Wednesday, 2 December 2015

Limerick Maternity Hospital

Two months ago it was announced that Limerick’s Maternity hospital will be relocating to the main campus of University Hospital Limerick under the government’s €27 billion capital plan[1]. However there is no mention of what will happen to the hospital building.
Limerick's obstetrics and midwifery services are centralised in the Mid-Western Regional Maternity Hospital located on the Ennis Road, north of the city centre. I can see the logic behind this move for those cases that require a newborn to be rushed from the Ennis Road to University Hospital Limerick in Dooradoyle. Battling the traffic each minute must seem like an hour to any parent. It is natural that a high proportion of people in Limerick choose to live in that area near the hospital rather than the city centre. Best practice internationally confirms that the preferred site for a maternity hospital is to be co-located with an acute hospital. Nevertheless I will be sad to see the end of the stand alone maternity hospital. This is where the future of the hospital remains uncertain and if it shall still remain, in some shape or form, a hospital or care unit or even if it will be demolished.It is a building type that emerged in the last century and will go in this one. 
My mother was born in a nursing home, her four children in the Limerick Maternity Hospital. Her first grandchild was born in that hospital in February of this year. If she has any more grandchildren it looks like they will be born in the mammoth University Hospital Limerick campus. It was a joy to be able just walk up into this medium-sized hospital to visit my new nephew without the screeching ambulances of A&E. There is something so intimate about a site dedicated purely to waddling women and babies. 

OS Map of Limerick (1872) showing Bellefield House
History of maternity care in Limerick
Up to the 1950s, home births were the norm in Ireland and Lying-in or Maternity Hospitals was considered to be for the use of the poor or if medical intervention was required. The Hospitals Commission Report 1933-6 noted that the practice of calling for the ‘handywoman’ if help was needed during home deliveries. The ‘handywoman’ was a sort of traditional, untrained midwife who would often through her ignorance of sources of infection, cause death by septicaemia. It would not be until 1918 through the Midwives (Ireland) Act that midwifery was regulated. The first Lying –in Hospital
Lying-in Hospital, Bedford Row
in Limerick was founded in 1812 as a voluntary hospital and then moved to junction of Bedford Row and Henry Street in 1866 and from then on was known as the Bedford Row Lying-in Hospital[2]. Service slowly expanded and a training centre for midwives as set up at the end of the nineteenth century. In 1935 the Hospital took over the domiciliary maternity services for the City with the appointment of a midwife to attend women in their homes during childbirth. From its foundation, the Hospital was critically dependent on subscriptions and fundraising which was organised by the Ladies Management Committee, populated by many of the wives of attending doctors at the Hospital. The religious orders were not involved in the running of Bedford Row as nuns were not permitted to nurse maternity cases at that time however St Munchin’s parish has and always had provided a chaplaincy service for the hospital. 
Alternatively births also took place in the city up until the early 1980s in Nursing Homes which were often in private houses such as St Anthony’s on Barrington’s Street or ‘Mrs Moloney’s’ in the Irish Estates, Corbally.
The new hospital was located on the other side of Sarsfield Bridge (left hand side of photo). Image
taken from Limerick Museum & Archives
The location of the new maternity hospital
The Lying-In Hospital could not cope with the number of births for the city and the use of private maternity homes became increasingly popular during the twentieth century[3]. The Hospital Commission first advised in 1933 that a fresh site should be bought for the building of a new maternity hospital and the site identified as Belfield, just north of the river Shannon was purchased for £2000 in 1935 with the purchase also of old Belfield House for an additional £3000 in 1936 to provide a larger site. In 1936 the Department of Local Government and Public Health put forward the proposal that a large maternity hospital consisting of eighty-six beds to be built in the city that would cater for the poor as well as those who could afford to pay. Thus in 1938 legislation was introduced in the Dail to build a maternity hospital and the site on the Ennis Road was secured[4].
Image taken from Limerick Museum & Archives
It was envisaged from the outset that a new hospital on the Belfield site would be managed by a committee made up of seven representatives from Limerick Corporation and seven representatives from the existing Bedford Row Committee. However the intervention of the Second World War resulted in inordinate delays and Bedford Row continued to function as per usual with patients in 1935 having to put up with the very considerable noise generated from the construction of the adjacent Savoy Cinema. Dr James Deeny, Chief Medical Officer visited Bedford Row on a countrywide hospital tour in 1945 and was left unimpressed by the state of the Bedford Row Hospital at that stage. A letter was sent to the City Manager from the Department of Health in July 1948, proposing that a Regional Maternity Hospital catering for Limerick City, Tipperary and Clare be built on the Belfield site and that this Hospital should be operated, not as was previously envisaged, jointly by representative of Limerick Corporation and the Bedford Row Committee, but exclusively by the Limerick Corporation. The Bedford Row Committee had considerable funds from the Sweepstakes contributions but ultimately agreed to transfer their interests in the Belfield site to the Corporation as they felt they would be unable to pay for the construction and maintain the running costs of the new maternity hospital without the support of Central Government.
Belfield House was at one stage suggested as a suitable building to house patients suffering from pulmonary tuberculosis. In a letter dated 26 September 1944 the Tuberculosis Officer, T.W Moran to the City Manager described the building as
‘A two storied building standing on open ground. On the ground floor in front there are three rooms of twenty-four feet, eighteen feet, and twenty-seven feet long by eighteen feet, and twenty-seven feet long by eighteen feet, twelve feet, and eighteen feet long by twelve feet deep. At the back, there are two rooms each of separate W.C. is provided upstairs[5]’.

