
“Luckily I was able to answer no, and the nurse shut her file. Case closed, it seems. And then I was effectively discharged from the public health system,” she says.
“The checks for my baby will continue as she grows and changes. But for postnatal mothers, the formal, scheduled checks wind up at three to four months.”
She acknowledges the State has set up postnatal hubs, but says that “puts the onus on women to go to them”.
“It’s another thing on my super-long to-do list. I’d do it if I have to. But the baby could get sick that morning and you’ll put it off. You always deprioritise yourself. The home visits are far more feasible,” she adds.
Susan’s story: ‘I thought they were going to take the baby off me. It’s horrendous’
Susan, which is not her real name, knows first hand the importance of postnatal follow-up care. She spoke of very different experiences in two pregnancies, the first delivered privately and the second in the public system.
Susan had a history of anxiety and depression when she was a teenager but was doing well before she became pregnant with her first son in 2016, and wasn’t on any medication at the time.
“During pregnancy, I had quite significant prenatal depression. I had extreme tearfulness, depressed mood, anxiety and panic attacks,” she recalls.
She told her consultant when she was about 28 weeks’ gestation that she was worried about her mental health but she says he told her he ”wouldn’t be putting that in my chart because that would get a social worker involved”.
Because of that comment, Susan did not get any help.
Women are so vulnerable when they’re pregnant and my concern about my mental health was undermined
— ‘Susan’
“I thought they were going to take the baby off me. It’s horrendous. You’re so vulnerable,” she says.
After she gave birth, her symptoms worsened. She had frequent tearful episodes and panic attacks.
“I was hyperventilating, feeling weak, crying. It escalated so badly. I was wailing like a banshee. I was having rolling panic attacks. It would burn itself out after four minutes, then I’d have two minutes of feeling exhausted, and then another panic attack would come,” she says.
“It was really upsetting for my husband and my mother. There was a period in which every night my mother or my husband slept with the baby and the other person slept with me. I was really sick.”
She eventually attended a GP and was referred to a psychiatrist. She tried different medications for her anxiety and depression, until she found one that suited her. She also engaged with other supports, such as therapy.
“Women are so vulnerable when they’re pregnant and my concern about my mental health was undermined,” she says.
During her second pregnancy in the public system, concerning symptoms developed again but it was handled more sensitively this time.
“I was prepared for it; I had a care plan in place,” she says.
But it’s not just the care that has been delivered to women that has changed since the launch of the strategy; the population itself has also transformed over the past decade.
There is an increasing population of migrant women who may require a translator or who may not have had the same level of healthcare as someone who grew up in Ireland. This results in a need to spend longer with these patients, according to McGrane.
“Gestational diabetes doubled between 2015 and 2024. It went from 6 per cent to 12.7 per cent but it’s over 15 per cent now. The obesity rate went from 16 per cent in 2014 to 22.3 per cent in 2022,” he says.
Clíona Murphy, who is also a consultant gynaecologist, says that in some hospitals more than 40 per cent of women are overweight or obese.
“It has an impact, as some people may not do as well in labour, then they may have a Caesarean section, then they could have a wound infection, so their length of stay is longer,” she says.
Added to that, the risk of complication is higher, meaning the “episode of care is getting bigger”.
As the current strategy comes to a conclusion, the team responsible for its implementation is beginning to focus on what they still want to see achieved.
McGrane says there are elements on that supported care pathway that we “haven’t fully gotten” that they would like to address.
He believes there is a need to ensure staff are able to cater to those who are currently underserved, such as people living in direct provision, or individuals who are in socioeconomically deprived areas.
Although many women who spoke to The Irish Times criticised the maternity system, there was an overarching appreciation for the staff who delivered their care.
Lily’s story: ‘The midwives were incredibly kind and supportive’
Lily: ‘You could visit your little one any time, day or night.’ Photograph: iStock
Lily, which is not her real name, says she had an “extremely positive experience” of pregnancy, labour and postnatal care when she gave birth in the midwest in 2025.
“Due to concerns about my baby, I was induced early. In the days leading up to the induction, the midwives were incredibly kind, supportive, and always available whenever I needed assistance,” she says.
The day after her daughter was born, she was admitted to the neonatal intensive care unit as she wasn’t feeding.
“She was there for two days and one night. You could visit your little one any time, day or night. It was a shock to the system because you don’t know what to expect when you give birth,” she says.
“But from the get-go, the midwives were very good. They were very hands on and always coming down to check up on me. I could not fault them. I couldn’t have done it without them.”