Grabbed By The Pussy: biopolitics and power dynamics in Hungarian birthing care

a paper by Réka Kinga Papp on biopolitics and power dynamics in contemporary Hungarian birthing care

The leader is slayn but the war is won: after 60 years of illegality, decades of vexation and persecution, home birthing is now legal in Hungary, in a large part due to Ágnes Geréb's advocacy and activism. Geréb herself is yet disbarred and still under trial for many cases. The medical regime of birthing care hasn't evolved much in a women-friendly fashion. The stone wall Geréb had been hitting for exactly 40 years now is built from the rocks of a regime of patient bribes, a strict biopolitical demand for the mechanization of births, and the historical process of midwives's subordination to doctors. The original sin of the child bed fever epidemic, the tragedy of Ignác Semmelweis, and the unaccounted deaths of the mothers he didn't manage to save, are the mortar sticking it together.

Silent resistence
Hungarian home birth protagonist Ágnes Geréb had just had one of her sentences somewhat lifted this month, yet she remains disbarred from practicing her profession as a midwife or a gynaecologist, forbidden to be present around pregnant persons, and is still under persecution in a myriad of cases.
Geréb was arrested in 2011 and kept in primary custody after the police were called to a postnatal complication at a birth which was unplanned and Geréb happened to be present. At the time home births were illegal in Hungary. She has been on trial for perinatal complications which hospital obstetricians do not get persecuted for. Internationalexperts of high merint state that Geréb seems to have not made professional mistakes. Often times her persecution is recognized as a witch hunt against home birth ativism.
Her cases are obviously problematic, have a strong political touch and are surrounded by vivid debates whether she is a saviour or a scharlatan, an activist or a criminal, a professional or a hippy on a loose leash. Authoritative figures of obstetrics and midwifery have taken her side and campaigned for her release, reminding of Geréb's professional qualities which even her opponent acknowledge. Yet these international experts were not admitted to testify in her trials. In court only Hungarian medical expert witnesses and institutional doctors were heard, people who themselves have never seen home births. Geréb has very few allies among her fellow Hungarian medical professionals anyways. She is the only doctor who openly opposes and takes a risk standing up to the highly hierarchized regime of birthing care; clearly a black sheep of obstetrics in her country.
And it has ever been so.

'So I went along'
Ágnes Geréb was a university student in traning as a general doctor when one day she was, as she puts it, wandering around in the hospital looking for a task. That was when she stumbled upon a woman in labour with her already dead baby, left totally alone in a room. She stayed there with the mother through her birth which she later described as a transformative moment: there she decided to become an obstetrician. In the birthing machinery tipical of the 1970s, this was an odd and sad yet unique opportunity for her to ever see an undisturbed birth, basically because a dead baby being born was less of an interest for the already overwhelmed doctors at the clinic.
Geréb graduated in 1977 and started to work at the Szeged Women's Clinic right away as a medic. She kept her attitude of going along with patients' wishes, silently disobeying some hierarchical rules of the medical discipline which she saw pointless. Already form the start she would let fathers be with their wives through the births, a specially big no-no at the time. She was temporarily disbarred from the clinic for this activity in 1978 and other times later on. Seven years after she started it, in 1984 hospitals started to admit to letting fathers be present at the births. Geréb was not pardonned, neither compensated for the disbarrments. By the hospitals were busy with what to do about those newly occurring fathers, she was already advocating for a holistic model of seeing through births instead of delivering them, and also, into home birthing.
One of her patients had just returned to the country after having lived in the US where she gave birth at home. This acquaintance suggested Geréb to entertain the possibility of extrainstitutional births, and even helped organize a study trip to a birthing centre in Livermore run by independent midwife Bea Haber. By the time of this study trip of six months Geréb had already had clients form the clinic whose births she started seeing though in their homes. After returning home, in 1992 she organized an international conference in Szeged and set up the Alternatal Foundation. She organized several publictalks and translated and published literature on methods alternative to the contemporary medical regime. She got to know international superstars of the free birth discourse souch as Sheila Kitzinger, Ina May Gaskin and Michel Odent. She promoted the advancement of midwives in the duties around birthing, a profession that at the time was – and mostly still is – fully subordinated to doctors in Hungarian hospitals. But neither were doctors, nor were midwives fascinated by Geréb's new paradigm. After giving birth to her fourth child in 1994, she discontinued her clinical carrer. 'I fel unwelcome. I just didn't go back.' – she sayes.