Four years later there was an obvious need for a new maternity hospital in Limerick as the Lying-In Hospital on Bedford Row could not cope. The City Medical Officer observed that between 1943 and 1948 there had been 1,400 births in the Limerick city and county borough. To serve this number was a meagre 26 beds of the Bedford Row Hospital complimented by several smaller nursing homes[6]. In a letter from the Limerick City Medical Officer it is evident that the Minister early on recognised that the site on the Ennis Road was the best possible option
‘It is very desirable that the Maternity Hospital should be located as close as possible to the main centre of population and for that reason a more central site than that of the Regional Hospital should be selected. There is a suitable site at Bellefield, Ennis Road, which is owned by the authorities of Bedford Row Maternity Hospital and the Minister is of opinion that the Regional Maternity Hospital should be built on that site if it can be secured[7]’.

The Medical Officer thus wrote to the Minster for Health asking for the authorisation of a grant from the Hospital Trust funds of 100 per cent of the approved cost of the new maternity hospital which was approved in May 1949. Belfield House was demolished to clear the site to make way for the much needed Hospital. The legacy of Belfield House remains as the name for a residential avenue next to the hospital called Bellefield Gardens. The architect for this hospital was Patrick Sheahan who began preparatory drawings in 1951 and its build overlapped with the construction of the Mid-west Regional Hospital. Always economically practical Sheahan ensured that any surplus steel from the Regional site was transported to the Maternity site. The building of St. Munchin’s Regional Maternity Hospital commenced in 1955 and received its first patients in October 1960[8]. Prior to this, large numbers of patients continued to have their babies delivered at home, with Bedford Row accounting for 572 deliveries in 1952 and a number of private Nursing Homes around the City accounting for an increasing number of births. As an interim solution, prior to commencing construction of the new Maternity Hospital, the Department of Health remedied the lack of State provision of maternity beds by opening a seventeen bed Maternity Unit in the City Home in 1954 and this did have a welcome impact on the activity at Bedford Row with the number of patients reducing from 771 in 1953 to 604 in 1955[9].
After the building of the Regional Maternity Hospital, Bedford Row was excluded from the receipt of any funding from the Hospital Commission and subsequently its Local Authority support was also reduced and eventually withdrawn in 1957. To meet expenses it began to charge its patients and ironically this facility for the maternity needs of the destitute was now a private hospital. By 1969 only one other nursing home apart from Bedford Row offered obstetric services. The Hospital continued to have financial difficulties as a result of rising healthcare costs and had no option but to close down in 1975.
The Regional Maternity Hospital subsequently grew into the largest Maternity Hospital outside of the three major Dublin maternity hospitals. The ground works for the hospital began in 1957 and the complex was completed in 1960 but did not receive any expectant mothers until the following year. This was due to two factors; (a) medical practices had changed so much during the period of construction that the hospital had to be re-equipped with more modern machinery and operating equipment[10] and (b) am accommodation block was designed for the nurses but this wing was reassigned for a different purpose. This marked the social change that nurses no longer resided on the hospital premises as they had done previously. When it opened it had 60 beds and 30 cots and this was subsequently increased to 80 beds in 1969. At the end of its first full year of operation in 1961, there were 1576 births. A number of phased developments have taken place at the Hospital in particular the opening of the first Home Birthing Unit in the country (see Appendix C for photographs of original plans and elevations). The Maternity Hospital had an interrupted view of the river Shannon and Sarsfield Bridge before the construction of brick faced apartments in the eighties and what was formerly the Intercontinental Hotel facing the hospital is now the rebuilt Strand Hotel.
Hospital elevations. Photo taken by Emma Gilleece. Plans courtesy of family of original architect.
 
