Birthing at home in Hungary

Already in the first half of the twentieth century women who lived in cities gave birth in hospitals, although I assume most country folk still had their children at home with the help of a midwife. Today I would say almost every child is born in a hospital. No longer can one find some tiny little village noted as the birthplace on birth certificates. Not long ago a relatively small town was about to lose its hospital, and the most serious concern of the locals was that the children of the town would have a different birthplace recorded on their birth certificates. In any case, if the statistics that appear nowadays in the papers about home birthing are correct, their number is minuscule: 500-600 a year.

The apostle of home birthing is Ágnes Geréb, a gynecologist with seventeen years of experience. I understand that she was also the one who introduced the practice of husbands being present at the moment of their children's birth. Then Geréb started a movement that advocated the thesis that giving birth is not an illness with which one must go to a hospital but a natural part of life. And if there is monitoring of the pregnancy and there is expert help after a normal pregnancy, birth could be easily accomplished at home.

Apparently, the Hungarian hospitals' inhospitable surroundings gave the impetus to Geréb's movement. The care given in many cases is inadequate. The doctor who is supposed to be present at birth doesn't want to get up in the middle of the night or over the weekend and therefore he simply induces birth at a time that's convenient for him. In addition, it is a well known fact that obstetricians are perhaps the richest segment of the medical profession. Although gynecological services, including the birth of the child, are covered by medical insurance, there is a "fee" that is expected by the doctors. I'm not sure what the going rate is, but not long ago I heard about 150,000 Ft., that is, about $750.00. And, naturally, the doctors don't pay taxes on money earned this way. If a gynecologist has no more than 20 births a month he will receive 3 million forints tax free. Not bad. Thus the mostly male gynecologists are dead set against letting women give birth at home with the help of a well trained midwife. I'm not familiar with the education of Hungarian midwives, but in the United States it is a two-year program after a four-year-long bachelor's program.

A veritable witchhunt began against Ágnes Geréb that reached its pinnacle in 2007 when she was briefly arrested and charged with negligence resulting in the death of one of the babies. In the usual way of the Hungarian courts it is only now, three years later, that the case reached the court. By that time Geréb was in jail in connection with another case. On October 6 the police arrested her because a baby had to be revived after a difficult birth outside of the hospital. I quite intentionally didn't describe this incident as a home birthing because the birth didn't take place in the young couple's home but in a house owned by Ágnes Geréb where she normally gives lectures. The house also has facilities for giving birth in a family type of setting.

The birth occurred unexpectedly during a lecture. As we know, such things can happen. Who hasn't heard of babies born in a taxi on the way to the hospital? Or, one of my favorite stories about star doctors is the following. During the war the Dutch royal couple received shelter in Ottawa, Canada, where the queen's last child was born. The attending physician, after being chosen by the queen, became a much sought after gynecologist in town. An acquaintance of mine who had already had two children was his patient and after two children she had a pretty good idea of when the baby was coming. So she phoned the famous doctor who announced that it wasn't time yet and that was that. Eventually the baby was delivered with the help of the next door neighbor in the living room on the sofa! She still had to pay the doctor, though!

Well, something like that happened in this case too. The baby came too early--the details are not known--but the baby was in bad shape. They called an ambulance and they managed to revive the child. The next morning Geréb and three other people who were assisting were arrested. As far as I know, she is still in jail.

Meanwhile she had to appear in court because of her case from 2007. She was in handcuffs at the end of which dangled a chain at least a four-five feet long. A policeman held the end of the chain while the poor accused was led into the courtroom as if she were a dog. On the other hand, one can hear of real criminals who were allowed to leave the courtroom and who simply walked out of the building.They didn't stop until they reached Spain!

At the trial all the experts blamed her for the death of the newborn in 2007. I read the allegations about the administration of oxytocin and of course I don't understand all the details. In fact, I'm rather proud of myself for even knowing about oxytocin and what it is used for. One of the experts admitted that giving birth at home is legal but "the profession doesn't recommend it." Another expert claimed that birth at home is okay but only if a gynecologist is present. So the experts themselves cannot agree on the recommended action. Now the new government is promising definitive legislation on the question. Knowing Hungarian lawmakers' way of thinking, the legislation most likely will be quite complicated and thus will make giving birth outside of a hospital very difficult.

