Advocates join Hungarian midwife Agnes Gereb's fight for home births

I dreamed I was Agnes Gereb, Hungarian doctor and midwife who was jailed by state authorites for her work in delivering babies in a mother's home -- something that is common around the world, but is criminalized in Hungary.

The only difference was I wasn’t in jail…yet. In the dream, I had a half hour before lock down and I knew there was no time; not for goodbyes, not to complete my life’s work, and certainly not to establish any form of justice.

Luckily, I awoke. But for some reason I’ve not been able to shake the cold and pressing feeling of imminent incarceration. Might it have to do with the fact that earlier that same night, I had agreed to write an article to help free her?

Next to air, food, and water, birth and death are the only other essential ingredients each of us is destined for. So after immersing in articles, films, websites, and interviews regarding Gereb’s case, it’s not surprising that her story presents a human rights issue with questions about Hungary’s democracy running a close second.

Hungarian health authorities resist midwifery

“Birth in Hungary stands where we stood in the United States-- quite honestly about 30 years ago,” said Elizabeth Davis, founding board member of the International Alliance of Midwives.

“The European nations that have autonomous midwifery have the best outcomes. The mothers do better, the babies do better, the society does better”.

Indeed, eighty years of medical research does show that birth has long-term consequences on health. For this reason, the World Health Organization cautions that no more than 15 per cent of births should be by caesarean. Statistics show that midwives decrease the rate of cesarean sections by 50 per cent, the use of drugs during birth by 30-40 per cent and the episiotomies (when the mother's vaginal opening is cut during childbirth), by 75 per cent.

Knowing this, Hungarian midwives, led by Gereb, have petitioned Hungary’s government for the necessary license granting them autonomy. Despite their consistent attempts, they have been rejected for the past 22 years. Because Hungarian health authorities oppose the practice of midwifery, midwives are left open to criminal investigation every time a home birth takes place.

On the rare occasion, a midwife deems it important for a birthing mother to go to hospital. In Hungary, an ambulance arrives accompanied by police and often the press. .

“The police intimidate the birthing mother, the father, and the midwife,” said 35 year-old Orsi, whose friends have had home births. “Then, they (Hungarian doctors in hospitals) will leave the child for up two hours if they know it came from Agnes or a midwife just to make the situation worse."

“I hope I will never be forced to give birth in a Hungarian hospital because I’d be scared for my child.”

Gereb’s arrest

Gereb was placed under pre-trial detention on Oct 8 , 2010, after a pregnant mother, who due to abnormalities had earlier been instructed by Gereb to give birth in hospital, presented at Gereb’s clinic already in labour. The baby was born unusually fast and before ambulance could arrive. Police immediately arrested Gereb and seized all documents in her clinic. At the end of 2010 she was released into house arrest.

On Feb. 10 , 2012, the Budapest court made a ruling, sentencing Gereb to mandatory two years in prison with a 10-year prohibition to practicing obstetrics or midwifery. Six other midwives have also been on trial. Gereb has been quoted saying she sensed being set up for two years before her Oct. 2010 arrest.

Hungarian-born Vancouver psychologist Andrew Feldmar, whose work is highly regarded in Hungary, spoke up against the persecution of Gereb and other midwives.

“Let’s get out of the dark ages where women who were envied, were accused and declared to be witches, then sentenced to be burnt," Feldmar said. " OB’s (obstetricians) are threatened, jealous, feel left out, and out of greed and conservative fear, want to postpone the moment when it becomes obvious that things need to change.”

“It’s about biopolitics, about who has the power to make life/death decisions when someone is weak like during birth, death, madness, and illness.” 

This proposed 21^st century “witch hunt” might explain Gereb’s “special” treatment in court and in jail. During one hearing she was brought in and made to sit in hand cuffs, leg cuffs and leg irons for hours without water, leaving a ten-inch gash in her ankle.

While in jail, she was subjected to strip and body cavity searches before and after every visitor. Assuming it was common practice, she shared this with inmates only to discover through their astonishment that she was receiving “special treatment”.

