Sign in. It’s quick, free and it’s up to you.
An account is an optional way to support the work we do. Find out more.
InvestigatesBirth ChoiceA SOUGHT-AFTER modern labour room with a birthing pool funded by the HSE to the tune of €100,000 is being rarely used in Sligo University Hospital (SUH).
The Journal Investigates can reveal that despite it being the only delivery suite that complies with recommended modern infrastructure guidelines for maternity care at the hospital, the room has often lay empty in the two and a half years since its completion.
“I don’t know why they won’t embrace it,” Sandra*, a midwife at the hospital who spoke on the condition of anonymity, told us.
The ‘Suaimhneas Room’, which translates as peace or serenity, is part of the HSE’s rollout of home-from-home delivery suites, a priority in the National Maternity Strategy to offer less medicalised birth options.
Often called “the good sitting room” by frustrated mothers and birth workers, it is equipped with a heated water birth pool, an ensuite with a shower, a sound system and mats for labouring on the floor.
It is the only delivery suite with an ensuite. One staff member called the rest of the labour ward “archaic”. According to staff, SUH has been waiting for a new maternity unit since 2007.
Sandra said staff often keep the door of the Suaimhneas Room shut and claim it’s being used when it’s empty. She added:
They’re not facilitating what the women need and what we have to offer in physiological birth, and we’ve got the most beautiful place to do that in.
Generally, physiological birth means there are no interventions performed, such as continuous monitoring and drugs to induce labour.
Benefits are many and include increased breastfeeding rates, greater maternal satisfaction and reduced costs of care. This type of birth, however, is not recommended for women with certain risk factors or conditions, like preeclampsia or placenta previa.
Other reasons SUH staff gave for rarely using the room was lack of confidence, fear of litigation if things went awry, lack of adequate staffing and distance, the room being too far away as compared to the other labour suites — despite a difference of a few steps.
When presented with these claims, a SUH spokesperson said: “Not all labouring women will meet the criteria or indeed wish to use the room.”
On staff shortages, SUH told us that the hospital currently has “a number of vacancies within its midwifery department” but recruitment is ongoing.
In line with the National Maternity Strategy, SUH provides one-to-one care for birthing women. When asked directly how staff shortages affect care in the Suaimhneas Room, given it is all one-to-one care, the hospital did not respond.
Over the past two years, in antenatal classes and clinics, women have been told the room “might” be ready by their due dates.
But The Journal Investigates spoke to women who used the suite at the times when staff claimed the room was still under works.
In the months of reporting this story, we spoke to nearly 40 women who gave birth in the Sligo area in the past two years, as well as midwives, GPs and other pre and postnatal birth workers.
Of the mothers we spoke to, only five used the Suaimhneas room for all or part of their labours and only two used the pool, which cost more than €15,000.
Conversations with women in other parts of the country suggest similar underutilisation of these style labour rooms.
When asked about this, the HSE’s National Women and Infants Health Programme (NWIHP) said: “The development and implementation of home-away-from-home delivery suites across maternity sites and services in the country has been enabled so as to support women to have a greater range of birth options.”
Dozens of low-risk women shared a variety of reasons they were given as to why they were not allowed to use the room. Often these reasons conflicted.
Some included too few staff working in the labour ward, especially during night and weekends.
One was told that she couldn’t use the room because she was already 8 centimeters dilated; another woman who arrived at the labour ward with 8 centimeters dilation could use the room.
Some women we spoke to were not told that an induction meant they would risk-out of the room.
One woman was refused access to the room for being unable to provide urine for a test, though the few women we spoke to who were able to use the room did not need to provide urine samples.
Others were told that birthing in the Suaimhneas Room was not permitted, so even if they used the room for part of their labour, they would need to move to push. This is not in line with SUH’s guidelines.
Others were told the room was not complete or that the tub takes hours to fill, both are false.
One second-time mother was initially told she could not use the Suaimhneas room due to staffing constraints. Then, because the ward was at capacity, she was admitted to it but was not permitted to use the pool.
She told us she felt comfortable there and had a greater satisfaction with her second birth.
SUH said it could “not comment on individual cases”, but encouraged women to raise their concerns and feedback with a member of their clinical team or to use the HSE’s Your Service Your Say. The spokesperson added:
There is a rigorous complaints process in place in SUH that any patient can access.
In regards to staffing at night, the hospital said: “As is standard for all maternity units, there is a difference on staffing levels Monday to Friday in comparison with out of hours (nights and weekends).”
The 2016 National Maternity Strategy, which aimed to normalise birth, outlined that each maternity network would provide alongside birth centres run by midwives rather than obstetrics. And where those were not feasible, provide designated low-technology spaces, like the Suaimhneas Room.
