Birth Week is an annual event in Hungary during which providers of baby- and pregnancy-related services put on all sorts of free workshops and events all over the country. If you speak Hungarian, you can check out the myriad of offerings on their website (www.szuleteshete.hu)

I am delighted to offer the following FREE English-language events in honor of Birth Week:

Tuesday, May 19th, 8 am – 10 am

Expecting in Hungary

Lecture and discussion

Content: Prenatal care in Hungary, how to find and choose the right hospital/doctor/midwife for you, who is the védőnő and what is her function, what kinds of maternity benefits (if any) are you eligible for, how to register a baby’s birth in Hungary if one or both parents are foreign nationals, what’s your due date and why is determining it correctly important, thinking ahead to your birth experience, and how much you can expect to pay for a birth in Hungary

Handouts: Prenatal Care in Hungary article, list of hospitals and clinics with maternity wards, birth plan worksheet, list of registrars, registration and maternity benefits information sheet

Wednesday, May 20th, 10 am

Mommy-baby group

This is an informal support group for women to talk about their questions and experiences with pregnancy, particularly being pregnant and giving birth in Hungary, as well as questions about life with a small baby, breastfeeding, sleeping, etc. Older siblings are welcome too! 

Wednesday, May 20th, 12:30 pm

Movie showing + brown bag lunch

We’ll be showing (based on popular demand) one of the following films: 

• The Business of Being Born
• Orgasmic Birth
• The Strength Within

Bring your own lunch, sit back, and watch some of the most eye-opening films about birth! Discussion to follow.

Thursday, May 21, 10 am

Newborn care

Lecture and discussion

Content: what is a just-born newborn like, what does the Apgar score mean, when to cut the umbilical cord, cord blood banking, what do newborn babies expect from the world, why is skin-to-skin contact important, why is early and frequent breastfeeding important, baby’s secretions: what’s normal and what’s not, feeding and expected weight gain, burping, sleeping, dressing, bathing, umbilical cord care, crying and comforting, types of babies, learning, playing, baby wearing, how to survive the first six weeks

Handouts: English-Hungarian shopping list of baby supplies, breastfeeding cheat sheet, registration and maternity benefits information sheet

Friday, May 22, 10 am

Breastfeeding

Lecture and discussion

Content: why is breastfeeding good for the baby, why is breastfeeding good for the mother, how to get off to a good start and avoid problems down the line, how does milk production work, how to ensure you have enough milk, how can you tell whether baby is getting enough milk, feeding on cue versus feeding on schedule, sore nipples and other breastfeeding complication, lots of pictures and videos about how to get the baby on the breast correctly (to avoid damage to the nipples and ensure proper milk flow), when to express milk, how to express milk, how to safely store milk, using artificial nipples (bottles and pacifiers), herbs and foods to increase supply, breastfeeding and illness, breastfeeding and medications

Handouts: breastfeeding cheat sheet

Saturday, May 23, 10 am

Labor and childbirth

Lecture and discussion

Content: mother and baby at term, how does labor start, when to go into the hospital or call the midwife, inducing labor, what are the stages of labor, what to expect during them, what does it feel like at each stage, what can the helper do at each stage, the importance of positioning for mother and baby, natural and medicated pain management, how to avoid an episiotomy, what to expect at a Hungarian hospital, what to expect during a C-section, what to expect during a premature delivery, recovery from birth

Handouts: what to pack for the hospital, English-Hungarian shopping list of baby supplies, birth plan worksheet, What Is Labor Like article, What About the Pain in Childbirth article, C-section article

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Location: Élet-kör

II. Szilágyi Erzsébet fasor 43/b, 3rd floor #3, Élet-kör buzzer. By public transportation: Városmajor utca stop on the 61 or 59 tram.

Warning!!! This is not a baby carriage/stroller/pram-friendly location. Prams generally do not fit into the elevator, but may be left on the ground floor if you feel comfortable with that.

Registration: Not necessary

If you’re interested, simply show up for these events! However, since I will only have a limited number of handouts with me, if you’re interested in attending any of these events and want to make sure that I have enough for you, let me know in advance that you’re planning to come! You can do this by sending me an email at rekamorvay@gmail.com

Please spread the word!

Part 1:

Part 2:

If you’re newly pregnant and unfamiliar with the Hungarian health care system, you might wonder what your options are in this country for prenatal care and giving birth. The system is confusing even for those of us who speak the language. I tried to summarize the available options below.

1.  You go into the Hungarian health care system, visit the local clinic (szakrendelő) and see whichever obstetrician happens to be on duty there. Your prenatal care would be coordinated by your health visitor (védőnő) , the obstetrician at the clinic, and your general practitioner. Between the three of them, they send you to all the appropriate lab tests and exams. Then when it’s time for you to give birth, you go into the hospital and you’ll be attended by whoever is on duty that day.

The money: All your care is covered by the Hungarian health insurance (TB). Doctors and nurses may still give you the feeling that they expect something for their services, though.

