Magyar 
English It is not possible for an independent midwife to do the job she was trained to do at a home birth without immediately breaking a law. She achieves this simply by walking in the door of the pregnant mother’s house with the expectation and the willingness to give birthing assistance if it is sought and required. In fact, even, if the midwife has the intention to sit passively in the home while the mother gives birth unassisted, she still will have managed to break the law. It is a law supported by the Hungarian State authorities and patrolled by the Public Health Authority (ANTSZ) and it requires the midwife to have one of their licences to legally work in a home environment. For twenty years now the independent midwives have applied for the licence and for twenty years they have been refused. Why? Because, the State has failed, through successive governments, to recognise independent midwives as a professional group. Without this recognition and the follow-on regulations necessary to provide independent midwives with a set of professional codes, then ANTSZ will not issue a licence. So, to do her job and serve the needs of Hungarian parents the State has ensured that it is impossible for the midwife to avoid breaking the law, and she can expect to be fined or sanctioned accordingly.
Difference between how a hospital doctor and an independent midwife is treated when a birth complication arises
Births in hospital are understandably treated as medical events. But, because the State refuses to recognise the role of an independent midwife and the concept of a natural home birth then, more surprisingly, a homebirth is also classified as a medical event. This means that any birth complications occurring in these two dramatically different settings are theoretically subject to the same investigative procedures though, in practice, as you will soon read, the investigations are handled entirely differently and very much to the home birth midwife’s disadvantage.
Similarly, the appropriate actions of the respective doctors and independent midwives, the personnel levels present, the range of equipment available at the home or in the hospital where the birth complication arose are judged against the same professional “protocols”. Which might seem fair and equal until you realise they are using only HOSPITAL protocols/standards as the measure. This never occurs in countries where the role and setting of independent midwives is properly recognised as home birth protocols exist and are rightfully applied to evaluate accurately the causes of the homebirth outcome.
In a hospital, two investigative procedures usually start but normally only when a death and/or a serious injury happens during a childbirth there. First, they have an internal investigation, during which the specialist doctors of the hospital give a professional appraisal on the case. In conjunction with this, an administrative procedure starts, which is the responsibility of the police. In this procedure, the police can involve an independent expert who will usually be another hospital obstetrician. These procedures, almost without exception, end with the hospital doctors not being held responsible for the death because they followed the professional protocols. Only in the rarest of cases have criminal proceedings ever started against hospital doctors.
By complete contrast, when ANY type of complications occur during home-birth and the midwives call an ambulance then normally, either the paramedics files a complaint against the midwives, or its the doctor in the hospital to whom the woman and the baby were delivered who does. Regardless of how minor the complication, the police investigation immediately starts. They question the parents, the hospital doctors, the midwife and the doula, and an expert is appointed to the case. This expert will be chosen from the “official” list and is normally a hospital doctor with no professional homebirth experience. He will also be a member of the College of Obstetricians and Gynaecologists, the group most opposed to independent midwives and the same one who formally stated in 2006 their belief that “home birth is dangerous and should be avoided”. In fact, it is the expert's opinion which will primarily decide the outcome of the police investigation. Not unsurprisingly, when Agnes Gereb is involved it is virtually certain the expert will decide that the professional midwives have made an error and the police will send the case to the prosecutor's office with recommendations for criminal prosecution.
(Last year about 10% of home births end up in the hospital, yet the police chose to launch investigations into every case where an ambulance had to be called, regardless of the gravity of the case)
On foot of the police recommendation it is the prosecutor who will eventually decide whether or not to bring forward charges. If he decides to proceed the prosecutor writes the indictment based on the documents produced in the police stage and sends it to the court.
COURT CASES AGAINST DR.AGNES GEREB AND OTHER MIDWIVES.
Events of 5 October 2010
On Tuesday, 5 October, the police took Dr. Agnes Gereb into custody. The intervention by the police was in response to a birth which took place at the Birthing Centre (located on Alma utca and founded by Agnes Gereb) when complications arose which required the help of paramedics. Originally, Agnes had declined to assist at this particular birth, as she felt a home birth would not be a safe option, based on certain conditions present during the pregnancy. Accordingly, she agreed to perform the necessary examinations on the mother prior to her hospital birth. When the expectant mother arrived at the Birthing Centre for her consultation on that Tuesday, she presented herself in an advanced stage of labour and the child was born extremely rapidly. As the midwives began to assist the mother, they also immediately called for an ambulance. The ambulance arrived approximately 20 minutes after the call, and the police arrived a few minutes later.
Steps taken by the police
While the infant was still being treated, the police began to demand the identification papers of the child's father as well as those of the health professionals present. Meanwhile, in another room in the Birthing Centre, a prenatal class was underway. The police did not permit the families present (primarily pregnant women) to leave the building until everyone had produced their identification papers. Dr. Gereb was taken into police custody at 3 PM that day, and her hearing began that evening at 10 PM. Meanwhile, the two other midwives who had assisted during the birth were also taken away by the police and interrogated them some 4 or 5 hours later. On the evening of that day, Agnes Gereb was placed into 72-hour custody as a suspect for having endangered life during the exercise of her profession (a crime under the Hungarian Criminal Code).