To date, there are still only two ‘alongside birth centres’ – the midwifery-led units operating in Cavan and Drogheda.
Home-from-home delivery suites have been developed in 15 units. Another, in Letterkenny, “is in the early stages of development”, the NWIHP told us.
The HSE has invested around €1.2 million in these style rooms nationwide. The NWIHP said that the full budget of €100,000 was spent on the Suaimhneas room.
Only women with normal-risk pregnancies under the Supported Care Pathway may have access to these rooms. In 2020, that amounted to almost 35% of women giving birth.
But, there seems to be little oversight of their success. When the number of women who accessed them was requested via FOI, the NWIHP said that it “does not collate this data at a national level”.
The response stated it “will continue to work closely” with the maternity networks and sites to support their “ongoing deployment and use”.
According to SUH staff, there is a record of use of the Suaimhneas room kept on the labour ward. When asked about this, a spokesperson for the hospital said: “There is no data available on the number of women using the unit.”
Nearly all sources interviewed expressed disappointment in not only the lack of the Suaimhneas room’s use, but also how long it took to create.
In preparation, staff told us that a reconfiguration of the labour ward in order to not lose beds was complete by 2018.
“The funding for Sligo was provided in three phases. €10,000 in September 2019, €35,000 in November 2019 and €55,000 in June 2022,” the NWIHP said.
Then, staff told us, for years the room sat empty.
In response, a SUH spokesperson said that before the room was upgraded, “it was used for other clinical purposes within the maternity unit including a triage room and a labour room for women with Covid or suspected to have Covid throughout the height of the pandemic”.
Plans for the Suaimhneas room were further delayed due to the pandemic. An invoice, obtained by FOI, shows works to the room were completed in June 2022.
Rooms in other parts of the country opened earlier, such as University Maternity Hospital Limerick’s Danu Suite, which opened to mothers in May 2018. NWIHP stated they funded all rooms between 2018 and 2024.
In Sligo, there are four other delivery rooms which share a single bathroom.
The most recent unannounced inspection of SUH’s maternity services by the Health Information and Quality Authority (HIQA) occurred in 2019.
The report concluded that the hospital “was compliant” with the majority of standards inspected but highlighted the physical environment of the labour ward:
It did not meet recommended design and infrastructural specifications needed to provide safe, high-quality care in a modern maternity service.
Numerous maternity units in the country have similar infrastructure issues.
With the Suaimhneas room being the only delivery room with an ensuite, not much has changed in Sligo in the five years since the audit.
SUH said they are seeking funding to upgrade the remainder of the labour ward.
In February 2023, a letter from the HSE to Sligo County Council stated the hospital launched the home-from-home room during 2022.
When asked for clarification as to when the Suaimhneas Room was first used, a spokesperson for SUH said that it was opened on 31 July 2023.
Yet, several women we interviewed were told in antenatal clinics and classes after that date that the room was not yet operational.
The earliest use of the Suaimhneas suite we could confirm by a woman who was not also part of the maternity staff was September 2023. That woman, a private patient, was told by staff that she was only the second or third woman in labour to avail of the suite.
Many women are ineligible based on the room’s criteria. Our investigation found from the experiences of many women who did qualify, they are rarely let in.
SUH stated that decisions around a mother’s suitability to safely use the birthing pool are determined in line with hospital guidelines and that “the safety and well being of the mother and their unborn child are central to all clinical determinations and criteria applied in this regard”.
“It’s hard to describe in words the feelings a mother-to-be goes through when her dream birth is slowly taken away from her, bit by bit,” one first-time mother, Eva, described her experience to our team. Due to privacy concerns, she asked that her last name be withheld.
Eva, who was 41 during her pregnancy, originally wanted a home birth but could not access the service. She also said did not qualify for the midwife-led unit in Cavan, due to “advanced maternal age”.
She described the possibility of birthing in the Suaimhneas room as a “small plaster on my wound.”
At every antenatal appointment and in classes, Eva tried to get clarity on the criteria for the room to little avail. After several visits to the labour ward, when the room was never in use, she “thought something was fishy,” and her hope of using the suite dwindled.
Because of SUH’s high intervention and C-section rates and Eva’s low confidence in the likelihood of using the Suaimhneas room, she planned to give birth at home without medical assistance, also called ‘freebirthing’.
Since freebirthing is unregulated and unregistered, there are no statistics on how many women have had them in recent years. The Journal Investigates reported a growth in unassisted births as part of our investigation in 2023.
In June 2024, Naomi James, a professional photographer and mother-of-four, died after giving birth at home, assisted only by a doula (a non-clinical birth worker). She had a postpartum haemorrhage after giving birth to her baby, who survived.