Corruption in the hospitals

There have been neonatal deaths in Gereb’s case. Although devastating, it is understood across the health professions that death is part of birth both in and out of hospitals. The difference in Hungary is that hospital deaths are rarely tried in court, while cases involving midwives become criminal cases. All the parents involved in the charges brought against Gereb, except one, have spoken in her defense. 

“Many unpleasant things that take place inside Hungarian hospitals are carefully concealed," said Dr. Istvan Vilaghy, a Hungarian obstetrician formerly practicing in Switzerland. "There are approximately 20 mothers each year who die and about whom we cannot hear a word.”

Hungarian attorney Laszlo Abraham, who works on behalf of families within the hospital system, agreed.

“ I have only heard of one case where an obstetrician received a jail sentence,”  he said. “Physicians in Hungary are interested in gratuities alone as far as I can see. They are paid as much as a road sweeper in the streets, and many of the younger generations go to work abroad where they are paid much more.”

It is customary for parents to pay up to $1,000 US under the table to ensure their baby will be well taken care of, he alleged. The money is dropped in a box inside the change room. For many families, this can mean up to two months’ income. 

Corruption in the Courts

Obtetricians who stand vehemently against midwifery have been the only expert witnesses summoned for all of Gereb’s cases -- none have experience in out of hospital births. When six international world-class experts in obstetrics and midwifery submitted their testimonies, all were denied.

Elizabeth Davis, one of the denied experts, says, “ I went to leading OB and midwifery texts on standards of care, and found on every count Agnes Gereb’s standard to be impeccable. Hungarian government refused to look at the testimonies by using a loophole in the system. How does a court dismiss world-class experts in the field? (It's) shocking.”

Is Gereb getting a fair trial?

“No, I think not,” Davis said.

Vancouver’s Saraswathi Vedam, former faculty head at UBC’s esteemed midwifery program was also one of the six experts consulted. She could not be reached for this article.

Gereb's track record of creating change

Gereb graduated from medicine in 1977 and as an obstetrics specialist in 1982. During her years of practice, she was the first to invite fathers into the birthing room. (After being suspended for six months, the hospital later proudly announced it was the first to allow such progressive, western measures into Hungary.) Gereb decided to become a midwife and trained extensively with leaders in the field in both obstetrical nursing and midwifery. Her expertise gained her recognition as a world expert on home birth.

In 1992, she opened the Alternatal Foundation to promote natural and safe childbirth with world-renowned obstetrical authority Michel Odent as its honorary chairman.

To date, she has delivered over 9,000 births, 3,500 of them at home, has opened a birthing center, trains midwives locally and internationally, has contributed to ten books published about health and birth, and has been featured in six films. She is one of 2,700 international Ashoka fellows acknowledged for social entrepreneurism and chosen for being “an engine of social change and role model for the citizen sector”.

There is even a Hungarian yearly holiday, “Home Birth Day”, drawing hundreds of families together from around the country, started because of Gereb. Gereb has hosted conferences whose presenters have included representatives from the World Health Organization and respected scientific researchers and pioneers including Marshall and Phyllis Klaus, Marsden Wagner, Ina May Gaskin, and others.

The call for international support

Is it surprising that Gereb’s case can go on in an EU country with a steadily developing open, market economy, and parliamentary elections?

One of Agnes' interpreters, when speaking of her some 10 000 supporters in the world, said: 

“We’ve lost this in Hungary, international attention is our only chance.”  

I asked Gereb, “What is your one wish for Hungary?”

Over a crackling Skype line, her interpreter quietly responded: “Freedom”.

Looking at how long Hungary has staved midwifery from its rightful place and at the inhumane and unfounded treatment Agnes Gereb has suffered, using your voice can make “history repeating itself” transform into people breaking tradition and “making history”.

I’ve been told Gereb will be returned to jail any day now. Please sign and send this petition to grant full clemency to Agnes Gereb.

For more, see this video on midwifery.