Constitutional Court decision encourages further discussion on home births

Ivana Königsmarková, photo: CTK

The Constitutional Court made a landmark ruling on Wednesday morning, which struck down the verdicts of three previous courts on the guilt of midwife Ivana Königsmarková. A leading home birth advocate Koningsmarkova was given a suspended two-year prison sentence, a hefty fine and a ban from her profession for delivering a baby with serious neurological defects during a home birth. For proponents of more liberal birthing regulations this can mean a big step forward, but whether the decision will actually advance the debate on home births remains to be seen.

Ivana Königsmarková,  photo: CTK
For Ivana Königsmarková, a dedicated midwife with years of experience, the court decision was maybe the first relief after four years of being held up by the conservative medical community as a prime example of why home births are dangerous. In 2009, a district court in Prague ruled her criminally negligible for not recognizing the risks of a complicated home birth as a result of which the child suffered serious brain injuries and later died. Two other courts later confirmed the verdict.

The defense maintained that Mrs. Königsmarková was not given all the relevant facts and medical history beforehand by her client, and that a similar situation could have occurred at a hospital as well. A member of Mrs. Königsmarková’s legal team, Adéla Hořejší, who spoke to me earlier on the phone:

“The Constitutional Court reflected in its decision all of the objections we raised with the previous court proceedings. And, of course, parts of the decision also have a wider relevance beyond Mrs. Königsmarková’s case, as for example the recognition of the need to create specific legal standards for care during home births, which currently do not exist at all.”

Ivo Pospíšil,  photo: archive of the Constitutional Court
The Constitutional Court did not actually rule on whether Mrs. Königsmarková was guilty of criminal negligence, but concerned itself primarily with the due process of the previous court cases. The constitutional judges agreed that the plaintiff was not allowed to bring all of the evidence she wanted to the attention of previous courts and that the prosecution’s main evidence was an expert analysis that was not impartial. The General Secretary of the court, Ivo Pospíšil, says that this decision encourages further discussion, but it is not up to the Constitutional Court to decide on the present state of legislation:

“In its ruling, the Constitutional Court affirmed that a debate on the issue should continue, but it did say that the current laws are insufficient. This issue is rather complex, and even this court has differing opinions on it among its judges.”

The decision means, in a sense, a decriminalization of home births, even though under current laws it is practically impossible to carry them out even for certified midwives. In fact the respective laws have been made even stricter since Königsmarková’s original sentencing in 2009. Speaking after the ruling, the head of the Union of Midwives Kateřina Hájková Klíčová said that current regulations have forced many midwives to stop assisting home births, which in the end causes more risks for mothers who prefer alternative birthing options.

Illustrative photo: Kristýna Maková
“According to European law, women who have health insurance have a right to this kind of care. And the only result that the Czech state has achieved is that these women give birth at home either completely without assistance or they seek out the help of untrained individuals, who cannot provide them with proper medical care.”

The case against Königsmarková will be returned now to the Prague 3 court, which will re-consider it in view of the Constitutional Court’s decision. Even if her case meets with a positive result in the end, another suspended prison sentence for midwife Zuzana Štromerová this week puts at risk the possibility of a real discussion on home births within the medical community.