Eva and her partner bought supplies, like a birthing pool and waited. She told us:
I felt pushed to such desperate measures by the system.
While Eva was meeting her doula to finalise her birth plans, contractions came on suddenly and quickly became less than a minute apart. She was more than an hour away from home but only a few minutes away from the hospital.
After some deliberation, she decided to go to the hospital. As she predicted, she was not able to use the Suaimhneas room and was disappointed. While she had a quick labour with no interventions and called her midwife “awesome”, she was still frustrated by the lack of privacy at the birth.
“There are many midwives that do everything possible to accommodate mother’s wishes, however I often got the feeling that their hands were tied,” Eva said.
Despite knowing the risks, Eva said she would still prefer to freebirth, rather than give birth in the hospital, for future pregnancies.
More than half of the women we interviewed said they would be interested in a home birth for future pregnancies and several others either already freebirthed or intend to freebirth.
When this was put to the NWIHP, a spokesperson told us: “The HSE is aware of a small minority of women birthing without medical assistance.
“Unassisted births are associated with an increased risk of complications… The HSE would strongly advise all women that a trained maternity healthcare professional i.e. a midwife and/or an obstetrician, is present at all births.”
The NWIHP spokesperson also stated that SUH rates of induction of labour, instrumental delivery andor caesarean section are “in line” with national averages.
Many of the women interviewed expressed frustration and grief about the lack of birthing options in the north west and the high rates of interventions at SUH.
While the HSE provides a home birth service through privately employed midwives in some of the country, mothers in Sligo and the surrounding areas do not have access to this service.
Private Midwives Ireland, whose package of care is €6,800, has only one midwife who can cover up to Sligo, but not north of this. Thus, capacity is very limited.
A decade ago, Sligo had the lowest C-section rate in the country, at 19%. In 2023, the National Healthcare Quality Reporting System (NHQRS) reported Sligo had the sixth highest C-section rate in the country.
Last year, Sligo’s C-section rate was 42% and its induction rate was 35%. For first-time mothers, this increased to 43% for C-sections and 45% for inductions. This rise in intervention rates is consistent with the rest of the country.
Ireland has one of the highest C-section rates in Europe, according to the latest NHQRS report.
First-time mother, Saffron Demarco, who gave birth in May 2024, was determined to have a birth without medical interventions.
“To me that room was the answer,” she said.
While pregnant, she too originally hoped for a home birth. Saffron learned about the Suaimhneas Room at SUH’s antenatal classes and felt hopeful as she looked at the picture of a beautiful room.
Her class consisted of about twenty-five pregnant women. The facilitator warned not many would be eligible for the room and asked everyone who was low risk to raise their hands. Only two did and she was not one of them.
Saffron explained that she was low risk, but was put under consultant-led care because of her choice to forgo blood transfusions. Refusal of blood transfusions is not listed under the exclusion criteria for the Suaimhneas Room.
She could never get a clear answer as to whether she qualified for the room. While her obstetrician apparently recommended her for the room to the ward, they cautioned that ultimately the decision would remain with the head midwife on the day of her birth.
“That never made sense to me because why should it be their choice? You should be able to use the room or not use the room,” Saffron said.
When it came time for Saffron to give birth, she was denied access to the room. Her midwife said that she wanted her to use the room but it was out of her hands.
“I had a very traumatic experience of the birth and I feel that if I had that room, maybe things would have been different,” Saffron said. “Maybe I would have felt safer and more calm and the birth would have gone better.”
In response to an FOI, SUH said that all midwives have received education on the use of water immersion and on evacuation from the pool, and approximately 50% of the staff received training in water births.
Though water births are offered in some other hospitals around the country including Coombe, Wexford and Drogheda, SUH does not offer water births, so women must exit the pool before the pushing stage.
A SUH spokesperson said the hospital “ would like to offer this service for women” but it is “dependent on a number of factors”. These include “the finalisation of a national clinical guideline on water births and the completion and availability of a HSE waterbirth training module for midwives”.
“Work in these areas is actively ongoing at national level,” they added.
“There’s no point forking out all that money for that gorgeous room and then not being able to use it. It’s so disappointing,” said Síofra MacMahon.
She was one of two mothers we spoke to who managed to use the room and pool when her son was born in January 2024.
“You want things to go forward, you want water birth to be an option.”
* Name has been changed
Our previous six-part investigation into birth choice can be read here. The Journal also published your stories last year of trauma endured during and after labour.
Reporter: Adriana Casserly • Editor: Maria Delaney • Main Image Design: Lorcan O’Reilly • Social Media: Cliodhna Travers
To embed this post, copy the code below on your site
have your say