Home births on trial after boy left with brain damage in botched delivery

Home births are currently under the spotlight in the Czech Republic; a trial began in Prague last week involving the chairwoman of the country’s Union of Midwives. Ivana Königsmarková, one of the very few Czech midwives qualified to deliver babies at home, faces up to four years in prison after overseeing a botched delivery that left a baby boy severely brain damaged. She denies any wrongdoing.

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Ivana Königsmarková was interviewed at length last year by Czech Television on the merits of giving birth at home. Mrs Königsmarková – one of just twenty or so midwives in the whole country legally qualified to deliver babies at home - said in her experience there were rarely complications in home births, and she criticised the scepticism of the Czech medical establishment.

Yet just weeks later she found herself in charge of one such complicated birth, one that ended in a nightmare for the child’s parents. A baby boy was taken to hospital after being deprived of oxygen; he survived, but was left with brain damage for life.

Mrs Königsmarková – who says the birth had been going normally – now faces between six months and four years in prison for criminal negligence, in the first such case to go to court in the country. Petr Velebil, the chief obstetrician at Prague’s Podolí maternity hospital where the boy was rushed into intensive care, had this to say to Czech Television:

Ivana Königsmarková,  photo: CTK
“The home is simply not the safest environment in which to give 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. These complications are usually sudden, immediate, and they require immediate medical attention.”

Home births are a rare phenomenon in this country; the Czech Republic has a long tradition of medical care provided by a strong, paternalistic state, from the times of the Austro-Hungarian Empire right through to the Communist period and beyond. That care has left little room for decision-making in the hands of the patient – a good thing when it comes to something as unpredictable and potentially dangerous as childbirth, say the country’s doctors.

In fact the Health Ministry is currently tightening regulations on home births. A doctor will have to be present at all times, and the birthing room must be equipped with all the same equipment that’s found in a hospital delivery room. That requirement is simply unfair, says the deputy chairwoman of the Union of Midwives, Marie Vnoučková:

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“The thing is, midwives just don’t use this equipment when delivering a baby in hospital. In fact not even all the maternity hospitals have all of this equipment on their maternity wards.”

The case against Mrs Königsmarková would appear to be terrible publicity for home births – the doctor who treated the boy in hospital said she was 100% convinced the complications arose because he was delivered at home; qualified doctors and modern medical equipment could, she said, have saved him from a lifetime of disability. Yet the boy’s mother, who’d had a previous child delivered at home, was quoted in the media as saying she would give birth at home again. Indeed Kateřina Klíčová, the Union’s Executive Director, told me home births were not automatically more dangerous than hospital births:

“I think it’s just a hypothesis, because even in hospital, babies sometimes die in childbirth. At this moment neither you nor I have the necessary data to hand. There have been cases of babies suffering damage or deformity at the hands of trained hospital staff; babies who suffered injuries from forceps delivery for example, or babies who developed deformities that were overlooked at birth. But these cases aren’t seized upon by the media.”

The Union of Midwives stresses it is merely a professional association representing both private midwives and midwives who work in hospitals; it is not, says Kateřina Klíčová, a pressure group lobbying women to give birth at home. But she points out that most women who want to give birth at home tend to be women who’ve had unpleasant experiences in hospital the first time around, and want their second birth to be more as nature intended; induced by hormones, not injections, epidurals and scalpels.