The Hungarian state of affairs of non-institutionalised birth

by Ágnes Geréb

AIMS Journal, 2008, Vol 20 No 2

Ágnes Geréb highlights the difficulties faced by women and their birth attendants

2007 has been the most difficult and afflicted year in the history of Hungarian home birthing. You may have heard that on 15th September 2007 a newborn died due to shoulder dystocia during a delivery that started as a home birth.

Many times in the past decades independent midwives have proposed legislation on this kind of childbirth, with no results at all. Often the lack of regulation has led to legal proceedings. The standpoint of the Professional College of Obstetrics and Gynaecology is that those Healthcare professionals, who assist at noninstitutionalised births commit professional and ethical infringement. This position represents a danger to the mothers wishing to deliver at home, to their newborns, as well as to their professional assistants.

On the last Home Birth Day, 7th April 2007, the Hungarian Civil Liberties Union and the Foundation of Alternatal addressed an open letter to the Prime Minister, in which they requested that he used all means at his disposal to achieve a satisfactory and competent resolution of the position of planned non-institutionalised home births. An answer to this letter was received in November 2007, lacking any substantial information regarding the solution to this problem.

In 2007 the independent midwives submitted a written professional proposal to the Ministry of Health, outlining a carefully drafted set of conditions regarding noninstitutionalised childbirth. This proposal initiated a dialogue, which has radically changed since last September, due to the above mentioned, tragically ended home birth.

The press has taken full advantage of this gruesome and painful tragedy to start a systematic campaign, the effect of which was that the troubled and persecuted midwives did not feel they were able to assist at undisturbed physiological deliveries any more. An undisturbed birth needs peaceful circumstances, hence disturbed or persecuted midwives are not able to assist at undisturbed home births. By the same token those wishing to birth their babies undisturbed during these weeks displayed much more illness, although not severe ones, like heavier bleeding after delivery, or newborns' adaptation problems which require hospitalisation.

The midwives, prosecuted by hospitals, harassed by journalists, recognised that amid these conditions it is impossible for them to work, to assist at undisturbed births. They suspended their non-institutionalised activities, and accompanied those who originally did not intend to deliver their babies in an institution as their doulas at hospitals. These women had to go to a hospital, but under normal circumstances this may have been unnecessary. This went on for about a month and a half.

This state of affairs was joined by the attacks of the newspapers, certain physicians' statements and the fact that the Ministry would not respond to petitions, and interrupted all dialogue with the midwives who have been working for decades in Hungary. At the same time the Ministry asked precisely those physicians who opposed non-institutionalised births to draft the regulations. The civil community, including the families concerned, 'the consumers' and certain part of the profession have raised their objections.

The rather active civil Association of Parents for Free Birth, and the Physicians for the Free and Safe Birth have been founded. They have proposed thoughtful initiatives and petitions to the Ministry.

Among others, hundreds of public personalities signed a petition that has been published in one of the biggest daily newspapers. It can be read on the webpage of the Association of Parents for Free Birth along with an increasing number of signatures at www.szabadonszulni.hu.

The Ministry of Health has published last October a regulation draft regarding the planned legislation. The lack of professional and practical elements proves again the well-known fact that the originators of the draft have no theoretical or practical sense of what a home birth entails. In case the regulation draft gets enacted, it will not solve but eradicate Hungarian home birth. Meanwhile Ágnes Geréb has been punished, she has been banned from practicing her profession of obstetrics and gynaecology (but not from general practice), and also has been unable to obtain her midwifery license.

Under civil pressure the Ministry invited Ágnes to the arbitration held with the participation of obstetricians and gynaecologists (who have never assisted at noninstitutionalised births), together with the associates of Daylight Birth Centre, National Midwife Association and Moon Circle Midwifery House who have assisted at home births for years or decades.

After the arbitration the basically unchanged proposal of the Ministry of Health was reissued, reflecting primarily the views of the Professional Board of Obstetrics and Gynaecology, which are not based on scientific evidence.

On 27th December 2007 parents and children handed over an open letter to Dr Agnes Horvath, Minister of Health, signed by 84 national and international professionals, among them renowned authorities such as Michel Odent MD and Professor Dr Marsden Wagner, in which they drew her attention to the fact that the Hungarian Professional College of Obstetrics and Gynaecology do not respect scientific evidence.

Some result has been achieved, since the regulation draft now includes a compulsory exam to be taken by midwives, obstetricians and gynaecologists that will qualify them to assist at home births. It is quite reassuring, that the curriculum of this exam has been worked out with the help of competent independent midwives, but has not been accepted yet (and may never be).

Another success of the active participation is that the intended enacting date of 1st January, has been brought forward to 1st July of this year.

Sheila Kitzinger, observing the pressing situation, has decided to visit Hungary on Home Birth Day. The Alternatal Foundation published her Birth Crisis book.

Ágnes Geréb
Obstetrician and GP
Founder of the Alternatal Home Birth Foundation
www.szules.hu
Translated by Tamas Bojtar