Birth Around the World: Home Birth in Hungary

In 1998, a decision by the Hungarian Parliamentary Ombudsman confirmed a woman's constitutional right to give birth in the location of her choice, including at home. However, the Hungarian government has still not implemented any regulations or implemented licensing procedures, making it nearly impossible to have a home birth in Hungary. Home birth providers are actively prosecuted for attending births.

In early October, physician and home birth attendant Ágnes Geréb was arrested minutes after she attended an unscheduled birth at her birth center. She was charged with "reckless endangerment committed in the line of duty." She is currently being held in a maximum-security prison and is facing a 5-year jail term.

Here is more detailed information about the events leading up to Dr. Geréb's arrest:

Events of 5 October 2010
On Tuesday, 5 October, the police took Dr. Ágnes Geréb 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 Ágnes Geréb) when complications arose which required the help of paramedics. Originally, Ágnes 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. Geréb 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, Ágnes Geréb 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. Geréb 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.

Dr. Geréb has attended close to 9,000 births, over 3,500 of those at home. She worked as a hospital-based OB-GYN for 17 years before becoming an independent midwife in 1991. The Guardian recently reported on Geréb's arrest in Midwife Agnes Gereb taken to court for championing home births. Thousands of Hungarians showed up for protests in the days following her arrest. An excerpt from The Guardian report:

Geréb, 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, Geréb 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.

Geréb'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.

A press release issued October 11, 2010 by the Hungarian Homebirth Community (1) gives more information about Dr. Geréb and the home birth climate in Hungary: 

The story of Ágnes Geréb is the story of homebirthing in modern Hungary. A story that shows how Hungary, since its return to full independence in 1990, continues to restrict free choice to its citizens in the hugely important area of childbirth. From the all- powerful Board of Obstetricians down to the local police, the Hungarian state has continually tried to force expectant mothers and their partners to give birth in hospital. But there have always been couples determined to choose their own way to birth and who needed to find someone who could help them fulfill their wishes. Ágnes Geréb took on that role when after seventeen years of hospital service she decided in 1991 to become an independent midwife. She was prepared to face the risk of heavy fines and imprisonment to help parents to satisfy their desire to have their babies at home.

Now, nearly 20 years later and with over 3,500 healthy homebirths behind her, she still encounters incredible resistance within the Hungarian establishment to home birthing. She has been struck off the doctor’s register by a licensing body which dogmatically opposes homebirth and, even before Tuesday’s detention, she and 4 colleague midwives are currently before the courts facing further serious criminal charges. Like all other independent midwives and the parents of homebirth babies, she is continually exposed to levels of harassment and intimidation from police, ambulance and hospital staff whenever a homebirth delivery has to transfer to the hospital system. Her arrest was the logical climax of a campaign of vilification and criminalisation which has last nearly twenty years and which is rooted in the determination of a clique of obstetricians to maintain their own power and earning potential from hospital birth. Obstetrics is one of the most lucrative branches of Hungary's supposedly free healthcare system, in which parents expect to pay up to a month's salary to the doctor who, according to law, must be present at each birth.

Also, Ágnes Geréb's work is not restricted to homebirth as she has long represented the opposite end to the over-medicalised, over-interventionist practice of hospital birth. Her work proves that it is possible for midwives to take over the doctor's role, in Hungary, as the main health-care professional at birth.

The persecution of Hungary's most experienced midwife in gentle, natural birth continues, despite a 1998 decision by the Parliamentary Ombudsman, confirming that the Constitution affords mothers the right to give birth where they wish. But foot-dragging by successive governments has prevented any regulations from actually being implemented. As a consequence we expect both the Hungarian Constitutional Court and the European Court of Human Rights to rule against the Hungarian Government in the near future for failing to draw-up and introduce the necessary regulations, and to order Parliament to do so without further delay.

In the meantime citizens are exposed to the double-speak of a state which admits a mother’s right to choose her home as a birth location, but prevents her from doing this on the pretext that the practical conditions for conducting homebirth safely do not exist. By continually failing to introducing legislation to support the practicalities of home birthing they have tried to remove homebirth as a birthing choice for its citizens. But many parents still insist on doing what their Constitution allows through the services provided by Ágnes Geréb and a small band of independent midwives. These midwives have been refused the ”necessary” licenses to operate legally, but are prepared to give their professional support to parents despite being under the constant threat of arrest and imprisonment. The state has, until now, not taken the logical next step of prosecuting the parents of homebirth children, as well as the unprotected professional service providers. We parents remain baffled and desperately saddened that the Hungarian State has yet again chosen to attack not only a true servant of the people but a highly ethical and professionally gifted doctor and midwife.

On October 14, 2010, the Hungarian Homebirth Community emphasized that the struggle to free Ágnes Geréb was not just about home birth:

All we are asking is for women to be empowered, in hospital and at home, to give birth in the position, in the way, and with those present, whom they choose. Our campaign to free Ágnes is not just about homebirth. It is about establishing a mother-centred, midwife-centred, baby-centred practice in hospitals as well.

For further reading and information:
Support for Agnes Gereb Facebook page
www.birth.hu (which also has an English version)