       By that time her clientele started to grow and without much of a setup she started to work as an irregular freelancer, providing a service for home birthing which was not clearly ciriminalized yet not legal. Medical assistance to extra-intitutional births were not allowed, but birthing out of a hospital itself wasn't banned. Geréb appealed multiple times for professional licence to legalize her work but never got the permit.
By the second half of the 90s her movement grew with the number of her clients and colleagues, and she became known in Hungary as the strange, out-of-the-box figure doctors hate, many people are suspicious about, yet her followers praise highly. Home births would be talked about on national television, often times labeling it as a fancy of well-off women who do not recognize the importance of hospital regimes and put their babies at risk. Suspicions were vioced about this being a well paying business. From the second half of the 90s whenever Geréb or her crew would call an ambulance to any birthing complication, most often a police car would also automatically arrive. The crach striked in when in 2000 a baby who was born without any complications suffered brain damage due to lack of oxygen and died a year later. Geréb beame persecuted and by the 2007 sentenced disbarred for three years from her profession as an obstetrician. Due to this process she had already started her college education as a midwife, partly because she was promoting a midwifery model anyway, but in large part because she imposed a loophole in the professional regulations. If she cannot practice as a doctor, she still could be active as a midwife, she suggested. Courts never acknowledged this logic and never took in consideration that midwifery would be a different profession with different protocols from those of medical doctors.
         In 2003 and 2007 more babies died, the former of them a twin who suffered from lack of oxigen, the latter child of shoulder dystocia. This latter complication is a topic of fright in hospitals as well: in the process of the delivery, tha baby's head is already born, but their anterior shoulder gets stuck in the mother's pubic bone. C-sections are no longer option at this stage. Geréb tried a knack known as the Gaskin-manoueuvre but could not save the baby. The parents pressed charges and the case resulted in a national scandal, Geréb depicted as a child murderer with manier medical doctors condemning her publicly.
Strangley, even these scandals drew light on the horrors accumulated in institutional birthing care and a discourse was started on changes needed. The Obstetrician College of the Chamber of Doctors clearly rejected the issue of home birthing in 2002. But the tide had turned by 2007 as they admitted to a possible legislation that would legalize it, when liberal Minister of Health Ágnes Horváth initiated a series of negotioations. Reconciliation was never met: the doctors blamed Geréb and her crew for being insistent on their demands, protagonists refused the overregulation of their work and both parties rejected the minister's ideas on ambulance protocols. Not much later, the government was impeached and the issue sank in the political chaos.
On October 5th 2010, Ágnes Geréb was visited by a pregnant woman whom she formerly turned down and had advised to give birth in hospital due to unfavourable haemogramm figures. The gravida came back with a new haemogramm to prove she was eligible for home birth, and her labour started during her visit. It was a storming birth, that means it happened very quickly and powerfully and as a result, the baby had trouble breathing. The midwives called and ambulance and the police came right along, arresting Geréb without obvious legal grounds.
She was kept in primary custody for almost three months among scandalous circumstances: official visitors would not be let meet her, she was driven to public court in handcuffs and leg shacles that caused open wounds on her legs, subjected to strip searches and let only once a month be visited by her family. Protesters gathered and international professionals sided her asking the Hungarian authorities to let her go free.
Two months later, in December 2010 an unforseen aid helped turn the tide: Anna Ternovszky, an individual citizen who at that time was pregnant and a Geréb client, appealed to the Strasbourg Court of Human Rights who condemned Hungary for violating women 's right to choose where they would give birth. Shortly after Geréb was moved form prison to house arrest and a legistalion frenzy started. Within only four month, fresly appointed Secretary of Health Miklós Szócska pushed through a law which came in effect on the 1st of April 2011, legalizing home births after 61 years of illegality.
