A woman's right to give birth at home is back in the spotlight in the Czech Republic, as a group of pregnant women intend to file a complaint at the European Court of Human Rights in Strasbourg. The Czech state makes planned home births virtually impossible; there are midwives qualified to deliver babies at home, but they lack official registration and insurance companies won't cover them.
Home births are common in many parts of Europe; in the Czech Republic the practice is opposed by the authorities and made virtually impossible by reams of Health Ministry bureaucracy. Home births exist in a sort of legal grey area; midwives are legally permitted to deliver babies at home thanks to an EU directive. However under Czech law, midwives must carry out home deliveries using almost the same conditions as that of a maternity ward, which is of course virtually impossible. That's partly why there are so few of them - only about 500 each year. That's far less than in western Europe, where an estimated three percent of all births happen at home.
Home births are highly frowned upon by the Czech medical establishment, which - while excelling in many fields of medicine, including obstetrics, has also inherited a somewhat paternalistic attitude to patient choice, dating both from the communist period and the Austro-Hungarian Empire. Dr Petr Velebil is from Prague's oldest maternity hospital, Podolí.
"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."
Sceptical doctors say it was exactly such unforeseen complications that led to the botched delivery in 2009, in which a baby boy suffered severe brain damage and later died. Last year the midwife who presided over that planned home birth - the head of the Union of Midwives, Ivana Königsmarková - received a two-year suspended sentence for negligence resulting in grievous bodily harm.
Supporters say the case is being used to close all the remaining loopholes that allow home births a limited degree of legality. They point out that for a start, babies die or suffer severe brain damage in hospital births - hospital doctors and midwives, too, make mistakes, they say. The regulations on home births also require technical equipment present which is often not even used in hospital births.
The case being presented to the European Court of Human Rights claims the Czech Republic is ignoring a European directive which allows professional midwives to carry out their trade, and denying Czech women their constitutional right to give birth at home. At present three pregnant women have come forward to file a complaint in Strasbourg; the lawyer representing Mrs Königsmarková says more will follow. She is convinced her client was wrongly convicted.
"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."
Last year a Hungarian woman won the right to give birth home after a landmark verdict; Czech women who want to give birth at home believe their turn is next. The Czech Republic, they say, is stuck in a post-communist paternalistic mindset, refusing to allow a practice which in western Europe is both safe and widespread.
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