Could it be that the Rotunda board noticed this year marks the 75th anniversary of the resignation of the then minister for health, Dr Noël Browne? Like those hobbyists who re-stage old battles, the board tried, before it sounded the retreat last evening, to mark the anniversary by dressing up as 1950s bishops and leading the charge against socialised medicine. It was Mother and Child II: just when you thought it was safe to dream of equal treatment.Browne was forced from office in 1951 because he had the temerity to try to introduce free medical care, on an equal basis, for all mothers and children. He was defeated by an omnipotent alliance of medical consultants and the Catholic hierarchy, led by the archbishop of Dublin John Charles McQuaid.The victory of the combined episcopal-medical forces over Browne’s Mother and Child Scheme was a crucial moment in the shaping of contemporary Ireland. Britain had introduced its National Health Service – one of the greatest achievements in the history of humanity. The unionist government in Northern Ireland had to follow suit. Would the Republic do likewise?Not while there was a crosier left to knock social democracy on the head or a stethoscope to strangle it with. The reactionary establishment got its way. A unique two-tier system of hospital care was embedded in Ireland. The church could keep control of the system (and continue to deny women basic reproductive rights) and the consultants could earn small fortunes by charging women for private care. Seventy-five years on, episcopal power is much diminished and the battles over reproductive rights are largely over. But the attempt by the Rotunda board to defy a Government plan to ensure equal treatment for all mothers in publicly-funded hospitals was not just a blast from the past. It was an attempt to control the future.As of now, the Rotunda has no trouble providing private care to women who opt for it. It advertises this commercial business and boasts that those who pay will have “the best of both worlds” – meaning private care with access to all public facilities. How long can the Rotunda keep doing this? In 2023, the Rotunda board was told that most of its consultants (who have not signed the public-only contract) can “still deliver private practice as their contract remains unchanged” and that the disappearance of private obstetric services in the hospital would happen in a time frame “estimated at 12-15 years”.So we’re talking about something that will happen sometime between 2035 and 2038. Why, then, did the board try to make a last stand? Because the future of maternity services is up for grabs. The Rotunda and the National Maternity Hospital (Holles Street) believe there is still a big and lucrative market for the provision of private maternity care. There’s a lot of money still to be made in this business – so long as the State subsidises it. But the main driver of this market is fear. Listen to the women who have been calling Liveline or writing letters to The Irish Times and what you hear is trepidation. They believe that they and their babies would not be safe if they don’t pay thousands of euro to a consultant.Why do they believe this? Because the Rotunda tells them so. Explaining to the Oireachtas health committee why the hospital had chosen to allow consultants who have signed public-only contracts to continue charging for private care, Rotunda master Prof Sean Daly said: “That is why the board of the Rotunda made that decision. It is primarily about safety for women and women’s choice.”Three things about this claim are remarkable. The most obvious is the implication that there are two levels of safety for women and their babies provided in the same hospital – a top tier for those with a lot of money and a lower rung for those without. What, one wonders, does the Medical Council make of this claim?Second, though, this implication is patently false. The Rotunda is independently inspected by the Health Information and Quality Authority (Hiqa). Its most recent report finds that “clinical risk management” is “functioning effectively and efficiently”. The Rotunda has a system “which enabled board members, senior managers and frontline staff to address local issues and to prevent, detect and mitigate risks to patient safety”. Daly himself told Hiqa that “resources were reallocated as needed to maintain safe staffing levels”. Not only did Hiqa report no evidence of differential treatment of women, it found that women felt they were treated in accordance with their needs: “It was evident that staff in the Rotunda Hospital were committed to promoting a person-centred approach to care and were observed by inspectors to be respectful and responsive to the women’s individual needs. Women who spoke with inspectors on the day reaffirmed this. Inspectors found that women were supported in autonomous decisions such as those related to birthing choices and infant feeding. Staff were observed to be diligent in their efforts to provide privacy, and inspectors were informed that women with particular needs (including after suffering bereavement) were prioritised for single rooms.”The third point arises from this evidence: why on earth is a hospital talking down its own excellence and ethic? In order to maintain the fear factor that drives women towards private care, the Rotunda board implicitly insulted its own staff. How do the dedicated midwives who form the backbone of the hospital feel about the implication by their own leadership that what they do for women and babies is less safe than it might be? Who on the board is speaking for the midwives? Who is coming out and telling the truth of which everyone at the hospital ought to be proud: that this is an institution fuelled by love and compassion and professional commitment and not by the profit motive? Now that it has belatedly stopped re-enacting the battles of the 1950s, the Rotunda’s board should be fighting for all the women who pass through its doors and all the babies who make their first cries within its walls.