Many sad stories have been told about the health system in recent weeks, often by women arguing for the retention of private maternity care in public hospitals. Similar stories feed a new social media account created to campaign for “maternity choice” (@ourmaternitychoiceireland). It’s a small country, so hardly surprising that some followers and advocates have familial or professional links in the maternity field. Many insist they have no objection to the public system; in fact, they would switch right now if it offered the same conditions – continuity of care, swift appointments, private rooms – currently available only to relatively well-off private patients. But such seismic change doesn’t happen without a fight, as the stand-off between obstetricians in the Rotunda and Minister for Health Jennifer Carroll MacNeill demonstrated in recent weeks. Those who can afford to pay can choose to join the battle or wait it out in comfort. A popular post on the our maternity choice social media account warns that removing access to private care before the issues are resolved in the public system will put women at risk. This is untrue but no one pushes back. It echoes the many stories of people who paid so that their “much-wanted child got the best possible care” and who then felt vindicated because a late, difficult-to-detect condition was identified by their private obstetrician. This suggests that those babies or their mothers survived only because they were privately delivered for a handsome fee. There is no evidence for this, as Gabrielle Colleran, president of the Irish Hospital Consultants Association, noted here on Monday. Our maternity hospitals have excellent outcomes and strong safety records, she wrote, and women who attend them, publicly or privately, are in very good hands. This is borne out separately by perinatal mortality rates, which have decreased in all socio-economic groups over time, with the lowest ever recorded in 2023, according to the National Perinatal Reporting System. Colleran also addressed the assumptions that women who choose private maternity care do so out of fear, or that anyone who argues for choice is implying that public care is less safe. Both assumptions are wrong, she said. They may indeed be wrong, but influential people on various platforms continue to make those arguments, using them to advocate for private maternity care while rarely acknowledging the publicly-funded infrastructure, the indispensable team, the ancillary (essential) services. Nor do they appear to consider how such a system can spare such valuable consultants for private work, since, as Colleran also notes, Ireland has the lowest number of consultant obstetricians and gynaecologists per capita than any comparable jurisdiction. Yet “choice” advocates contrast women’s narrowing access to private maternity care with men choosing, say, private prostate surgery. It’s probably true that if men could give birth it would be in palaces of quietude with one-to-one nursing and sommeliers on standby, but in real life there is a reason why Dublin alone has three large public hospitals dedicated to maternity rather than prostate surgery, and why the country cannot sustain a single private maternity hospital. Full-time private obstetricians would have to shoulder the prohibitive professional indemnity insurance for one thing, all of which is currently covered by the State.In the meantime, many women most in need of continuity of care never see it. Rebecca Moynihan posted on Instagram that she had three pregnancy losses before giving birth to her first baby at the age of 41 and to her second at 43. Here was the very model of a woman whose untold grief, loss and age profile screamed out for continuity of care, but Moynihan was a public patient. She never laid eyes on the consultants assigned to her on either of her pregnancies. They both had private practices, she noted. [ ‘I felt nobody had my back’: What the Rotunda row says about public v private maternity careOpens in new window ]As a taxpayer who funds the consultants’ salaries, argues the Labour politician, she should expect the same level of care, continuity and attention as everyone else but, as she wrote, “that won’t happen until they are rostered to be in the hospital for the full-time salary they collect and attend the antenatal clinics for the women they are meant to provide care to”. This is the environment in which people are demanding choice, the favoured word of those defending the status quo. How women or men spend their money is of course their choice, but this is surely arguable when applied to the inequitable uses of taxpayer-funded public hospital resources. Colleran argues that if Carroll MacNeill means what she says about women’s choice, she needs to measure it in funded consultant posts. That is a perennial truth across the health service. It is also true that the Minister has enormous public support for standing up to vested interests. Consider the impact if all the voices raised for the privileged few converted that energy into a noisy, insistent battle for radical change for all, or if a handful of influencers declared their intention to choose public maternity care and reported on it in the same filmic detail as their private maternity experiences. Consider if, instead of backing themselves into an ideological corner, the Rotunda obstetricians had – in the words of retired consultant Chris Fitzpatrick – rolled up their sleeves and played hardball with the Minister and the HSE to put the necessary provisions in place to make the plan work. They might want to reconsider, if not for their own sake then for their children being born into a deeply unstable world and who in a few decades’ time may not have the privilege of choice.