As for the accidents that occurred in Ágnes Geréb's practice, her defenders recall that she has delivered more than 3,500 babies and there were only a couple of problems. People on her side rightly point out that problems occur in hospitals as well and there are also babies born dead or mothers who die in childbirth. Their doctors are naturally not led in chains to jail. Recently there was a rather suspicious case. A young woman, six and a half months pregnant, complained of severe abdominal pain. The doctor gave her a painkiller and sent her home. She was dead within twenty-four hours. She had a severe abdominal infection.

I don't know what will happen to Ágnes Geréb but I'm not too optimistic. The doctor lobby is very powerful, and I assume that the judge is baffled by the differing expert opinions. We know that the association of gynecologists will fight very hard to keep birthing within the walls of the hospitals. It certainly is in their interest. 

 

Comments

[Paul]

Thanks for this post, Éva, it more or less confirms my suspicions about this case. It also tells us a lot about 'modern' day Hungary, none of it good.

Although the wrong sex to have babies, I have quite a bit of experience of this matter, having had my first family in the 70s/80s and my second in the last 5 years. And in England things have changed dramatically in that short space of time.

My first wife had no option but to go to hospital for the birth of our first child (1978). She was shaved, painted with something purple, had her legs put in stirrups(?) and a bright 'dentist' type light trained on her nether regions. The midwife carrying out the delivery was abrupt and unfriendly and made it clear that I was in the way.

Immediately after the birth the baby was taken away and put in a ward full of other babies, where he was bottle fed. Breast feeding wasn't encouraged, let alone promoted. The baby was then brought back to my wife periodically and then taken away again after an hour or two. She had no control over this schedule. My first sight of my son was in a cot in a row of about a dozen, through a plate glass window. To be honest, I wasn't even sure which one was mine. My wife had to stay in hospital for 10 days.

Things improved a lot shortly after this and the conditions for the birth of my second son and first daughter were quite different. And by the time my second wife gave birth to our daughter (2005) the whole process had changed.

We were given the option of a home birth (although not recommended for first babies), and we could also choose a variety of ways of giving birth in the hospital (e.g. in a birthing pool - although we opted out of that one!). When my wife was admitted, she was shown to a single room, which was decorated to look like a domestic bedroom, with an ordinary looking bed, comfortable furniture and restful lighting. She was allowed to wear her own clothes and play music of her choice, and the midwife was friendly and considerate. I was encouraged to attend, whereas in 79 I had barely been tolerated.

After the birth, the baby was immediately placed on her mother's breast and wasn't even cleaned for some hours. The necessary tests, etc were all carried out in the room, so our daughter was never taken out of the room, and she remained with my wife for her whole stay in hospital.

After the birth my wife was moved into a small ward, containing just six beds (she could have had a private room, but would have had to pay), and she went home on the third day (she chose how long she stayed in hospital - with the second child, she went home the next day).

And all of this was free. No need to choose a gynaecologist in advance (in fact, if everything is OK, you only see one for a few minutes in the whole process) and no money in brown envelopes. My wife's best friend had her first baby about the same time in Hungary, under the 'free' health service, and it cost her 100,000 Ft.

I unthinkingly assumed the same revolution in birth care had taken place in all 'western'/European countries more or less at the same time (if not a lot earlier in many countries), so I was amazed, and very shocked, to hear the stories of the mothers I came to know in Hungary. One friend of ours, who gave birth only a couple of years ago, could not afford to pay a gynaecologist, and (surprise, surprise) none appeared at the birth. Luckily, the birth was without problems, but she was given the absolute minimum of attention and treated very brusquely. Her husband actually had to scrub up and assist, such was the limited 'service'. Incidentally, my wife's friend who paid 100k Ft also complained bitterly about the attention she received, and, during this conversation, I was stunned to hear her description of the birth - pretty much what my first wife had been put through 30 years ago.

My apologies for the length of this post, especially to the non-parents among Éva's readers, but this is something I feel very strongly about. I have had a fair bit of experience of the Hungarian health service over the last 10 years (and am also married into a family of doctors and consultants - including a gynaecologist), and mostly my experiences have not been good (although the care of children at the local GP/clinic level is a usually very welcome exception).

For me, there are two key points which come out of all this. First, and most obvious, the Hungarian health service's attitude to birth - and to health in general. Not only is pregnancy and birth regarded as some sort of illness, and therefore something that must routinely involve hospitalisation, the presence of doctors, etc, but the general attitude to health and the health service is also something that badly needs dragging into the 21st century. For instance, the way patients are treated is appalling. In a country that prides itself (mostly, quite rightly) on its attitude towards children, the brutal and uncaring way my 3 year old daughter was treated when she needed stitches for a cut mouth still makes me angry. And the eternal queues you see in hospitals (and the way doctors are regarded as some form of minor nobility, instead of public servants) is practically medieval.

