Hostility Toward Home Births

Restrictions on Home Births Due to Medical Paternalism and Inhumane View of Mothers, Critics Say

By Celine Sidani

There are only 500 home births per year in the Czech Republic. Photo courtesy of Flickr.

There are only an estimated 500 home births per year in the Czech Republic. Photo courtesy of Flickr.

After positioning herself on all fours and squatting, Jitka Charvatova found herself most comfortable squatting on her kitchen floor with her elbows resting on her husband’s knees. No one was in Charvatova’s home that afternoon besides her, her husband, and her midwife, who sat directly next to the pair.

One second she was squatting and the next she was laying on the kitchen floor with her baby son resting on her breast. She does not recall the in between. It was “quiet,painless,” she said of the birth of her youngest son in 2013.

The 37-year-old mother of two said she had never felt so energized. “I felt fit after the birth. I remember that I had just delivered my baby and I went to go unpack my hospital suitcase,” she said of her precautionary measure.

Charvatova’s choice to have her son at home is rare, a choice at the center of a debate over just how much control women have over the birth experience. Recent court cases have blamed newborn deaths on home births, others legal battles challenge the tough restrictions in the country that make home births nearly impossible.

In 2011 and 2012, two Czech women filed a lawsuit with the European Court of Human Rights in Strasbourg, stating that Czech law makes it unfeasible to give birth at home with the assistance of a health professional. The law, they say, violates their right to respect for private and family life, as listed in the European Convention on Human Rights. This month the court ruled that there had been no violation of the applicant’s rights, stating in a press release that “there is no European consensus on whether or not to allow home births.” The plaintiffs intend to appeal the decision.

A social and medical taboo in the Czech Republic, home birth has long been celebrated by advocates of natural childbirth in many developed countries such as United States and the Netherlands.

There are approximately 500 home births per year in the Czech Republic, .47 percent of annual births. In the Netherlands, 30 percent of births are at home, in the United Kingdom 2.4 percent, and in Western Europe as a whole, three percent. But the Czech Republic stands out as having some of the strongest restrictions on home birth in the 28-country European Union.

“Czech hospitals, their doctors and their midwives have absolutely no knowledge of home births, they are not going to help women in this situation because they are not trained to help,” said Zuzana Stromerova, a midwife and founder of Birth House Stork, a Czech non-governmental organization dedicated to promoting the legitimacy of natural births. Stromerova, who delivered Charvatova’s second son, is what is known as an independent midwife, one not affiliated with a hospital.

Home births are not technically illegal in the Czech Republic. However, the reluctance of the Czech state to insure the practice, coupled with licensing restrictions placed on birth nurses or assistants – known as midwives – make it virtually impossible to have a safe home birth. Hospital midwives are not allowed to assist in home birth, in contrast to many countries such as the United Kingdom, where many work both in homes and hospitals. In 2012 a law was introduced that punishes midwives with a fine of one million crowns, about $44,700, if they are caught helping a woman give birth at home.

“My hospital experience was all very disturbing,”

Critics say the Czech authorities’ skepticism towards home births has its roots in a communist-era system of the state, as represented by the doctor as an all knowing authority that knows what is best for women. It is, many women argue, the worst form of paternalism.

“My hospital experience was all very disturbing,” said Charvatova about her first birth in 2011. She was transferred to the Podoli Hospital midway through her home birth due to excess bleeding, results both her and her midwife were prepared for due to Charvatova’s existing medical condition of having two uteri.

At the hospital, she said, the medical staff asks you for information already present in their database, such as your birth date and address. “The birth process becomes much more painful because you’re always being interrupted.”

When she was in labor, Charvatova said she was unable to cooperate with her baby by switching positions, and was put through several processes and medical interventions, such as pubic shaving and enema, that she was opposed to. Many hospitals will even reject a mother’s birth plan, a set of requests respected by most doctors in countries like the United States. The lack of informed consent, she said, is common in many Czech hospitals. “They will say, ‘we have to do this or you will kill your own baby.’”

Judy Cohain, an American midwife working in Israel since 1983 described hospital births as bureaucratic. “The infinite variety of personalities of mother and baby are repressed in the hospital setting, where women are treated as numbers, impersonally, in the same gown, on the same bed, and with the same routines that are indigenous to any institution.”

There is a growing number of Czech women, it seems, who share Cohain’s outlook.

The Active Motherhood Movement, founded in 1999, strives to reverse “authoritarian childbirth practices” in the Czech Republic. The organization lists pubic shaving, enema, the induction of labor, restrictions on eating and drinking during child birth, epidural, directed pushing, and the separation of the baby from the mother as restrictive measures taken in many Czech maternity hospitals.

It is these routines and medical interventions that have been rooted into hospital protocol for generations that women like Charvatova seek to avoid.

