Dublin's maternity hospitals are proposing special payments for midwives in the capital to help ease acute staff shortages in their wards.
The payments would be "ring-fenced" to avoid implications for other areas of nursing and would also stop short of amounting to special Dublin weighting, according to the master of the Coombe Women's Hospital, Dr Sean Daly.
Dr Daly, who met hospital matrons and representatives of the Nursing Alliance yesterday to discuss the staffing crisis, said the proposals were designed to compensate midwives who worked in so-called "beacon units" - those handling more than 5,000 deliveries annually.
Any deal for midwives in the three Dublin hospitals could extend to a future beacon unit in Cork, Dr Daly said.
He and his counterparts from the National Maternity Hospital and the Rotunda held a "critical" meeting with the Eastern Regional Health Authority on Thursday, amid warnings that patient quotas would have to be introduced if the staff problem was not addressed.
The loss of midwives to the provinces and to other areas of healthcare has created more than 100 vacancies.
But in an unusual statement yesterday, the three masters moved to reassure the public that the staffing crisis would not affect standards of care for existing patients.
"The masters are confident that the ERHA realises the extent of the problem and that the authority is committed to implementing a real and lasting solution," the statement said.
It also warned that if standards were to be preserved, "it must be accepted there is a limit to the number of babies that can be delivered within the current hospital infrastructures even if the midwifery problem is resolved".
Last night, the master of the National Maternity Hospital, Dr Declan Keane, said a quota system remained part of the "doomsday scenario, but we all hope it will never have to be introduced."
Another option was the dispersal of patients who did not need to come to Dublin, he said.
The NMH already accepts non-Dublin patients only if they have been referred by consultants, but the ERHA could yet impose such a restriction on the other Dublin maternity hospitals.
The separate possibility of dispersing asylum-seeking patients, currently concentrated on the Dublin hospitals and accounting for 3,000 births a year, would be a matter for the Department of Justice and other agencies, Dr Keane said.
The focus of this week's meetings had been on compensating midwives in the busiest hospitals.
"We're trying to justify extra payment for midwives in the capital, but to ring-fence it in such a way that it doesn't amount to Dublin weighting, with all the problems that would cause," Dr Keane added.
Dr Daly said the birth yesterday at the Coombe of quadruplets illustrated the special challenges facing the Dublin hospitals.
Up to 40 staff attended in the theatre during the births, which were of three boys and a girl weighing between 1 and 1.5 kilos each.