But the attitude of the patients themselves also puzzles and angers me. Everyone expects at least one medicine (if not two or three) on every visit to the doctor, so doctors are under immense pressure to prescribe something, whether it's needed or not. It is still common for antibiotics to be prescribed in Hungary for almost every complaint, whereas, in England, they are rarely prescribed at all, as most illnesses are not bacterial (for instance, if you go to the doctors with a cold or flu, you are told to go home, go to bed, keep warm, drink lots of fluid and take paracetemol!). In the age of the superbugs, with the efficacy of antibiotics already on the slippery slope to disaster, Hungarian doctors are still dishing them out like sweets - because Hungarian patients demand them. (And don't even get me started on the Hungarian love affair with suppositories!!)

And secondly, there is the depressing matter of the money in the proverbial brown envelope paid, not just to the doctor, but often everyone else involved as well. This is often discussed, and generally regarded by everyone as a crazy system and something that has to go before the Hungarian health service can even be dragged kicking and screaming into the last century, never mind this one. But does anyone do anything about it? No. Because quite simply, everyone is complicit in it.

The government gets away with paying doctors and heath service staff derisory salaries, the patients daren't break with the practice for fear they won't get looked after properly if a few thousand forint notes, or a nice piece of homecured aren't forthcoming, and of course, doctors live very nicely off the system. My brother-in-law has only been qualified a few years, but already has a larger flat, two cars and a Balaton dacha, and is buying a plot of land for his future villa. And none of his medically qualified relatives are exactly begging on street corners either. And (and I don't know if I find this surprising or just depressing) they are all strong Fidesz supporters.

Each of them, of course, deplores the brown envelope system, but they continue to do nothing to change it. Of course, they claim that there is very little that they can do, but the fact remains that no government salary on its own, no matter how generous, could give them the lifestyle they currently enjoy.

And, no doubt, the gynaecologists involved in the case Éva highlights will use every means to resist homebirths for the same reason. Doctors, surgeons, etc form a very privileged sub-class in Hungary and they are (mostly) determined to maintain the status-quo that gives them their privileged status and lifestyle. It's noticeable that, in a small country that produces an abnormally large number of doctors, dentists, etc, very few of them go abroad. And why should they, when they can live so comfortably at home?

As Ágnes Geréb and her supporters have already discovered, nothing is going to change in the Hungarian health service while the vested interests of the medical elite are under threat. But also nothing will change while the Hungarians themselves accept the system and put no pressure on doctors of politicians to change it.

[Rigó Jancsi]

If you want to bring your child into this world in a state hospital in Hungary, you should bring bed-linen, your own nightgown, slippers, your own towel, your own sanitary towels, something to eat and drink, toilet paper, and your own clinical thermometer, since none of this will be provided. And of course, don't forget the big brown envelope for the doctor, the god in white.

When our son was born in August this year, we could afford a private hospital close to Róbert Károly körut. The standard of that hospital was like that of a usual state hospital in Germany. If I were not in the position to pay for such a hospital, I, too, would consider home birth, since a child should not come into this world in such a horrid place like the university hospitals in Budapest.

[Paul]

Thanks for your post, Úr Süti. I was beginning to feel guilty about suggesting the subject of this post to Éva!

The state of hospitals in Hungary and the health 'service' in general is one of the main reasons we still live mostly in the UK.

Our original plan was to move completely to Hungary before our daughter was 5 (the age children start school in England), but various factors delayed our move. Then I ruptured a disc in my back and experienced both English and Hungarian health systems in some depth (my first experience as anything more than a visitor in both).

As someone fast approaching 60, my back problem was a wake-up call for me. Much as I love Hungary, I realised that being old and ill there was not going to be a bundle of laughs.

The reality of the school system also affected our decision to stay (and April's election result just about put the kybosh on it). Are you planning to stay in Orbánistan when your son gets to school age?

[Eva S. Balogh]

Paul: "I was beginning to feel guilty about suggesting the subject of this post to Éva!"

Oh, don't feel guilty. In fact, I feel passionate about Hungarian health care. Maybe too much so and therefore I lose my usually calm and moderate style of writing that I learned while studying history. But when it comes to doctors in Hungary outrage takes over me. I have stories to tell which are hair raising. I'm not surprised that you didn't want to spend your later years in care of Hungarian doctors. This was one considerations with me too. Among many others.

[Eva S. Balogh]

Paul: "Thanks for your post, Úr Süti."

