It is with considerable dismay that I write to you to protest at the imprisonment in Hungary of Dr. Agnes Gereb, an internationally respected obstetrician and midwife who has resolutely supported a woman's right to birth where she chooses, having attended over 3,500 healthy home births in the past 20 years.
Dr Gereb attended a woman in childbirth and when the baby developed breathing problems she appropriately referred the mother and baby to hospital, both mother and baby are doing well. The Hungarian authorities and medical profession are consistently opposed to home birth and have used this incident as an opportunity to act. Dr. Gereb was immediately arrested by the police and held in custody.
The majority of EU countries follow the National Institute for Clinical Excellence (NICE) guidelines which advises on best practice. The NICE guidelines clearly state that a woman has the right to choose her place of birth and the right to make informed decisions. Furthermore, the guidelines clearly state that women who are considered to be at higher risk should be recommended delivery in an obstetric unit. This is only a recommendation and the decision is that of the individual woman so long as she is fully informed.
NICE Guideline for Intrapartum Care states:
- [For] women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth.
- Women should have the opportunity to make informed decisions about their care and any treatment needed.
- Good communication between healthcare professionals and the woman and her family is essential. It should be supported by the provision of evidence-based written information tailored to the needs of the individual woman. Care and information should be appropriate to the woman.
- Saving money and bed days.
- Preventing over-crowding and securing more time with consultants for women who choose or need consultant led care.
- Providing evidence based and safe care.
Hungarian obstetric care is highly interventionist and damaging to the majority of fit and healthy women for whom hospital based obstetric care is inappropriate. Research clearly shows that women who birth at home have fewer interventions, fewer caesarean sections and have fitter and healthier babies. We are dismayed that the Hungarian authorities and medical profession consistently fly in the face of the research evidence and vigorously oppose home birth and have used this incident as an opportunity to act.
Every health professional has a moral and professional responsibility to act in the best interests of their client. Dr. Gereb acted promptly and responsibly in calling for an ambulance to take her client to hospital so that the baby could receive appropriate treatment for his condition. We understand that the mother and baby are well. Can you ask your Government to explain how they intend improving maternity care when the reaction to such appropriate action is aggressive behaviour from the hospital staff and punitive action by the police and judiciary. This kind of behaviour will only create an underground home birth practice and a reluctance to refer women to hospital when justified - this will increase the risk to mothers and babies.
Your Government's action not only breaches Dr. Gereb's Human Rights it also breaches the Human Rights of every woman who decides to birth at home.
I appeal to you to draw your Government's attention to the concern that there is in the UK about this incident and ask you to help persuade your Government to take steps to release Dr. Gereb from jail immediately. I understand that AIMS will be investigating taking them to the European Court of Human Rights.
Your Government is in breach of Article 3 of the European Convention of Human Rights which enshrines the fundamental right to bodily integrity. Under this Article citizens are entitled to free and informed consent. For consent to be free and informed, it must be based on information and choice, neither of which feature in the provision of maternity care in your country.
Agnes was taken into police custody in the evening of Tuesday, Oct 5th, just minutes after attending to a pregnant woman who had unexpectedly gone into labor at her homebirth centre in Budapest. The mother transferred by ambulance to the hospital with her baby boy when he displayed breathing difficulties immediately after birth. The police arrested Gereb and held her for 72 hours with access only to her lawyer. After the 72 hours in detention, she was taken before a closed criminal court and charged with "reckless endangerment committed in the line of duty" and was to remain in custody without bail for a further 30 days. It is common in Hungary to spend more than a year in prison while awaiting trial.
On October 6th, more than 600 people protested outside Budapest's prison that held Gereb. Two days later, more than 2,000 people made a human chain from the municipal court to the national parliament.
On October 12th, Gereb appeared before a court - shackled and handcuffed. She faced several charges including negligent practice and manslaughter for a birth where a baby died after a difficult labor.
According to Tamas Fazekas, one of the lawyers fighting Gereb's case with the Hungarian Civil Liberties Union, said Gereb is confined to a four-woman cell for 23 hours a day. "She is subjected to strip searches, only allowed to see her family once a month — they have not been allowed to visit her since her arrest — and can have just one 10-minute phone call every week. When she appeared before the public court she was in handcuffs and leg shackles so tight that she had a 10cm bleeding wound on her leg."
As of yesterday (Fri, Oct 22) Gereb has been moved into a maximum security prison and faces a five year prison sentence.
Obstetrics is well known to be one of the most lucrative branches of Hungary's "free" health care system. Inductions and episiotomies (as well as an assortment of other interventions) are ubiquitous. Women who want to step away from this medicalized birth face a very difficult challenge to find a skilled birth attendant. In fact, there are only 15 midwives in all of Hungary who will attend women at home, and 5 of them currently face lengthy prison sentences for the births they've attended. Gereb is the founder of the Napvilág Birthing Centre, is a highly experienced OB/GYN, midwife, and internationally recognized homebirth expert. She has attended over 3,500 births at home in Hungary.
To learn more and support the "Free Gereb" movement visit these sites:
More of the story, as reported by Tyler Spalding here.
More of the story, as reported by Amelia Hill here.
More of the story, as reported by Amelia Hill here.