Since 2011 independent midwives are getting their licences and working in Hungary now in a growing number and report a tendency of rising tolerance toward their work from institutions. One might think, Ágnes Geréb at last won the war. The truth is, as usual, more nuanced than that. Home birth activists are dissatisfied with the law since they think it overregulates the work environment, yet medicare doesn't finance their work. Institutional birthing hasn't evolved much lately, some progressive spots were refashioned and restricktened since. Geréb is no longer in house arrest, yet she cannot leave the country and is forbidden to practice her profession. She appealed for presidential pardon but was refused with the argument: despite the importance of her work and achievemnts for advancing the cause of free birth and women's rights, disobeying the law still needs to be punished. She even thinks she will never be let work according to the new law. She lost her work, which provided her integrity and her living just as well. Eventually, she takes tasks as a typist.

The Semmelweis lesson
Despite Geréb meeting international standards and having professional and moral support, she is clearly on the loser side. To see why Hungarian obstetrics refuse this strictly to admit to her points, one should look to the history of this profession in Hungary, and in a wider context, in the Austro-Hungarian Empire.
      The founding moment of modern obstetrics has a lot to do with a Hungarian phisician Viennese readers might be familiar with. Ignác Semmelweis earned his doctoral degree and his specification diplomas as an obstetrician and a surgent in Vienna in 1844 and 1845. He then started to work as an assistant to Professor Klein at the Obstetrical Clinic of the Allgemeines Krankenhaus.
      This time period is the late phase of the anatomical revolution, an important movement of the Enlightment since the 16th century. Having gained legal access to human bodies and their insides, medics started to map up organs and mechanisms within the human corpse. It took approximately another century for doctors to gain access to the business of birthing. The discovery of the uterus itself involved experiments on enslaved women, used as research dummies without any anesthesia. By the anatomical mapping of the uterus medical doctors demanded and gained access to births, a highly personal, intimate, yet phisiologically completely normal process, a feminine sanctity which they then quickly conquered.
      Huge inventions and undue interventions paved their way. The history of modern obstetrics is a history of benevolent advancement as well as a history of abuse of power and disrespect for women. The progress of medicine brought essential life saving methods, but many of these were developed at the price of patients being hospitalized, cathalogued and drawn into the biopolitical machinery of production of manpower. Enlightened absolutist strated to value human resources more and more as extensive means of gaining power seemed to have been exhausted.
At this stage when Semmelweis started to practice in Vienna, the anatomical revolution was in
its prime, ripe and all over the place. Autopsy reports were published in newspapers. That is exactly
how Semmeweis discovered the correlation between cadaverous poisoning and puerperal fever, also
known as childbed fever. Semmelweis was mourning the death of Jakob Kolletschka, a friend and
colleague of his in a quite morbid, yet at the timevery average fashion: by reading his autopsy
report. That is how Semmelweis recognized that Kolletschka's simptoms form a poisoning he
suffered during an autopsy, were identical to those birthing mothers had in institutionalized
circumstances.
Two maternitiy clinics were operating parallel in Vienna, one run by midwives and one by medical doctors. The training of these professionals were ruled and regulated by Marie Theresa – happy birthday, your Majesty, by the way – in her order Generale Normativum in re Santiatis in 1770 and institutions set up according to Ratio Educationis in 1777. Midwifery was gradually regulated as a profession to be excercised by only those who had a diploma. This demand for a professional training was enforced gradually, as most midwives in rural areas, the so-called peasant midwives most often could not go to school, in part due to their duties in their communities, partly because many of them were illiterate, and some of them because they did not speak German. Hungarian and Slovakian language trainings were introduced some years later and thus the middleclassisation of midwifery started in the Empire.
Seventy yeras later, by Semmelweis's time midwives and doctors had a theoretical schooling together at the medical universities, but their vocational training happened at two separate clinics. At this time institutional birth was still a novelty, and these maternity clinics were set up as gratis institutions for urban women who could not afford midwives. Most of them were very poor urban dwellers, many of them unmarried and/or prostitutes. As a return for the service, women would be subjects for training purposes.
