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Equality Before the Law? Hungary’s Homebirth Pioneer

Internationally recognized homebirth expert Ágnes Geréb has finally, after her last appeal, been sentenced to two-years imprisonment for three homebirth incidents, though some have argued that the outcomes would have been no different even if the births had been conducted at hospitals. The case, however, draws attention to structural healthcare problems, and raises questions about legal equality.

Homebirths have only recently been regulated in Hungary. Previously, the state, and the healthcare system, tried to discourage them.

It appears that gynecologist and midwife Geréb will, finally, have to go to jail for two years, and not practice her profession for ten, as a result of two fatal homebirth incidents and a third with unexpected complications. The long-running case has divided much of Hungarian society and prompted debate on homebirth.  

The case against Geréb, an internationally acknowledged homebirth expert, who was also a pioneer of letting fathers into Hungarian labor rooms, dates back to 2010, when a woman unexpectedly went into labor at Geréb’s homebirth center and had to be transferred to hospital when the baby encountered serious breathing difficulties.

The parents made no accusation against Geréb, as they did not believe the midwife was at fault. The hospital, however, had to report the case by law. After a few months in custody back then, Geréb has spent the past seven years under house arrest. Her case also takes in two other tragic incidents in 2003 and 2007; in only one case have the parents pressed charges.

To understand how an internationally admired professional with decades of experience and 3,500 healthy homebirths behind her could find herself in this situation, one has to recall how under regulated homebirth in Hungary was until relatively recently. Although there was no law preventing homebirth, those who performed it faced far more serious consequences than their colleagues at official institutions.  

If a hospital is found guilty of malpractice, the institution is usually obliged to make financial amends but the responsibility of the doctor involved is rarely examined in a criminal procedure.

Law as a Shield

“The rules of medical work at hospitals are laid down in labor regulations, which the doctors can use as a shield when asked about their acts in a problematic situation,” Zsombor Kovácsy, an attorney specializing in healthcare, tells the Budapest Business Journal. By contrast, as a result of the lack of a regulatory framework around homebirths, when any type of complication occurred, however minor, a police investigation was immediately started.

Following overwhelming media attention in Geréb’s case and the loud opinions expressed both in favor of and against homebirths, Parliament finally passed detailed regulations on the issue in 2011.

Hungarian law has since then allowed women to decide where they want to give birth, as long as the baby is not in danger and therefore in need of a hospital environment. The professional requirements of those who help baby deliveries were also laid down for the first time, while mothers have to declare in advance that if the leading birth assistant or pediatrician decides hospitalization becomes necessary, they will accept it without opposition.

The regulation could obviously have no effect on Geréb’s case, whose charges dated back to before the law was created. Nonetheless, she has maintained in court that she was not violating professional protocols in any of the cases.

As she pointed out at her last appeal, when she lost a baby due to shoulder dystocia in 2007, altogether 132 Hungarian babies died at birth that year. Only one of these tragic incidents hit the headlines or resulted in a criminal law case; the one that Geréb was attending. Geréb argued at court that tragedies happen sometimes without a single mistake made, and all cases should be measured on the same scale, as people are equal in the eyes of the law.

Prenatal care and delivery is a special field of the troubled Hungarian healthcare system. It is a decades-old open secret that many expectant mothers - regardless of salary level - chose semi-private care in the hope of better service.

While the state-financed “free” system suggests roughly three visits during a pregnancy, many mothers opt for a monthly private check-up to discuss the pregnancy with their doctor for about HUF 8,000-25,000 per visit.

However, apart from these meetings and a promise that the doctor will attend the delivery no matter whether on duty that day or not, no extras are included; everything follows standard procedures and uses the state  infrastructure. All the examinations, as well as the delivery, are conducted at the hospital. If everything goes as planned, fresh parents express their gratitude towards the doctor by giving a gratuity that can be tenfold the price of a single visit.

Healthcare trade unions have recently threatened a pre-election strike in announcing their demand for a pay rise that also covers nurses, ambulance workers and maintenance workers, who, the unions say are not only forced to work long shifts but also have to take second and third jobs to be able to maintain their family. The situation of doctors is not much better either. In such an under-financed system, which is burdened by overwork on one side, and framed by vulnerability and expectations on the other, tensions are understandably high.

However, since only a few hundred mothers wish to deliver their children outside of hospitals, they pose no real threat to the unofficial pregnancy business. According to Geréb, the resistance to homebirth could be attributed to hospital professionals’ concerns about giving up their exclusive competence.

Despite the final appeal, the Geréb case might yet still run. Local and international midwife communities have called on the President of Hungary, János Áder, to offer clemency to Geréb (at the time of writing, the Amnesty For Agnes Gereb Facebook page has 582 likes and 573 followers), while other supporters are organizing peaceful demonstrations on the streets.