The reality: It’s totally luck of the draw what kind of experience you’ll have. It can range from being totally ignored to being perfectly well attended. If you choose this option, prepare yourself for long waiting times at the clinic, which will be old and run-down and possibly dirty. Hospitals are also old and run-down with not enough staff on duty, and also possibly dirty. Get to know your local hospital to see if their methods and facilities are acceptable to you. Many hospitals, especially those outside of Budapest, still have shared labor and delivery rooms, so you might find yourself giving birth in the same room with 2 other women, separated only by a curtain. In most hospitals, you will not have a private room for the 4 days you spend at the hospital, but rather share a room with 3-7 other moms. Teaching hospitals allow medical students to wander in and check your dilation. Over 70% of first-time mothers receive an episiotomy. Many hospitals do not allow you to move around during labor. Many hospitals still do not allow rooming-in. VISIT YOUR HOSPITAL!!!

The pros: Cheap. Also, if you would like an unmedicated, uninterrupted birth, having no designated doctor may actually work in your favor, since there will be no doctor feeling obligated to “do something” during your labor so as to earn their fee.

The cons: Impersonal and luck of the draw. The doctor on duty may have very different views on childbirth than you. Staff will most likely not speak English. And sometimes you still need to pay to get things done.

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2. You choose/designate a doctor who oversees and coordinates your prenatal care and sends you for all the lab tests he deems necessary. “Designating” a doctor is completely informal, a matter of a verbal agreement between the two of you. You go to wherever he holds his visiting hours, either at the hospital or at a private medical office (rendelő), and pay for each visit. Sometimes these fees are implied rather than stated outright, especially if your doctor holds his hours at a hospital. You will most likely NOT get an invoice for the money you pay. Doctors who do not hold their hours at the hospital will usually rent an apartment at some central location, and hold their office hours there, and the quality of these offices will vary wildly, as will waiting times and your impression of their service. When it’s time to give birth, you go to the hospital that your designated doctor works at, and he will come to oversee your birth. In addition to designating a doctor, you may also choose to designate a nurse who will stay with you and give you a bit more attention at the hospital during your birth. Typically, the doctor, even a designated doctor, only comes in once in a while to check on your progress, and then at the end for the pushing.

The money: You pay your doctor his stated or implied fee after every visit, and you also pay for the birth. Fees these days range from HUF 5000 to HUF 12 0000 for a visit. Almost always, there is also a fee for the birth itself, which is typically 10x the visit fee. So if you find a doctor whose visits cost 5000 HUF, his expected fee for the birth would be 50 000 HUF.  If you designate a nurse, she will also expect some kind of money for attending your birth, usually around 20-30 000 forints.

The reality: Doctors are constrained by the hospitals they work at. (See point 1 for a description of Hungarian hospitals.) It is really important to visit the hospital your designated doctor works at, and inform yourself of what’s possible at that hospital. When you designate a doctor, you are essentially paying so that one person instead of three coordinates your care, and hopefully in order to have someone attend you whose views on birth are similar to yours, not a random person on duty that day. Some doctors (though certainly not all) will give you a cell phone number that you can call with your questions. You’re also paying for him to come into the hospital for your birth, day or night. This can work against you if you happen to have a lengthy labor in the middle of the night after a full day of work for your doctor. Very few doctors are able to resist the temptation under these circumstances to try to speed up your labor by some means. This is an especial danger with doctors who are very popular, or who work at multiple hospitals/clinics.

The pros: You stand a better chance of finding a doctor that you can communicate with, and whose views on birth coincide with your own.

The cons: More costly, and often you won’t find out what your doctors views on birth really are until after the birth.

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3. You go to a private clinic like Rózsakert or First Med Centers, and pay a package fee for their prenatal care.  Most often, you will have a list of doctors to choose from who work at this clinic. This is usually more inclusive than the standard Hungarian health care system protocol, so there are more tests included, and often with the added convenience of doing the labwork on site, so you only have to go to one place for all your prenatal visits and tests. It is also very expensive, and as far as I know does not actually cover your hospital fees. You then still have the choice of going into a public Hungarian hospital (see point 1) where your chosen doctor works, or going to Telki (the one and only private hospital in Hungary) and paying their birth fee over and above the prenatal care package at the clinic.

The money: I just looked up Rózsakert, and right now their prenatal care package is 200 000 forints. Telki’s birth package is approximately 600 000 forints. If you do not have Hungarian health insurance (TB), then a vaginal birth at a public hospital costs around 80 000 forints, a C-section around 160 000 forints. The good news is your private health insurance may cover these fees.

The reality: The clinics claim that they operate at Western European or American standards, but feedback from moms has not been that glowing. Without a doubt, these clinics look nicer than your average Hungarian szakrendelő, but they may not be any more efficient. Also, not all the staff may speak English. For a fact, most of the nurse-midwives at Telki do not speak English, which can be a real problem during and after birth.

