Tallinn doctors want maternity care moved closer to children's hospital
Transporting critically ill newborns across the city puts lives at risk, pediatricians warn, calling for a maternity hospital next door to Tallinn Children's Hospital.
Doctors at Tallinn Children's Hospital say maternity care and neonatal intensive care being split across the city is putting lives at risk, warning that delays in getting critically ill newborns to the neonatal intensive care unit (NICU) can be fatal.
In an appeal to the Ministry of Social Affairs, they have called for a maternity hospital to be built alongside the children's hospital in Mustamäe.
"Delayed level 3 intensive care can, in the worst case, cost both the mother and child's life," the doctors wrote in their appeal to the ministry, emphasizing that deaths linked to logistical delays in the Estonian capital are not confined to the distant past.
Several recent cases reported in the media have followed the same pattern: complications arise at a maternity hospital, forcing an emergency transfer of a newborn by intensive care ambulance to Tallinn Children's Hospital in Mustamäe.
"Our main concern is the children and families," said Johanna Hade, attending physician at the pediatric intensive care unit (PICU) at Tallinn Children's Hospital. She said obstetric and pediatric intensive care are fragmented in Tallinn, despite years of calls from doctors for a solution.
This fragmentation, she continued, means the most fragile newborns — including those needing surgery — are separated from their families in their most critical moments and transported across the city.
While maternity hospitals can provide initial care, higher-level neonatal intensive care in Northern Estonia is available only at the children's hospital. According to Hade, research shows that transporting critically ill newborns worsens outcomes.
Separating infants from their mothers also worsens maternal outcomes, she noted, as postpartum mothers may leave maternity wards early to be with their hospitalized newborns.
Fewer maternity hospitals, more money and staff
Doctors also point to inefficiencies in the current system. Tallinn currently has three facilities capable of providing NICU-level care, all funded by the Estonian Health Insurance Fund (EHIF), despite falling birth rates, staff shortages and tight budgets.
A healthcare system already running a deficit paying for duplicate equipment and staffing, Hade said, "is, clinically speaking, a misuse of public funds." Based on birth numbers, she added, one maternity hospital should suffice in Tallinn.
The overlap also strains staffing. PICU and NICU doctors are trained through anesthesiology and intensive care residencies, and there are now so few specialists that the future of the field itself is at risk, the doctors warned in their appeal.
From the children's hospital's perspective, the solution is clear: build a maternity hospital at the Mustamäe medical campus, where North Estonia Medical Center (PERH) and Tallinn Children's Hospital already operate. That would keep prenatal, obstetric and neonatal care — from pregnancy through birth and discharge — all in one location.
State and city weighing options
The Social Affairs Ministry said it would comment after responding formally to the pediatricians' appeal. Minister of Social Affairs Karmen Joller (Reform), a licensed and practicing family doctor herself, has previously voiced support for closer integration of PERH and the children's hospital.
"Tallinn Children's Hospital and PERH are connected at the hip," Joller said last month, noting that doctors from both institutions already support each other's work.
She said she would favor a merger, but stressed that talks with the Tallinn city government are needed.
Tallinn Deputy Mayor Riina Solman (Isamaa) said the city has discussed both expanding the children's hospital and building a new facility.
She confirmed that Joller raised the possibility of transferring the pediatric hospital to state ownership but said the city would expect to be paid for it.
For doctors, ownership is secondary. What matters, Hade said, is that political or administrative decisions do not hinder care.
"We believe women and children should receive the best possible care regardless of what party is in power," she said, noting that further south, Tartu University Hospital (TÜK) somehow manages to function as a hospital run jointly by the state, city and university.
Doctors want the ministry to take the lead and launch a broader discussion on how to ensure care that puts patient safety first, she added.
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Editor: Mirjam Mäekivi, Aili Vahtla
