Home births under fire as court case highlights family tragedy

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The issue of giving birth at home once again came to the fore this week after the country's most senior midwife was found guilty of criminal negligence after overseeing a botched home birth in Prague. A baby boy was left severely brain damaged after being deprived of oxygen, and later died. The midwife denies any wrongdoing, and says the complications were unforeseen and unavoidable.

Ivana Königsmarková,  photo: CTK
Ivana Königsmarková, chairwoman of the country's Union of Midwives, was charged with negligence resulting in grievous bodily harm in a case that happened in July 2009. Mrs Königsmarková is one of a handful of people qualified to deliver babies at home in the Czech Republic, and was approached by a woman in Prague, who'd delivered two previous children in hospital and wanted to give birth this time at home.

Unfortunately the birth went badly wrong; the baby boy was unable to breathe and was only revived when an ambulance was called. Despite being taken to hospital the boy suffered severe brain damage, and died earlier this year. The case attracted considerable media attention, with the Czech medical establishment lining up to condemn home births. Dr Petr Velebil is head of the perinatal programme at the country's oldest maternity hospital, Podoli, and he had this to say to Czech Television after the case was brought to court.

"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."

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The judge handed down a two-year suspended sentence to Mrs Königsmarková and banned her from practising as a midwife for five years. Her lawyer, Adela Horejsi, immediately appealed, claiming the court had refused to hear crucial evidence and arguments and had instead relied on flawed and biased testimony from doctors who were known for their opposition to home births. Mrs Horejsi spoke to me earlier by telephone.

"We are of course convinced our client is innocent, and we sincerely hope we'll be given the chance to prove this in court. Mrs Königsmarková followed standards and procedures for home birth that were drawn up abroad, as such standards do not exist in the Czech Republic. She followed all of these required procedures to the letter. Unfortunately these 'optimal birth procedures' as they're called, contravene the standards laid down by the Czech Gynaecological Association, which are basically the same recommended medical procedures that are used in hospital births."

And this is the paradox that has led Czech home births to exist in a sort of legal no-man's land; midwives are legally permitted to deliver babies at home under the terms of an EU directive. However under Czech law, midwives must carry out home births using virtually the same conditions as that of a maternity ward, which is of course almost impossible. No wonder then that home births are so rare - only about 500 per year, and many of those were emergency deliveries, rather than planned births.

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The Czech media has since been alerted to two more cases - one of which saw a baby suffocating to death after being born with the umbilical cord round its neck. That case and Mrs Königsmarková's conviction has reignited what is a passionate debate; opponents of home birth, which is virtually the entire Czech medical establishment, say it poses unnecessarily dangers and the state must protect lives.

Supporters point out that babies also die in hospital deliveries, often through negligence. The Czech Republic, they say, is stuck in a post-communist paternalistic mindset, refusing to allow a practice which in western Europe is safe, popular and protected by European law.