Magyar 
English Budapest, 10 October 2010
The latest news reports appearing in the electronic media and the press concerning recent events at the Napvila?g Birth Centre in Budapest and the remand custody of dr. A?gnes Gere?b have been received by the members of Physicians for the Freedom and Safety of Childbirth, as well as other doctors with similar attitudes towards childbirth, with profound indignation. The information presented is contradictory and often misleading.
As doctors, we find it hard to believe allegations that after the birth that took place at the birth centre, the specialists with medical qualifications on the scene practically left a newborn without spontaneous respiration or sufficient circulation to its own devices without any life-saving interventions, or that the equipment for the resuscitation of adults and infants that are included among a midwife’s equipment were not put to use.
Thanks to the media, it is common knowledge that dr. Ágnes Geréb has been banned from practicing her profession as an obstetrician. This is something that she brings to the attention of all the pregnant women who approach her. Independently of her previous studies she has officially completed training and has qualified as a midwife and she has been attending births as a midwife. She has never withheld her identity from the ambulance units that were called when complications requiring hospital care were encountered. What are the grounds for the hypothesis that she now wishes to destroy evidence or to begin conspiring with anyone at this time, after having lived with several instances of criminal prosecution for several years? These are the false grounds on which she has been remanded in custody.
In the several countries of the world where this practice is entrenched, home births are attended by midwives who monitor the birthing women for any complications and request assistance when required. Neither a doctor, nor an ambulance is on site. That is the model whose introduction the civil organisations, doctors and specialists supporting home birth have been urging for two decades.
We agree with the part of the statement issued by the Ministry of National Resources that states that pregnant women have the right to choose the location where they wish to give birth. However, that also implies that, should a woman decide to give birth at home, she should have the option of specialist assistance. In the 21st century, noone can be expected to give birth without the assistance of a trained doctor. In view of that, we find it particularly alarming that the National Public Health and Medical Officer Service (NPHMOS) and the police take action against women giving birth at home and the specialists who assist them, and they do so in a manner that often appears to be harassment. Accordingly, we also agree with the Ministry’s statement to the effect that at present, conditions for out-of-hospital birth are not in place, not because of any lack of infrastructure in Hungary, but because of the degree of harassment to which birthing mothers, medical professionals and birth attendants are exposed by the state, if a decision is taken to continue the birth in hospital. We seek a model in which homebirth is properly integrated into the range of options made available to birthing women.
Data from the international scientific literature suggest that for low-risk pregnancies a planned home birth attended by a midwife is just as safe as a hospital birth attended by an obstetrician. The frequencies of perinatal mortality are equal. However, the incidence of invasive interventions and complications is statistically significantly higher in hospital. However, the sensationalist media devote disproportionate attention to complications associated with home birth. The detailed public discussion of those cases (in contrast with the internal reports about complications in hospital, which are kept purposefully confidential) is not only unethical and unlawful; it is also misleading because it gives rise to the erroneous impression that problems are more frequent with home births.
Everyone has the right to be presumed innocent until proven guilty and the right to protection against defamation in the field of medical practice, too. This is emphasised specifically by the Code of Ethics of the Hungarian Medical Chamber. Therefore nobody has the right to condemn those assisting home births or their professional work until the appropriate professional and judicial bodies have issued their rulings concerning these matters. At present, Hungary has no professional body in charge of home birth (which should not be the same as the professional body of the gynaecologist-obstetricians who attend hospital births), it is indisputable that the assistance of foreign specialists should be sought with the decisions concerning such activities (regulations, court verdicts).
Everyone has the right to be presumed innocent until proven guilty and the right to protection against defamation in the field of medical practice, too. This is emphasised specifically by the Code of Ethics of the Hungarian Medical Chamber. Therefore nobody has the right to condemn those assisting home births or their professional work until the appropriate professional and judicial bodies have issued their rulings concerning these matters. At present, Hungary has no professional body in charge of home birth (which should not be the same as the professional body of the gynaecologist-obstetricians who attend hospital births), it is indisputable that the assistance of foreign specialists should be sought with the decisions concerning such activities (regulations, court verdicts).
If the objective is indeed the establishment of conditions in which mothers may exercise their lawful rights associated with birth, and not the criminalisation of home birth and making hospital birth compulsory, then, we believe, the remand custody of dr. Ágnes Geréb and the associated scare-mongering is only making the situation worse. In our view, the only purposes of the remand custody are to intimidate those wishing to give birth in undisturbed conditions and to wear down the mental resistance of dr Ágnes Geréb – both purposes that are to be condemned and rejected without reservation in a country that purports to be a democracy.