      Semmelweis observed that the midwifery clinic had a mortality rate of 4%, whereas doctors produced a mortality rate around 10%, which was also kind of decent compared to other clinics thourghout Europe. In birthing institutions mortality rate could reach up to 30%. Studying the statistics and the practices Semmelweis concluded that doctors dealing with corpses are themselves causing childbed fever, since they perform autopsies and then examine mothers without cleaning their hands. He then intorduced a strict regime of handwash with chloride at the clinic and maternal mortality drastically decreased.
Let us keep in mind that this all happened three decades before the microbiological revolution started. People did not know about pathogens. Semmelweis himself concluded that toxins were transmitted from dead bodies.
After taking part in the 1848 Viennese revolution, he did not get his position extended at the AKH and returned to Pest to work as honorary professor at Saint Rokus Hospital, where he managed to decrease mortality to below one per cent. Yet he only published his findings a decade later in his book Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers in 1860. Often times he is talked about as the Cassandra of his time, a misunderstood protagonist, which is quite an overstatement. Semmelweis was applauded for his work and established himslef quite a reputation in England and at manier places thoughout Germany, and his regime of asepsis was established and maintained without any discontinuation in Pest. His peers and the upcoming generations of students understood and admitted to his theory. Yet it is true that he had very painful debates with professors of higher merit, especially in Vienna, where many former colleagues rejected him. His participation in the 1848 Vienna revolution did not help him politically, neither did he start with good chances in the ever so aristorcarizing medical community, being the son of a grocery store owner.

A threat to a new profession

But more importantly, Semmelweis's theory threatened obtetricians on multiple grounds.
First, it placed fatal responsibility in the newly established profession, which had for less than a century gained access to the formerly forbidden phenomena of birthing. Second, it reinstated the individual integrity of birthing women, not accidentally that of poor and morally compromised women, who were seen by doctors as intercontinuous masses for them to perform on. Semmelweis separated these corpuses from the dead corpses and also from each other, demanding an understanding for the individuality and the personal boundaries of a birthing body. And third, it schooled honorable gentlemen, pointing out that they should have paid more attention to midwifery, a feminine profession they were just about to get about. Doctors were ever competing with midwives for the control over birthing. The whole concept modern medicine was based on a refusal of traditional knowledge. Labeling it as scharlatanism, superstition and out of touch with reason. Turns out, midwives were way more reasonable this time.
One might even say I´m accusing doctors of homicide ahistorically, without acknowledging that pathogens were not known back then, so doctors themselves could not have been precautios about something they didn´t know of. But eventually, they could have had been. As long as the profession of midwifery can be traced back and documented, it midwives had had special cleansing regimes. So much so, that peasant midwives were often sustained by their communities, like some kind of district professional, whose villages provided them with a living and house maids, specially because a midwife could not deal with soil or livestock, in order to keep their hands clean at all times.
These are painful lessons many highly ranked figures refused. Neither did they wish to deal with the discovery that showed they contributed to multiple deaths, simply because they maintained an understanding of the patients and corpses as an intercontinous mass – a process of alienation which helped them gain access to these bodies.
Semmelweis himself was developing serious mental problems, partly due to an infection that
damaged his brain, and party due to his ever growing sense of guilt about the deaths of mothers he himself caused before his invetion, and the death of those who he couldn't save from his self absorbed colleagues. He died in a Mental Home in Döbling, where he went on a field trip thinking he is ispecting the hospital, but was kept custody against his will. When he tried to escape, it took six grooms to keep him back and he was beaten half dead, bones broken and lung punctured. He died two weeks later due to a sepsis resulting from his wounds. The decease he discovered was the one to kill him.
Even Viennese colleagues were shocked by the events, despite their antipathy for the victim. The report of Semmelweis's autopsy was secreted for over a century. Within two decades from Semmelweis' death, Lister started to experiment with antispetics and Louis Pasteur published his first works on pathogens. The microbiological revolution broke out and Semmelweis's words were not only proven, but even provided with a visualizable cause.

