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EAST EUROPE: Midwives Struggle to Deliver Home Births

Pavol Stracansky

PRAGUE, Jan 19 2011 (IPS) - Women’s rights in Eastern Europe have been put into the spotlight as a Hungarian midwife faces five years in prison for assisting with home births.

Agnes Gereb, who has delivered thousands of babies in home births, is under house arrest on charges of negligent malpractice over five births she assisted at.

But the 58-year-old’s supporters claim that her case, which follows years of police harassment, is not just a display of power by a conservative and ignorant medical establishment desperate to keep control of a lucrative stream of income, but an attack on women’s rights.

Donal Kerry, spokesman for the Hungarian Home Birth Community organisation which has been helping Gereb, told IPS: “This is absolutely not just about Agnes but about the denial of women’s rights.

“Agnes is someone representing women’s rights – the right of a woman to where she has birth and how she has birth.”

Home births are legal in Hungary in theory but authorities have repeatedly failed to give midwives licences to practice outside hospitals while successive governments failed to define what is a safe environment to give birth in.

This means that in practice any midwife assisting a home birth can be charged with endangering a mother or child by working unlicensed in an unsafe environment.

Gereb, a gynaecologist and globally-renowned home birth expert, has ignored the risk of criminal action though, to perform more than 3,500 home births over the last 20 years.

Her supporters say that she and others practising home births have faced campaigns of intimidation and harassment and that legislation on home births has left women with practically no option of giving birth at home.

Gereb was arrested in October last year after she had to transfer a woman giving birth at home to a hospital.

She was held in custody, being subjected to repeated body cavity searches and kept in chains which led to bloody wounds on her body. Just before Christmas, and following international protests, she was released and placed under house arrest pending a court appearance.

Midwife associations around the world have been scathing of the authorities’ treatment of her. Some of her strongest support has come from midwives in other central and eastern European countries who say they are facing similar, if slightly less extreme, opposition to home births in the medical community.

In many countries across the region home births are allowed by law but heavily discouraged by local doctors. In some cases, such as Poland and the Czech Republic, they are not covered by state health insurance – putting the practice out of financial reach of many parents.

In both countries there are only a few hundred home births per year. The rate of home births in western European countries is higher. In the Netherlands more than 30 percent of births take place at home.

Zuzana Stromerova, a midwife who has attended hundreds of home births in the Czech Republic, told IPS: “I completely support a woman’s right to have her baby where she chooses. Not covering the services of midwives at home births with general state medical insurance means anyone having a home birth has to pay for it de facto privately.

“This is discrimination against the midwives as well as against mothers by restricting their choice of where they give birth.”

The overwhelming majority of doctors in Eastern European countries argue that home births are extremely risky. Women opting for home births are routinely dismissed by doctors, privately and sometimes publicly, as stupid, selfish and gambling with the lives of unborn children.

Medical studies on the safety of home birth are often controversial and both supporters and critics of the practice, including medical professionals, have cited various studies to argue their case.

Midwives practising home births in the region argue that ignorance and reluctance to give up often under the table payments for being at births is also behind doctors’ vehement opposition to women giving birth outside hospitals.

“Doctors are against home birth mainly because of ignorance. They are trained in hospitals and largely see only pathological births, with interventions, rather than the full physiological process of a natural birth,” said Stromerova.

“Midwives trained and educated in home births have a different view of births to many doctors,” she added.

Home birth supporters in Eastern Europe add that the experience of many mothers at hospitals, where doctors often use interventions in pregnancies rather than allow births to take a natural course, is actually driving more and more women to consider home births.

Informal payments to doctors, in some cases little more than bribes, to ensure good health care in hospitals are common throughout Eastern Europe’s healthcare systems, especially for births where sums offered to, or demanded by, doctors can reach several hundred euros.

Kerry said this had been one of the driving forces behind the “campaign of criminalisation” led against Gereb for decades.

“This campaign 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,” he said.

Stromerova added: “If a doctor is in the position of being the ‘lord’ of the birth then he has the power to influence parents and tell them about all the terrible things that can go wrong in a birth and persuade them that he is the only person who can make sure that these things will not happen at the birth. And in those cases scared women will be very willing to hand over a lot of money to those to make sure the doctor is there.”

Gereb’s release from custody into house arrest came just days after a European Court of Human Rights ruling on a case of a woman who had been unable to give birth at home despite her wishes said that Hungary must allow women to have home births.

New legislation is expected to come in within months that will allow for births at home with medical supervision.

Home birth supporters hope midwives will now be allowed to practise home births without fear of prosecution.

Kerry told IPS: “What we want to do now that Agnes is out of jail is to keep her, and other midwives, out of it. We want to make sure the criminalisation of midwives in their work is ended.”

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