The falling birth rate now sees over 50% of all maternity hospitals deliver less than 1,500 babies every year, although more pregnancies are now increasingly complex, it said.

A longstanding national policy to co-locate maternity hospitals with acute hospitals for safety reasons has seen little progress. In Limerick, the maternity hospital is at least 5km from University Hospital Limerick (UHL), depending on the route taken.

Conflicting reports of where the hospital might move to were heard at the Oireachtas Health Committee.

Killian McGrane from the HSE’s national women and infants hospital programme said: “University Maternity Hospital Limerick will form part of the new Limerick hospital development, with a project board due to be established in due course.” 

This seems to refer to the new site near Raheen.

Later, Sandra Broderick, regional executive officer for HSE Midwest, said: "Obviously, a decision needs to be made on the co-location piece and where that is going to be."

She could not tell Senator Martin Conway if it would be on the new site, saying she has not yet seen the terms of reference for its development board. “The membership of that board needs to be decided upon,” she said.

She agreed with Fianna Fáil TD Cathal Crowe that the UHL campus is “heavily congested”.

The current national maternity strategy outlined plans for a new maternity hospital “at the front, on the left-hand side where the old nurses’ home is” at UHL, she said. That strategy expires in December. 

The HSE also said it is working on a review and surveys for the next 10-year strategy.

In Tralee, the maternity unit is in University Hospital Kerry but faces challenges with space and access to operating theatres. Fianna Fáil TD Micheal Cahill asked about expansion plans.

Mr McGrane did not have a timeline but is aware that planning is ongoing.

For accessing theatres, he said: “There is a dedicated lift in place, there’s a key that is only available to maternity staff to ensure emergency access.” 

Public v private pregnancy care

In Dublin, consultants at the Rotunda maternity hospital can still offer private pregnancy care despite being on a public-only contract, the hospital's master professor Sean Daly said.

He defended this to committee chair Padraig Rice, saying there are no private maternity hospitals and “the Rotunda has long believed that women should have choice”. He said when he told health minister Jennifer Carroll MacNeill, “suffice to say, she wasn’t happy”.

Mellany McLoone, the HSE’s integrated health area manager for this region, said: “We are aware and we are in discussions with Professor Daly.” She indicated few births are involved and said it’s an ongoing discussion.

Ms McLoone also noted “substantially low” uptake of the public-only contract — offering salaries starting from €233,527 — nationally among obstetricians and gynaecologists.

Labour health spokeswoman Marie Sherlock, among others, questioned safe staffing levels for midwives and consultants. Mr McGrane said this falls under planning for the new strategy. 

“We’re going to have to look at this differently than how we looked before,” he said, referring to expanding services for endometriosis and other care in maternity services.