“I once heard that hospitals here are just baby factories,” said Charvatova. “And I agree.”

Stromerova of Birth House Stork explained, “There’s an idea in the Czech Republic that doctors are always right and so all medical processes should go their way,” she said.

“They also do not take the mother into consideration,” said Stromerova, labeling the medical field as patriarchal. “We forget that the mother needs to be mentally and physically okay not only to have the baby, but to raise and educate the baby.”

Stromerova linked this idea of medical superiority to the Czech Republic’s communist past, where the country had the lowest infant mortality rate and doctors were seen as figures of authority.

“The authority of doctors takes women’s competency to say ‘no’ away from them,” she said. “Women are not lazy, but they like comfort. They will believe what the doctors say.”

Midwives, on the other hand, are women trained to “provide individualized care for the physical, mental, emotional, spiritual and cultural needs,” of the mother, according the Midwives Alliance of North America, a professional membership organization.

“Because the system is not working, so many women are giving birth at home alone with their partners, none of whom are healthcare workers,”

Still, the Czech Republic’s current low infant mortality rate of 2.63 deaths per 1,000 live births remains a compelling reason for the country to maintain its current hospital-based birth protocols. The United States, for example, has a birth rate of 6.17 and the former Eastern Bloc country of Hungary a rate of 5.09.

Charvatova said that because of the country’s significantly low rate, doctors believe that there is no reason to alter the birth regimen. While they may be willing to upgrade medical technology, she said, they are not as willing to address this as a social problem, or one that has to do with freedom of choice.

However, a 2013 British Medical Journal study of the Netherlands, the country with the most home births in Western Europe, reveals hospital births as less safe for mothers than home births. The rate of maternal morbidity for home births versus hospital births was one in 1,000 versus 2.3 in 1,000.

“The safety of home birth has to be considered in the context of the availability of local services,” Dr. Tony Falconer, President of the Royal College of Obstetricians and Gynecologists, London, told the British Broadcasting Corporation in response to the study.

Dutch midwives are highly trained professionals who are supported by the health care system, and thus held more accountable to mothers and their babies. In order to become a midwife, one must complete a four-year university program that includes 2,560 hours of practical classes and 3,160 hours of theoretical classes. In case of an emergency transfer to a hospital, the state has a clear-cut transportation protocol that is strictly followed. And, in order to give birth at home, women must live within 15 minutes of a hospital.

Hospital midwives typically have attended a special nursing high school. Private midwives, who have usually worked previously in the hospital setting, are not required to fulfill any other specific educational requirements.

In the Czech Republic, when a problem does occur with a home birth, the midwife is front and center of the public debate.

In 2009, a baby boy died in the Czech Republic due to severe brain damage. A year later, Ivana Konigsmarkova, the midwife who assisted with the infant’s birth, was given a two-year suspension for negligence. Konigsmarkova took her case to the European Court of Human Rights. Her lawyer told Radio Prague, “Mrs. Konigsmarkova followed standards and procedures for home birth that were drawn up abroad, as such standards do not exist in the Czech Republic.”

Dr. Petr Velebil from Prague’s oldest maternity hospital, Podoli, told Radio Prague that the home is not the safest environment for birth. “This is why the Czech medical community tries its utmost to convince pregnant women of the benefits of giving birth in a medical facility, which is prepared and therefore equipped to deal with any potential complications,” he said. “These complications are usually sudden, immediate, and they require immediate medical attention.”

Complications include stalled labor due to high stress, a prolapsed cord, which can restrict blood flow to the baby, and hemorrhaging, the loss of excess blood. In these cases, midwives are trained to detangle umbilical cords, give pitocin shots to stop hemorrhaging, and resuscitate babies.

Some believe that the restrictions placed on midwives are only increasing these potential risks.

“Because the system is not working, so many women are giving birth at home alone with their partners, none of whom are healthcare workers,” said Zora Javorska, who gave birth at home in the Czech Republic and studies midwifery at the American College of Nurse-Midwives. “Even if a midwife is there and sees complications, she will have to go away and protect herself instead of giving medical information to the ambulance staff.”

Javorska names her personal midwife as one of the few midwives in the country who are courageous enough to assist in births despite the heavy fine.

“It is not the most ideal or safest situation,” she said. “But that’s why we’re trying to change it.”

 

Celine Sidani is in the NYU College of Arts and Science Class of 2016. Her hometown is South Brunswick, New Jersey.

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Categories: Culture, Europe, Fall 2014 Issue Number 3, News, NYU Prague

Author:The Prague Wandering

The Prague Wandering is an NYU based study abroad webzine- the only one of its kind. It focuses on issues in contemporary Czech culture and the city of Prague, exploring beyond the study abroad bubble.

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