Background to the criminalisation of hungarian midwives

In January, 1998, the Parliamentary Human Rights Ombudsman affirmed the Hungarian Constitution upheld the right of mothers to give birth at home.

From 1998 to 2011 homebirth parents and Independent Midwives waited in vain for successive governments to introduce the necessary legislation to excercise this right.

In the absence of legislation parents wishing to birth at home were forced to do so alone without medical support, or forego their constitutional rights and have their babies in hospital

Independent midwives, led by Dr. Geréb, chose to support these parents and, working in an unlicenced capacity, helped deliver over 3,500 home births in the 22 years up to 2010.

From this 3,500 only one perinatal death occurred. There were two further cases where the babies were delivered at home but subsequently died some 7 and 14 months later. In each case Dr. Gereb and her midwifery colleagues faced criminal charges.

In contrast to the mistreatment of Dr. Geréb, and despite high hospital rate of birth fatalities annually in Hungary, obstetricians  hardly ever  face criminal charges.

Primarily this is because obstetrician’s birth actions are first reviewed by the hospital authorities who rarely if ever refer them to the police authorities for criminal investigation.

It was evident that Dr. Geréb and other independent midwives were being treated in a highly discriminatory way by comparison to Hungarian hospital doctors when it came to the investigation of adverse birth incidences.

Additionally, hospital obstetricians had sufficent influence on the political establishment to ensure that independent midwives’ work remained unregulated and therefore it remained a very high risk sector for them to work in.

In December, 2010, the Europen Court of Human Rights ruled against the Hungarian government in the Ternovszky verse Hungary Case, forcing them into framing laws that upheld the rights of mothers to have medical serices available when giving birth in their homes.

These regulations came into effect in April, 2011, too late to redress the mistreatment that Dr. Geréb and other midwives had to suffer. Nevertheless, the regulations – even with their fundamental flaws – represent a milestone for future home birthing mothers and the licenced independent midwives who provide their services to them.

The regulations introduced severe professional conditions and also restricts many pregnant women from meeting the criteria required to birth at home.

The regulations make it significantly more expensive for independent midwives – who are not exempt from the control of obstetricians – to meet the imposed criteria and secure their licences. Thus it became harder for birthing mothers to hire the more costly services of licenced independent mives so their freedom of choice – which is key to safety – got undermined.

The State Health Insurance Scheme was not adjusted to bring homebirth medical expenses under its cover and in line with pregnant women who, in choosing to birth in hospital, have their birth expenses included under this Scheme.

No regulations were enacted to deal with the inequality of treatment experienced by licenced independent midwives in comparison to obstetricians when facing investigation for adverse birth incidents. Therefore, licenced midwives remain exposed to automatic criminal investigation when cited for involvement in an adverse birth incidence.

Geréb continues to be processed through the criminal court and it is clear how inappropriate this setting is for dealing sensibly and properly with these birth related matters.

It is solely the hospital doctors who provide the expert medical advice to the court. It is in their interest to have Dr. Geréb prevented from working to avoid the threat of huge income loss if midwifery-led care became the norm in the Hungarian birth care system. Also, their traditional power position would be under threat if the rights of birthing mothers and the full and proper role of hospital and independent midwives were secured.

Consequently, it is nearly impossible to find a medical expert prepared to provide an unbiased opinion to the court with regard to Dr. Geréb’s professional actions.

Geréb endures these unfair obstacles and robustly tries to defends her reputation and professional actions in the law courts.