Czech midwives claim they are not allowed to do their job

The birth of a child is an unforgettable event in a woman's life and increasingly Czech women are convincing their partners to attend the birth and make the shared moment of happiness even more special. However many hospitals in the country still frown on the practice of allowing anyone to "get in the way" of what they perceive as a strictly medical procedure. The country has one of the lowest birth rates in the world - but many Czech women say they want more.

They want to give birth in a friendly environment, chose from alternative birthing methods and have one or more family members present. Because that is not possible in most Czech hospitals, three percent of Czech mothers decide to give birth at home.

In September of 2005 a group of midwives opened the country's first alternative birth centre - in view of providing pre-natal care, supervising the birth and then giving the mother and baby post natal care. But, because the centre does not fulfill the strict medical requirements stipulated by Czech law, it is only allowed to provide pre-natal and post-natal services. One of the centre's founders, certified midwife Zuzana Stromerova, says the demands placed on the birth centre are nonsensical.

"They demand that we have absolutely the same equipment as hospitals. That is impossible for us to achieve. And also we do not want to meet these demands - they are nonsensical and illogical. Midwifes care for healthy women - healthy mothers and they do not need a team of anesthesiologists and an operating theatre. They just need to have quick and easy access to a hospital and they need to be in contact with the mothers from the very beginning of pregnancy."

So if complications should arise - you would be capable of dealing with them?

"That is our job. If any complications should arise the midwife would immediately recommend mother's admission to hospital. And with her qualifications she should be able to recognize any complications at an early stage. So there would not be any need to perform a Cesarean section within minutes as doctors tell us."

Obstetricians are extremely critical of the home-births trend, arguing that complications could arise and action might need to be taken within a matter of minutes. Michal Halaska, head obstetrician at the Bulovka Hospital in Prague, thinks that in view of what doctors are able to do for an expectant mother, opting for a home birth is pure folly:

"Mothers who decide to give birth at home should be aware of the risk they are taking - they are putting both themselves and their baby at risk. Without immediate help complications could result in permanent damage and even death for mother and child."

The health ministry is siding with doctors on this and insists that unless midwives can fulfill the required conditions the birth centre will not get the necessary license to supervise births. Zuzana Stromerova says that for the time being midwives help where they can, but that by its decision the ministry is putting pregnant women more at risk than they would be if they could give birth at the alternative births center.

"We attend home births because they cannot forbid the mother that."

How many mothers in the Czech Republic choose to give birth at home?

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"There are no official statistics. We estimate that it is about 300 mothers a year, but there are some who give birth at home unattended. That's quite a paradox you know because the Czech Republic is a developed, industrialized country with a high standard of health care in hospitals and such - but when it comes to out-of-hospital births the state does nothing for the mother. The result of its policy is that some women do not have a midwife in attendance. Prague is the exception because here it is easier to get a midwife. I would say that Czech mothers who wish to give birth at home are often in the same situation as African, Indian or Asian mothers who do not have midwives in attendance for other reasons. However the result is the same. And that is against the recommendations of the World Health Organization which says that every woman should have a midwife in attendance when she needs her."

The association of midwives has not made much progress in lobbying its case. But recently news of the dispute reached the European Commission and it has now asked the Czech authorities for an explanation of why midwives in the Czech Republic are not allowed to oversee the birth of a healthy woman, as they do in other EU states. Czech midwives are now hoping that the EC will succeed where they failed - and that the first alternative birth centre in the Czech Republic will finally be able to serve its purpose.