That same Tuesday the police investigators closed the Birthing Centre and confiscated the documents that they found there. After going over the documents (among the papers seized were several hundred client information sheets), the charges against Dr. Gereb were expanded to include the crime of quackery. The only reason given for this was that, according to the documents, approximately 200 births had taken place over the last year that involved her.
The police then chose to interrogate the infant’s mother in the hospital shortly after she awoke from the effects of a full anaesthetic received for an operation. Because of this, both she and the child’s father will be launching a complaint procedure against the police. The parents will be represented by the Birthing Centre's legal counsel.
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A further 4 cases have actually reached the criminal court involving both Agnes Gereb and four other midwives who face charges of having endangered life during the exercise of one’s profession. The court decided that, as the four cases are similar and given that there are midwives who are involved in several cases at once, it would hear all the cases together as a single case. Among the four cases, two refer to births in which postpartum haemorrhage was greater than normal – a fairly common occurrence in obstetrical practice. In both of these cases, the mother having given birth was discharged from the hospital along with her child within a few hours. However, the charges against the midwives who assisted them have been pending for years. The two other cases before the court are more serious. One refers to a birth where an infant died as a result of shoulder dystocia. The fourth case was a birth of twins in which the second-born infant suffered from a lack of oxygen at birth and died 7 months later.
In all cases pending, except for the shoulder dystocia case, the parents support the midwives who assisted them. In fact, some of them have gone on to give birth to other, healthy children at home.
The defence of Dr. Gereb is being provided by the NGO the Hungarian Civil Liberties Union (known by its acronym TASZ in Hungarian). Her defence counsel has submitted an appeal against her continued detention in prison.
Several expert testimonies have been produced on behalf of the prosecution in the course of the four cases. The expert witnesses are, without exception, ob/gyns with a hospital practice. They have no experience, practice or information about home-birth, and the majority of them consider home-birth to be dangerous. Their personal opinions to this effect were also voiced in both their oral and written testimonies. The facts of the cases are being evaluated exclusively against hospital regulations and protocols, and it is on this basis that the expert testimonies are given. So far, all the expert witnesses called by the authorities (the police and the court) have held that, in all four cases, all five midwives have committed malpractice, and that they were negligent in endangering the birthing mothers and the infants in question.
Of the two more serious cases within the four cases, concerning shoulder dystocia and the second twin, counsel for the midwives attached an expert opinion written by a Hungarian ob/gyn who evaluates the liability of midwives differently from the official experts. However, this single expert testimony, which disagrees with those produced by the authorities, is not considered sufficient to ensure a full legal and expert defence of the midwives. Therefore, the defence believes that the midwife assisted births should be evaluated by independent experts who are familiar with both the midwife-assisted and the obstetrical paradigms. For these reasons, the defence requested expert testimony from five internationally acclaimed experts. All five, Marsden Wagner, Mavis Kirkham, Luke Zander, Saraswathi Vedam and Elisabeth Davis are exceptionally well-versed in the area of home-birth and well qualified to objectively evaluate the midwives’ professional liability. The presiding judge will decide whether or not to hear oral testimony from the international experts called by the defence.
Other criminal cases pending against midwives
In addition to the Tuesday 5th, October 2010 case, Agnes Gereb is also a suspect in another 3 cases related to home birth. An investigation related to these cases has been launched during the past year. This seems primarily driven by the actions of the police over the last year to press charges in any case in which an ambulance had to be called to the site of a home birth, regardless to the degree of gravity of the case
A final and further point of information regarding Dr. Gereb is to confirm that, in 2007, her licence to practice as an ob/gyn was revoked by a court for a period of three years. This action was taken with regard to a home-birth. Since then Agnes Gereb has not practiced medicine. However, like all other Hungarian midwives, Agnes Gereb holds a degree as an obstetrical nurse / midwife in addition to her medical degree. As the accompaniment of home births does not constitute the practice of medicine, Agnes Gereb – along with the other 10 to 15 practicing Hungarian midwives – have been assisting at births that do not require medical assistance.
INCREASING STATE INTRUSION AND AGGRESSIVENESS AS REFLECTED BY THE ACTIONS OF THE PUBLIC HEALTH AUTHORITY (ANTSZ)
For several years, the practice of local ANTSZ offices was to send a summons to families within their district having chosen home birth, a few weeks after the birth.<0} Given that families come into contact with the public authorities both before and after the birth (registration of the birth), as well as with health care institutions (vaccinations, check-ups, visits from the public-health nurse, etc.), parents would be officially summoned and questioned about the circumstances of the birth, and would also be asked questions regarding the persons present at the birth.<0} After a change in policy recognized that women have the constitutional right to choose where they give birth, procedures against parents were gradually phased out. Nowadays, with the increased intimidation and harassment of midwives and of Agnes Gereb in particular, ANTSZ’s previously deplorable habits in this area towards parents appears to be returning. If so it’s a disturbing trend that needs to be recognized and to be stopped forthwith as it has no place in a modern country committed to the policies and laws of the European Union.