And you complain about your Hungarian? It took me at least ten minutes to figure out why Rigó Jancsi is Süti úr! For those of you who don't know Hungarian, Rigó Jancsi is the name of a very delicious pastry (sütemény). Süti is a colloquial abbreviation of pastry.

[Passing Stranger]

I am sure the post is timely, though the Guardian recently did a piece on this shambolic show trial.
I have only one point to add: afaik at the moment the going rate for a birth is 200.000 fts. It is clear to me the wrong people are on trial.

[Eva S. Balogh]

Passing Stranger: "I have only one point to add: afaik at the moment the going rate for a birth is 200.000 fts."

Wow! There is real inflation in the medical profession.

[Paul]

200,000 Ft! I just worked that out in £s and it's still a lot even divided by 300.

No wonder our friends couldn't afford it (and they couldn't because he's a soldier - shame on you Hungary).

Éva - I had some help from my wife. I actually understand a fair bit of (spoken) Hungarian after nearly 10 years of living with it, but my spoken Hungarian is very poor and my reading/writing even worse.

My daughter, who is 5, already speaks far better Hungarian than me, and she is now also starting to read and write it, so soon she will be better than me in that too. The only one in the family whose Hungarian is worse than mine is our 16 month old son!

[Kevin Moore]

"It took me at least ten minutes to figure out why Rigó Jancsi is Süti úr!"

Strange, I figured it out in about 5 seconds. (Didn't measure the exact time though.)

[Kevin Moore]

Please do not bash Hungarian healthcare and doctors in general. I've heard horrific stories about the UK system from my sister who spent 3 years in Scotland.
I guess there are good and bad doctors everywhere. Among Hungarian doctors there are many caring and respectable ones, and most of them are still world-class in terms of professional level. (No wonder Norway has set up a whole walk-of-life model for Hungarian doctors - shame on the last 8 years' governments for expelling them out.)

[Paul]

Just on a note of accuracy, there is no "UK system" of healthcare. The (so-called) NHS is broadly similar in the 4 constituent countries, but there are some major differences (for instance, there is no prescription charge in Wales). And, of the three main countries, Scotland's differs the most.

But I can accept that your sister quite possibly did have a bad time. Wonderful as it is, the NHS still has some way to go to catch up with many of our European neighbours.

Also, Hungarians' expectations of their health system are quite different to ours. For instance, as already mentioned, a visit to your GP over here will most likely result in you being advised to go to bed and take paracetemol. You will not walk out with the three prescriptions and a free course of spa treatment most Hungarian GPs will typically give you.

Another example of differing expectations - in England, unless you are at death's door, you are expected to make your own way to hospital, even if quite ill, bleeding or in labour. Ambulances are only sent out for emergencies. But, when my father-in-law cut his foot a few years ago, not only did an ambulance come to pick him up, but he got quite angry when they refused to bring him home in one as well. All he needed was a few stitches.

As for doctors leaving Hungary, it would be interesting to know the figures. I suspect they are much lower than for similar countries. I have had the misfortune to see a lot of doctors over the last year or two, and have seen Asian, Greek, Turkish, Latvian, Polish and (oddly) German and Dutch doctors, amonst others, but never a Hungarian - although there are plenty of Hungarians working and living in this part of the country.

[Hank]

Here an MTI article from 2009 with figures about docters leaving:

"Besides higher salaries and living standards, better career prospects and higher respect afforded to them are motivating factors for moving abroad, Edmond Girasek, a researcher at the Budapest Semmelweis University's Management Training Centre, told the paper.

Last year 320 applications were made to work abroad, mostly by doctors in their 30s. Most specialised in areas where there is a shortage of doctors at home, he said.

Hospitals here, however, do not do enough to keep their professionals either, said Girasek. He quoted the example of a respected pathologist, 45, who left a leading hospital here to find employment in Britain after being demoted for no specified reason. He was among 40-50 who leave the country each month.

One solution would be to promote ethical framework of recruitment and employment, said Girasek. Head of the Hungarian Chamber of Doctors, Geza Gyenes, argued however that an EU directive setting the minimum salary level for doctors would be more effective than a code of ethics.

Well over half of Hungarian doctors abroad, 1,400, work in Britain, while every fifth choose Germany or Austria. Around 12 percent end up in the Scandinavian region, according to the chamber's data.

Since Hungary's EU accession in 2004 May 2,461 Hungarian doctors out of 32,000 have received a certificate to work abroad, the paper said."