Photo taken by Emma Gilleece
The design of Maternity hospital
This hospital has a moulded concrete stringcourse along the top of the central bay is divided in two by a chevron pattern which is typical of Art Deco eccentricities. The use of balconies along the length of the front façade gives the building its horizontal character and also by the bars on its vertical windows. This is a building of hard lines both vertically and horizontally broken only by the insertion of feminine detail at the ends of each balcony railing sections of a curvaceous inverted ‘S’ shape. Balconies were well established by this time as desirable design features for hospitals even though here it must have served a more aesthetic than functional purpose seeing as that it was always used as a maternity hospital.
Photo by Emma Gilleece
Another striking feature of this building is its use of brick which Sheahan departed from in the design of the earlier Mid-Western Regional Hospital in Dooradoyle. In a letter Sheahan sent to Limerick Corporation dated 8 January 1954 Sheahan draws attention to an earlier correspondence from the Department of Health stating that provision should be made for invitation of tenders on basis of concrete block or brick plastered externally, but with provision for alternative price for brick facing[11]. He ends this letter ‘I am most anxious that we be allowed to use brick facing on this building’. He unfortunately does not offer a reason.
Balusters on central staircase which matches one on balcony to front elevation of hospital.

 Recent extensions and alterations
Photo taken by Emma Gilleece
In 1995 the pre-natal and anti-natal wards had ensuite toilets installed in each four-bed or two-bed rooms. This was done simply by blocked off the corner of each room losing minimal space and keeping the same amount of beds. The year 2006 saw the completion of a new three-storey extension to the complex designed by Murray O’Laoire and O’Connell Architects. This much needed block gave the hospital a larger, better sited main entrance thus leaving the old entrance for the exclusive use of outpatients. In addition to the extra ground floor space it provided extra ward space on the first floor and a new operating theatre on the second floor. It is to the same specifications of the older theatre apart from the inclusion of air conditioning.
Extra space is vital especially after the closure of the Maternity unit in Ennis making the County of Clare reliant on either Limerick for Galway for its maternity care. 

The future of the hospital
These plans were welcomes by the management of the hospital for logistical reasons as all gynaecological care as previously mentioned is sited in Dooradoyle and the Maternity hospital has no laboratories so have to send everything to be tested to the Regional Hospital. The staff and management have been waiting over a decade for this news. The hospital for even more years has required urgent renovation and modernization and the minor additions with the 2006 extension acted as a band-aid bringing the hospital up to the minimum standard to carry on in its current condition.




[1] ‘Limerick to get new Maternity Hospital under Capital Plan’, Limerick Leader, 29 September 2015.
[2] Terry Forristal, ‘Bedford Row lying-in hospital 1812-1975’, OLJ (Limerick, 2006), p13.
[3] St Gerard’s Maternity Home, St Anthony’s Maternity Home, Alexandra Maternity Home, Mrs O’Malley’s Maternity Home and Bedford Row Extern, the Marian and Tranquiller in Fort Mary Park. (T. Forristal (2006), p.17).
[4] IB 22 Jan 1938, 73.
[5]‘Tuberculosis Scheme’, L/MIN/20 14 Nov. 1944.
[6] Letter from Limerick City Medical Officer to the Dept. of Health dated 6 July 1948, L/MIN/21, LCA.
[7] Ibid.
[8] Forristal (2006) ‘Bedford row lying-in hospital, 1812-1975’, p.18.
[9] Forristal, p.18.
[10] Per. con. with QS of hospital, Barry Sheppard.
[11] Ref: H18/7/1, L.A

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