Nobody was ever accounted for his death. Neither were the deaths of thousands of women thorught Europe ever accounted for. This original sin is a crypt in the founding myth of modern obstetrics.
      The Semmelweis lesson was not leart thoroughly. Disinfection became the central mythology of medicine, the handwash regime being the entering ritual. In any hospital you see leaflets above sinks teaching how to thoroughly wash your hands, and this we demands our kids and peers to perform on any given occasion. For a reason, let me state, so for the record: I am not opposing disinfection by any means. Actually, I am a huge fan of handwash and cleansing in general. What I am saying is that crucial parts of the Semmelweis lesson were ignored.
Neither was midwifery rehabilitated as a profession and a tremendous corpus of accumulated knowledge, nor did the integrity of the birthing woman become any more important to obstetrics.In fact, medicine grew more and more of a disciplinig authority throughout the years, in part due to rapid urbanisation, due to lack of resources and manpower in institutions duing the world wars, and also, by the separation of oxytocin.

The grease in the machinery: a synthetic hormone
Oxytocin is a hormone responsible for many bodily functions, among them lactation,
contractions through labor and delivery, and also, the formulation of emotional attachment. It´s effects on contractions were first discovered in 1906, and it was used to strenghen contractions as early as 1927. Silvester Hofbauer, the first doctor to ever use oxytocin prophilaxys already drew attention to the risks is holds. But excessive use was yet to come. This was the first polypeptid hormone ever to be synthetized, Vincent Du Vigneaud won a Nobel prize for it in 1955. Since this synthetized substance became available in infinite amounts, it became a key factor in the further industrialization of birthing care. It even has a nickname: Hungarian doctors call it 'gyorsító', that is, the speeder. It strenghens contractions and urges the process of birthing, which can be of vital importance in some cases, but in others it strenghens labour pain and causes complications which draw a whole long set of further interventions, which wouldn't have been needed in the first place,had it not been for unnecessarry use of the substance. One might check out the works of anthropologist and midwife Sheila Kitzinger who in way more detail and knowledge elaborated on this crucial issue.

Forced modernization
In the meantime, since we abandoned poor old Semmelwies, quite some things have happened in Hungary. Cities grew all around Europe and the world at an astonoshing speed. Budapest for instance grew from less than 400 thousand dwellers to over a million in only thirty years. The education of midwives differentiated: college training was available for not only independent midwives but also institutional professionals, who gradually became more and more subordinated to doctors. Yet the profession that has provided women with agency and independent means of living for thousands of years, still did exist, especially in rural regions.
This ended in 1950.
We all know how Stalinists loved to force modernization. Marx envisioned industrial capitalism bearing its successors in its womb. Bolsheviks did misread Marx in many ways, this time they saw this prophecy as a kind of a recipe. The Soviet experiment attempted to catch up to the industrialized West as quickly as they just could, hoping to overcome them later on.
In their modernization frenzy the Stalinist regime in post-war Hungary precisely in 1950 forbade birthing outside of institutions. For more or less another decade village midwives would still see through births eventually, calling an ambulance afterwards, relying on the lack of infrastructure. By the end of the 50s, these instances were extinct.
But not only did the Stalinist leadership forbid reproduction out the control and discipline agencies of state health institutions, but they also abolished the college education for midwives. In 1968 vocational schools were launched train future health care workers, and the higher education of independent midwifery was discontinued. Vocational schools trained nurses, and whoever wanted to specialize in birthing care would have to complete a further one year of traning and to obstetrix, that is, obstetrical nurses, clearly and fully subordinated to obstetricians, that is, docors. The formerly independent and for a long time partner profession of midwife was finally conquered and directed under the control of medical doctors. Which in this case most often means men. Ever since 1980 over 50% of new doctoral degrees are earned by women in Hungary. Right now over half of practicing doctors are women, still obstetricians and gynaecologists are male in 88% of the case.
College education of midwifery was reinstated in the early 1990s due to professional pressure and advocacy, but the independence of midwives not restored, still subordinating them and still forbidding performing any medical assistance outside of hospitals.