Contact person: Imre Szebik, M.D., PhD. Phone: +36-20-8243195 e-mail: Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát.
References
1. De Reu PA, Nijhuis JG, Oosterbaan HP, Eskes TK. Perinatal audit on avoidable mortality in a Dutch rural region: a retrospective study. Obstetrical & Gynecological Survey 2000;55(5):281-3.
2. Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nursemidwives. A retrospective descriptive study. J Nurse Midwifery 1995;40(6):483-92.
3. Garite TJ, Snell BJ, Walker DL, Darrow VC. Development and experience of a university-based, freestanding birthing center. Obstet Gynecol 1995;86(3):411-6.
3
4. Olsen O. Metaanalysis of the safety of home birth. Birth 1997;24(1):4-13.
5. Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, et al. Home versus hospital deliveries: Follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996;313(7068):1313-8.
6. Davies J, Hey E, Reid W, Young G. Prospective regional study of planned home births. Home Birth Study Steering Group. BMJ 1996;313(7068):1302-6.
7. Durand AM. The safety of home birth: The farm study. American Journal of Public Health 1992;82(3):450-3.
8. Gulbransen G, Hilton J, McKay L, Cox A. Home birth in New Zealand 1973–93: Incidence and mortality. The New Zealand Medical Journal 1997;110(1040):87-9.
9. Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. Canadian Medical Association Journal 2002;166(3):315- 23.
10. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: Large prospective study in North America. BMJ 2005;330(7505):1416.
11. Wiegers TA, Keirse MJ, van der Zee J, Bergh GAH. Outcome of planned home and planned hospital births in low risk pregnancies: Prospective study in midwifery practices in the Netherlands. BMJ 1996;313(7068):1309-13.
12. Woodcock HC, Read AW, Bower C, et al. A matched cohort study of planned home and hospital births in Western Australia 1981–1987. Midwifery 1994;10(3):125-35.
13. Moore DJ. A matched cohort study of planned home and hospital births in Western Australia 1981– 1987. Midwifery 1994; 10(3):125-35.
14. Janssen PA, Saxell L, Page LA, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal 2009;181(6- 7):377-83.
15. De Jonge A, Van Der Goes BY, Ravelli ACJ, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG: an International Journal of Obstetrics & Gynecology 2009;116(9):1177-84.
16. Young G, Hey E. Home birth in Britain can be safe. BMJ 2000;320:798.
4
2. Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nursemidwives. A retrospective descriptive study. J Nurse Midwifery 1995;40(6):483-92.
3. Garite TJ, Snell BJ, Walker DL, Darrow VC. Development and experience of a university-based, freestanding birthing center. Obstet Gynecol 1995;86(3):411-6.
3
4. Olsen O. Metaanalysis of the safety of home birth. Birth 1997;24(1):4-13.
5. Ackermann-Liebrich U, Voegeli T, Gunter-Witt K, et al. Home versus hospital deliveries: Follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996;313(7068):1313-8.
6. Davies J, Hey E, Reid W, Young G. Prospective regional study of planned home births. Home Birth Study Steering Group. BMJ 1996;313(7068):1302-6.
7. Durand AM. The safety of home birth: The farm study. American Journal of Public Health 1992;82(3):450-3.
8. Gulbransen G, Hilton J, McKay L, Cox A. Home birth in New Zealand 1973–93: Incidence and mortality. The New Zealand Medical Journal 1997;110(1040):87-9.
9. Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. Canadian Medical Association Journal 2002;166(3):315- 23.
10. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: Large prospective study in North America. BMJ 2005;330(7505):1416.
11. Wiegers TA, Keirse MJ, van der Zee J, Bergh GAH. Outcome of planned home and planned hospital births in low risk pregnancies: Prospective study in midwifery practices in the Netherlands. BMJ 1996;313(7068):1309-13.
12. Woodcock HC, Read AW, Bower C, et al. A matched cohort study of planned home and hospital births in Western Australia 1981–1987. Midwifery 1994;10(3):125-35.
13. Moore DJ. A matched cohort study of planned home and hospital births in Western Australia 1981– 1987. Midwifery 1994; 10(3):125-35.
14. Janssen PA, Saxell L, Page LA, et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal 2009;181(6- 7):377-83.
15. De Jonge A, Van Der Goes BY, Ravelli ACJ, et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG: an International Journal of Obstetrics & Gynecology 2009;116(9):1177-84.
16. Young G, Hey E. Home birth in Britain can be safe. BMJ 2000;320:798.
4