Obstetrician/midwife faces five years in Hungarian prison, prompting protests over authorities’ hardline childbirth policy.
Twenty minutes after the expectant mother went into labour, the police were knocking at the door. While mother and child were taken to hospital and treated well, the midwife at the birthing centre was thrown in jail. Dr Agnes Gereb is now being kept in maximum security conditions in a Budapest prison, facing a five-year prison sentence.
Gereb, founder of the Napvilág birthing centre, is a highly experienced gynaecologist, midwife and internationally recognised home birth expert. She has successfully helped deliver 3,500 babies at home. But her reputation means nothing to the authorities in Hungary, a country that has, campaigners say, relentlessly pushed to criminalise home births and make hospital deliveries compulsory.
In the hours after her arrest on 5 October, Gereb was subjected to intense interrogation before being called to a closed court at 10pm. Held for a further week without charge, she finally appeared in an open court on 12 October, shackled in leg chains and handcuffs, accused of negligent malpractice. She also faces several other charges, including one for manslaughter relating to an earlier home birth when a baby died after a difficult labour.
Gereb’s is the story of home birthing in modern Hungary and has sparked international outrage. A hero to women across Hungary, she has dedicated the past 30 years to defending the right of mothers to choose their birthing experience.
Her arrest is, say her supporters, the “logical climax of [the state's] campaign of vilification and criminalisation” of those who support a mother’s right to have a non-hospital birth.
Support for her plight is growing, with backers including Sheila Kitzinger, the British natural childbirth activist and author, Professor Wendy Savage, Britain’s first female obstetric consultant, and the Labour MP Caroline Flint.
The constitution in Hungary gives a mother the right to give birth at home but prevents her doing so by arguing that the practical conditions to ensure a safe home birth do not exist: a situation created by the refusal of the ANTSZ, Hungary’s public health authority, to issue licences to independent midwives, and the failure of successive governments to implement regulations compelling them to do so.
Women wanting to give birth at home, therefore, find themselves in an unlicensed and unregulated hinterland. Any midwife who gives medical assistance is breaking the law. In the last five years, police investigations have become increasingly aggressive. There are just 15 midwives in Hungary who will help women give birth at home. Five of these currently face lengthy prison sentences.
“The state’s campaign against home births has lasted nearly 20 years and is rooted in the determination of a clique of obstetricians to maintain their own power and earning potential from hospital births,” said Donal Kerry, spokesman for the Hungarian Homebirth Community.
Obstetrics is one of the most lucrative branches of Hungary’s supposedly free healthcare system, explains Kerry, in which parents expect to pay up to a month’s salary to the doctor, who is legally obliged to be present at each birth.
Obstetric care in Hungary is, by many measures, excellent. It is tightly run by skilled doctors, with low mortality rates. The problem, say campaigners, is that hospital births are doctor-centred and highly interventionist. Inductions and episiotomies are standard.
Mirtill Rackevei gave birth to her three daughters at home between 2002 and 2006, with Gereb’s help. “I decided to have home births because I had seen my sister have a child in hospital and it was awful,” she said. “My sister was reluctant to have any more children because of her traumatic experience but my home births were so lovely that she decided to try it,” she added. “The difference for her was so great that she went on to have third and fourth children, also at home. So now she has three children in the world who would not exist were it not for Agi. Agi is a wonderful woman.”
In addition to the most recent case, Gereb is facing four other criminal charges. Two involved births where postpartum haemorrhage was greater than normal – a fairly common occurence in obstetrical practice. In both cases, the mothers and babies were discharged from hospital after a few hours. The other two cases are more serious: one concerning an infant who died as a result of shoulder dystocia and the other a twin who suffered a lack of oxygen at birth and died seven months later. Only the parents of the child who died from shoulder dystocia are pressing charges. The others all support Gereb.
Tamas Fazekas, one of a team of lawyers fighting Gereb’s cause with the Hungarian civil liberties union, says she is confined to her four-woman cell for 23 hours a day. “She is subjected to strip searches, only allowed to see her family once a month — they have not been allowed to visit her since her arrest — and can have just one 10-minute phone call every week. When she appeared before the public court she was in handcuffs and leg shackles so tight that she had a 10cm bleeding wound on her leg,” he said. The day after Gareb was arrested, more than 600 people protested outside Budapest’s remand prison. Two days later, more than 2,000 people made a human chain from the municipal court to the national parliament.
Campaigners have asked the Hungarian constitutional court and the European court of human rights to force the Hungarian government to draw up necessary regulations without further delay.
European choice Variation in home births by country
United Kingdom: around 3%
Choice in maternity care is promoted by the NHS. Between 2006 and 2007 the number of home births rose by 10%.
Republic of Ireland: less than 1%
A bill expected to become law next month makes it illegal for midwives to assist home births unless fully insured; those attending births outside certain criteria risk a fine of up to €160,000 and 10 years’ imprisonment.
France: just over 1%
Although home births are legal, insurance does not cover midwives. Their association is trying to ban one midwife specialising in home births, for being uninsured, which may set a wider precedent.
Netherlands: around 33%
Home birth is a popular choice among women whose pregnancies are considered low risk.
Poland: around 300 instances a year
This month the health minister signed a protocol to limit excessive medicalisation of childbirth.
Germany: around 2%
Homebirth is legal but last June insurance for midwives rose in price, making it too costly for many.
Czech Republic: 100 instances a year
Thereis no law prohibiting birth at home but it is not recommended.
Figures: Guardian research department