The industrialization of birthing care, excessive use of oxytocin and undue interventions, and lately an ever growing number of C-sections happened quite smoothly, in large part because midwifery as a profession was put out of the way. The accumulated knowledge of mild methods to ease the pains and struggle of labour and delivery have been pushed aside, women hospitalized, told to stay silent, laid straight on their backs, cut in the vag and their babies trolleyed away right after being pushed out, often times with the force of a noble doctoral elbow.
The situation today is not much brighter. Despite WHO suggesting a 5-15% of caesareans as an acceptable ratio, institutional births in Hungary end up in C-sections in over 35 times out of a hundred cases and it’s been continuously on the rise for over a decade now. This places us at the top of the list among OECD countries, closely following Italy and the the notorius regime in Turkey, where over a half of all births result in operation.
As for episiotomy (Dammschnitt), the case is even worse. WHO suggests the rate should stay under a tenth of all instances, yet the latest national public results are 61,96%, and it even increases for first births, as most hospital protocols prescribe this actually avoidably intervention as compulsory for first-time-mothers-to-be.
But on top of this comes all the humiliation and hospitalization the machinery demands. A vast corpus of horror stories have accumulated among women, especially since blogs and internet media outlets started to provide space for birthing stories written by mothers themselves. Women often feel belittled, denied their decisions, treated as incompetent, underinformed, and treated with disrespect, experiencing vaginal examinations as forms of violence not only due to possible phisical pain but because they feel their integrity violated. Patients often times describe these instances as similar to rape, causing long lasting tauma, as Sheila Kitzinger and others have drawn attention to it.
The midwifery model, on the contrary, views the birthing woman as a subject and places emphasis on her integrity, bothers a great deal about psychological matters and states that interventions should only be used when there is a definite need for them. It does not deny the eventual necessity for a C-section or occasional oxytocin use when there is a strong indication, but states that most births are normal physiological occurences that need not be disturbed but supported.

Envelopes
Here I must mention another important phenomena that Ágnes Geréb was confronting, and thus threatening the obstetrician community. It is, at last, about money.
Geréb had been a tremendous competitor to fellow obststricians on the market of gratitude money in envelopes. That is the Hungarian habit of tipping medical professionals in hope of better treatment. This phenomena we call 'hálapénz' ('gratitude money' in a mirror translation), or more often 'paraszolvencia'. This latinizing formula you won’t find in the dictionaries, since in this form this word is a uniquely Hungarian development, culturally situated somewhere between a 'tip' or 'gratutity' and 'bribe'. This phenomena though is known in other countries as well, the Greek for instance call it 'fakelaki', little envelope. I will call them 'tips' now, for the sake of simplicity.
The regime of regularized tips play a major role in the inflexibility of birthing care. Obstetrics are a field to thrive on these tips, since the gradual develompent of clientele, the regularity and the rituals of pricing otherwise state financed medical services (monthly check-ups or CTGs for instance) allow obstetrics to cash and even plan with these income, which in other medical fields occur way more accidentally.
      Patients tip doctors since they are aware of the basic service being of expectably low quality, as elaborated on above. That is why gravidas choose individual doctors, sometimes even midwives and arrange with them so they are supposed to be around at the birthing. This is an informal, yet decriminalized agreement in which the income is not accounted for. Tips are a means of buying the benevolence of a given medical professional, who in return is supposed to treat the patient with extraordinary care. Yet, since these agreements are completely informal, the patient gains no actual rights or entitlements through the transaction. These are verbal contacts not penalized but neither regulated by law, nobody can go to court or turn to any other authority if the tipped professional does not treat them accordingly, or may not even show up at the time of the birth. Many doctors may perform devotedly or simply decently, but what actually happens at the given time, is a matter of pure chance.
