You don’t need to be an expectant mother, a midwife, an obstetrician or a paediatrician to understand the serious clinical concerns and frustration expressed recently by the master of the Rotunda Hospital, Prof Seán Daly, in The Irish Times. He outlined how women are occasionally being sent as far as Drogheda to deliver their babies because of a severe shortage of beds.
In the interview, he painted a worrying picture of a “really, really acutely busy” hospital whose ageing infrastructure is compounded by a severe shortage of space. It is the busiest maternity hospital in the State, having delivered 1,100 more babies than the National Maternity Hospital (NMH) and almost 1,700 more babies than the Coombe Hospital in the first 11 months of 2025; it has insufficient spaces in an overcrowded neonatal intensive care unit, with the need to transfer women in labour, not just out of the Rotunda but out of Dublin; it has to cope with increasing complexity of care and increasing demand for benign gynaecology services. And if all that wasn’t causing enough strain, planning permission for a new critical-care wing has been stalled in an appeals process because of objections.
The Health Service Executive’s Dublin and North East region (DNE), in which the Rotunda operates as the lead maternity hospital, has the largest regional population in Ireland (just under 1.2 million people). Between 2016 and 2022 the population in DNE increased at a higher rate than the national average, the highest increase being in the north inner-city (17.9 per cent versus the national average of 8.1 per cent). DNE includes the areas with the highest levels of deprivation and ethnic diversity in the country.
Regarding the Rotunda’s long-term future, it makes demographic sense for the hospital to be redeveloped in its current location, rather than be relocated to Connolly Hospital, as is the Government’s plan. Leaving it where it is would make it part of an expanded medical campus that also includes the nearby Mater hospital, which already provides the Rotunda with a comprehensive range of adult medical subspecialty services. The plans to build 6,000 new homes on land situated between Cabra, Glasnevin and Finglas supports the Rotunda staying where it has stood since 1757. Immediate investment on the site will have long-term benefits.
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Meanwhile, across the river in Dublin 4, more than €147 million has been spent so far on preparatory works for the relocation of the NMH on the campus of St Vincent’s University Hospital. This plan was conceived at a time when the NMH was delivering more than 8,000 babies annually (it delivered 6,722 babies in 2024). The new seven-storey hospital will have 80 more beds than there are on the current Holles Street site. It will also have two more operating theatres as well as 24 birthing rooms. Tentatively priced at €150 million in 2013, it is expected that it will cost close to €2 billion by the time the project is completed.
[ Number of babies born to women aged 45 and over rises 80% in 10 years - CSOOpens in new window ]
Notwithstanding a predicted upswing in the falling national birth rate after 2038 – and the certainty that additional patients will choose to attend or will be referred to a state-of-the-art new hospital – the scale of the NMH relocation project has been seriously misjudged. Worse, the projected overspend may have negatively impacted on other maternity hospital projects getting off the ground. The hospital plan was approved in 2022 and it is not due to open until the early 2030s. Given this long gestation and the €36 million already spent on design fees, change at this stage is not an option. Hopefully, lessons have been learned and the new financial safeguards being put in place by the Government for this project, based on the experience of the national children’s hospital (NCH), will work from now until its completion.
Then there is the Coombe Hospital, situated equidistant between the Rotunda and the NMH at Holles Street. It delivered 6,506 babies in 2024. It also provides the largest gynaecology service in the State (18,787 outpatient attendances and 6,967 surgeries in 2024). In 2015, the government decided that the Coombe should be relocated to St James’s Hospital (SJH) alongside the new NCH. Over the years, paediatric and foetal medicine experts have emphasised the benefits of a maternity hospital being co-located with the NCH to provide on-site delivery for those newborn babies with life-threatening conditions that require immediate complex paediatric interventions. This is also enshrined in legislation: the 2018 Children’s Health Act mandates the National Paediatric Development Board to “plan, design, build, furnish and equip a maternity hospital” for this very purpose.
But the absence of timelines and a financial commitment by Government for this, combined with concerns over space and hospital governance, and competitive conflicts of interests between hospitals have meant that nothing has happened in relation to the Coombe’s co-location.
A pragmatic, space- and cost-saving solution would be to move the maternity services of the Coombe alongside the NCH while continuing to develop the current Coombe site for benign gynaecology services as part of an expanded campus that includes the nearby SJH site. Importantly, the co-located maternity hospital should have a foetal medicine unit staffed by experts from all three Dublin maternity hospitals; the development of a stand-alone foetal medicine unit without the backup of an on-site maternity hospital would not be a long-term solution – but could work as an interim arrangement.
This is set to be a historic year: the Coombe will celebrate its 200th anniversary; the Rotunda will celebrate the delivery of its millionth baby; substantive work will begin on the new NMH; the NCH will open.
The stage is, therefore, set for the Government to make historic decisions in relation to maternity services based in the capital city – hopefully with a focus on demographic need, social deprivation and the care of critically ill newborn babies who need immediate access to the NCH.
Chris Fitzpatrick is a retired consultant obstetrician and gynaecologist, a former master of the Coombe Hospital, and a former member of the National Maternity Hospital–St Vincent’s University Hospital Co-Location Board. He has worked in all three Dublin maternity hospitals and is a clinical professor in UCD.