- I don't think these are very shocking figures and, again, they haven't changed much over the last 20 years: there has always been a steady but not huge flow of docters leaving.
- I'm always surprised how doctors in Hungary can demand that the state should give them the same kind of pay as their colleagues in Western Europe. Yeah, sure, that is what street sweepers, bus drivers, factory workers, teachers and office clerks would also want.
- Thanks to the brown envelopes an upper layer of doctors (5-6 thousand of them) do make that kind of salaries or even more: 150,000-200,000 euro a year (black and untaxed) is not unusual. Those are the ones blocking all and every reform (and not the ones going abroad).
- And than this myth of their world class expertise. Already for decades, the equipment they use in this country is way behind what hospitals in for example the Netherlands use. If you never use the best world class equipment, you also can't have the best world class expertise. Let alone the attitude, the knowledge about modern docter-patient relations etc.
- Sure, there are lots of very nice and friendly and hard working doctors in Hungary, too. But that is not the issue, is it?

[Rigó Jancsi]

It's my favourite süti, it used to be very good at Jég Büfé at Ferenciek tere. So I started using that name for stuff on the net. Since my name is Jan, it fits, and unlike many Hungarians, I don't care that it's a Roma name (Rigó Jancsi was a fiddler in one of Budapest's cafés and supposedly a rich lady ran away together with him).

And back to topic: Friends had to go to hospital yesterday with their 15-months-old son because of high temperature. Doctors told them they want to keep him for three days. Of course, there are no mother-child-rooms, our friends had to borrow our sunlounger (?) for the mother to be able to stay in hospital with her son over night.

A relative was operated on her finger in general anaesthesia last week, because of a splinter she got into her finger during garden work! She went into hospital at 8:00 am on Sunday and was seen by a doctor not earlier than 15:00, and he told her she should have seen him in the morning, now it was too late, they would have to operate. They kept her for three days. To me, that sounds like they wanted to utilize their capacities and get some extra money, both from the insurance and in an envelope.

So, this really is a topic to be passionate about, because unlike with party politics and tax law, you feel the consequences not only in your purse but on your body. That's frightening.

[Eva S. Balogh]

Hank: "Head of the Hungarian Chamber of Doctors, Geza Gyenes, argued however that an EU directive setting the minimum salary level for doctors would be more effective than a code of ethics."

Just an aside. This Gyenes turned out to be a Jobbik supporter and the party's health expert. Now member of parliament.

[Eva S. Balogh]

Rigo Jancsi, what you said about keeping the 15 months-old child and the splinter under the nail is correct. That is what they are doing. The whole thing is an outrage.

[Mark]

Paul: "But I can accept that your sister quite possibly did have a bad time. Wonderful as it is, the NHS still has some way to go to catch up with many of our European neighbours."

I think it is worth saying that based upon a lifetime's experience (nearly 40 years) of using the NHS in England I have never paid hálapénz, not even a single penny, for any purpose. When users of the Hungarian system are able to say that I will accept that one can make these comparisons, but at present that isn't the case.

Hank: "Thanks to the brown envelopes an upper layer of doctors (5-6 thousand of them) do make that kind of salaries or even more: 150,000-200,000 euro a year (black and untaxed) is not unusual. Those are the ones blocking all and every reform (and not the ones going abroad)."

This, I think, underlines the lie that hálapénz is primarily an outcome of low salaries for doctors. It has more to do with greed and institutional corruption, and it is only when these are properly tackled that wage rises can be considered as part of a programme to eliminate the phenomenon.

[Passing Stranger]

I have to apologise for a misleading statement I made earlier. I have been corrected by a friend. The bribe for a birth is not 200.000, but can be as high as 250.000 fts. It depends on the doctor, and you can haggle in advance over the price. I remember there was a suggestion recently that medicine students who go abroad should pay back their student grants; they are not the ones that are the problem.

[Julie]

Here's an update on this story from the Wall Street Journal: "In its ruling, the Strasbourg court said that the Hungarian state was violating the right to respect private life guaranteed by the European Convention on Human Rights. This right encompasses the right to choose the circumstances of giving birth, the court said." http://blogs.wsj.com/new-europe/2010/12/21/european-court-makes-homebirth-legal-in-hungary/

[Eva S. Balogh]

Julie:""Here's an update on this story from the Wall Street Journal: "In its ruling, the Strasbourg court said that the Hungarian state was violating the right to respect private life guaranteed by the European Convention on Human Rights."

An update to your update. A couple of days ago the Hungarian government came up with a bill that will govern home birthing. I looked at it only quickly but it looks half decent.