This phenomena is rooted in the formulation of health care in Hungary in the 1950s. When the governing Stalinist party, the Hungarian Workers Party force-collectivised agriculture in Hungary (which was quite similar to a simple confiscation), a decision was made to compensate agricultural workers by declaring universal health care for all citizens. Yet this service was not covered by the appropriate resources, staff or even hardware. Thus in 1952 the Central Bureau agreed to make it a 'tipping profession’, to compensate doctors for the excess duties. Even though state health care turned financially sufficient within twenty years, the surplus income was never spent on developing the health care infrastructure accordingly, but was spent on other projects of the socialist state instead. Paraszolvencia was here to stay and has been a virile national practice ever since.
It is worthy noting that despite the commonspread argument that gratitude money would be compensating doctors for their unfairly low income, these tips show a negative correlation with the financial need an actual medical professional might be in. To put it short: the higher the rank, the
more a doctor cashes. This well shows why tips are no efficient way to compensate the underfinancing, and has nothing to do with professional fairness. Had one wished to abolish lack of resources in health care, one would just as well campaign for transparent financing of state institutions, organize well lit fund raiser campaigns or even more likely demand a fairer and more sustainable taxing and insurance system. Tipping is rather about sustaining a highly hierarchized regime of power, on top of which are the highest ranked medical professionals. These decision makers are counter-interested in abolishing the habit of tipping since it benefits them excessively, despite it wrecking both patients and lower ranked medical workers. The state itself in counterinterested as well, since this system places tensions between the health care workers and the patients instead of the state and its concerned agencies, who are responsible for the conflicts in the first place.
Ágnes Geréb did not accept tips in her clinical years, and as an irregular freelancer she and her colleagues developed a pricing that was way below the averge tipping rates. Hospital docors would explicitly ask for sums from the most modest 200 € up to 500 € and more. Six years ago, when I gave birth the average Budapest tip would be around 320 €, while Geréb and her team asked for 160 €, but any patient could ask her for a lower price or state how much they actually can pay. That is a price already impossibly lower than those you pay at institutional births. Also remember that of hospital tips you get no receipt, nobody pays any taxes and you have no guarantee for any bit of the service. Also, it happens in a medical environment already financed by your state health care plan.
As we have seen so far, Geréb confronted the highly hierarchical regime of the obstretrical profession on many points. It is already threatening that somebody is trying to rehabilitate the midwifery model. This draws a demand for a service oriented helath care, a complete cultural turn to be made. This also involves implicitly accusing doctors of causing and having caused injuries and trauma, abusing their power, acting as an authority. And it evokes the myth of the original sin, the tragedy of the founding father of Hungarian obstetrics Ignác Semmelweis and the tragedy of those women killed by professional neglect. Deaths that were never accounted for. Hungarian narratives of obstetrics conceptualize their founding moment as the saving of those women, whereas their profession is rooted where they were killed.
This is a pile of conflict of interests great enough to position someone as a sort of a social bandit. And Ágnes Geréb is often times treated as one. She has been persecuted for complications around births institutional obstetricians do no get persectued for. She had been jailed for being present unplanned at somebody's birth. She has been on tiral for over a decade now and is forbidden to be present in the company of pregnant inividuals. International professionals of high merit are advocating for her, yet they do not get to testify in the trials. The sphere of speech is colsed up.

A stereotype enforced by the law
After Geréb was arrested in 2010, a legistaltion for extra-institutional births was been introduced very quickly. Her fights are over: free birth is now legal and possible. Institutional birthing care seems to evolve very slowly if at all. But they are not compulsory any more. One might say, the leader has been slayn but the war won. Geréb suspects she will never be let practice again. But she also draws attention to another important barrier: money, again.
Ever since Geréb gained some popularity, home birthing has been accused of being a whealthy fancy. As detailed before, Geréb's crew made sure people who did not have a lot of money would not be excluded form their services. One could state they have 15 € and Geréb's crew would accept to it, and they would find other ways of raising other funds. But the legislation that was introduced six years ago demands so much technicalities, accessories, insurances and alike, that pumps up the proces of home birthing. Not to mention, home birthing is not financed by medicare.
So home birthing now is legalized in a fashion, that at last, does make it a wealthy fancy, a priviledge of those who can already afford it. Thus the stereotype that never was true, now is enforced by the law.