Change in Maternity Provision in Ireland: "Elephants on the Move"

In an attempt to understand how change can occur in health services this article focuses on two recent developments in Ireland which came about as a result of an unexpected event and a consequent shift in policy which as Hinrichs (2001) and Castles (2010) suggest can be slow to move. Drawing on path dependency theory this article argues that maternity policies in Ireland were "locked in" between 1951 and 2001 in the wake of the Mother and Child controversy, an infamous milestone which led policy to develop along a very specific path and institutionalised the medical model of childbirth which has since endured. During the subsequent fifty years, the size of maternity units increased as did rates of medical interventions. Numbers of women giving birth at home declined from over a third in 1950 to less than one per cent today. This locked in policy for over half a century until it was challenged at the next critical juncture in 2001 when the withdrawal of insurance from two maternity units in the North East of Ireland led to their sudden closure in a region which was the area of greatest population growth in Western Europe. This led to a major shift in the hard to move "elephant" of maternity provision with potential to change policy on a national level in Ireland.