The pros: You get all your care in one place where most of the staff speak English. More tests and procedures are included than in standard Hungarian health care. Telki hospital truly feels more like a hotel than a hospital, cannot even be mentioned on the same page with a Hungarian public hospital for level of service.

The cons: Very expensive, especially if your insurance does not cover it. Also, they operate on an extremely medicalized model, and if you want to avoid unnecessary tests and procedures, may have these pushed on you. Having an unmedicated, natural childbirth at Telki is virtually impossible.

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4. You go to a home birth midwife. She will discuss and recommend which tests are necessary for you, and you go back into the health care system to get these done, either at a private clinic or through the public system. Then she will attend your birth at home or wherever you choose.

The money: Home birth midwives range between 50 000 and 140 000 forints for providing all your care, including birth.

The reality:  You have to understand that home birth in Hungary is unregulated, and home birth midwives may be prosecuted for providing care, so they all pretty much work underground, whether they are credentialed midwives from other countries, or licensed obstetricians/nurses. There are very few of them in Hungary. Their fees and their style of care vary depending on their background.  Some will offer you individual prenatal visits up to 90 minutes in length each time, others have one communal week-long course for all their clients. You still need to get all your lab tests done through the health care system, possibly at additional cost (depending on what provider you choose). Getting your child registered after a home birth will take extra steps. The responsibility to find a pediatrician who is willing to examine a just-born newborn outside of a hospital falls on you. The responsibility for getting yourself to a hospital and procuring your anti-D shot if you are Rh- and your baby is Rh+ falls on you. If it becomes necessary to go into a hospital, staff may be hostile to you.

The pros: Practically the only way you can be assured of a natural birth in Hungary. Birth in the comfort and safety of your own home, with the minimum of interventions. Individual, non-invasive care.

The cons: Extra administrative hassle. The risk that if there is the kind of life-threatening emergency where every second counts, you may not make it into a hospital in time.

Home birth in Hungary is not illegal – it’s alegal. It is not regulated by Hungarian law, which leaves a really inconvenient gap for those who want to give birth at home.

Hungarian law says that a woman has the right to choose where to give birth, but the law makes no provisions for anybody who wants to assist a birthing woman outside a hospital setting. This means that medical personnel (doctors, nurses) who do it may get prosecuted for misusing their license and could lose their license, and non-medical personnel (independent midwives) may get prosecuted for practicing medicine without a license. So the danger of prosecution is really on the helpers, not on the birthing woman herself.

Peaceful birth at home

With that said, if you choose to give birth at home, you must prepare for the fact that the medical and bureaucratic establishment may be none too friendly to you. They are simply not set up to deal with this “irregular” occurrence, it complicates their jobs, and so they tend to be grumpy or even hostile about it. Getting your child registered and squaring away the paperwork will have additional steps. If you need medical care for any complications that arise during a home birth, you might get some unfriendly looks at the hospital and a good talking to.

Even so, there are women who choose to give birth outside a hospital setting. Sadly, there really are no birthing centers as such that are actually recognized by the Hungarian system. So it’s either hospital or home.

Home birth midwives also exist, but for obvious reasons do not advertise themselves. Some are doctors who would (and do) lose their license.  Some are obstetrics nurses from hospitals. And some are independent midwives who were trained and licensed in assisting home births – just not in Hungary.

If you’re interested in giving birth at home in Hungary, you have to start asking questions relatively early on in your pregnancy to find a home birth midwife who will assist you because most of them will want to follow your pregnancy to make sure that you are a good candidate for a home birth with no complications. It also means that home birth midwives in Hungary tend to be more conservative in their practice than midwives in countries where they can expect cooperative medical backup, so they will for example rarely or never take on breech or twin deliveries.

For a healthy woman with an uncomplicated pregnancy who finds a home birth midwife relatively early on in her pregnancy (ideally by 20 weeks), giving birth at home in Hungary is possible.

The following is an excerpt from Ina May Gaskin’s excellent book entitled Spiritual Midwifery. Ina May Gaskin is one of the leading midwives in the world today. Her birthing center boasts intervention and complication statistics that make hospital maternity wards green with envy. I would wholeheartedly recommend any of her books, most especially Ina May’s Guide to Childbirth, for anybody who is interested in natural childbirth and why and how it works.

I believe that much of the reason why the women whose births we attended were able to get through labor without anesthesia or tranquilizers had to do with the atmosphere we learned to create at a birth. There is a sound physiological explanation for why some women experience more pain in labor than others. A woman who is the center of positive attention, feeling grateful, amused, loved and appreciated, has a higher level of the class of neurohormones called endorphins. Endorphins actually block the perception of pain.

On the other hand, there are also adrenalin-like substances which may be secreted by the body during labor, especially when the woman is afraid, cold, angry, humiliated or experiencing any other disagreeable emotion. Adrenalin is part of the body’s protective mechanism when it is presented with danger; the heart rate quickens, the muscles tense, labor contractions may be inhibited, and the perception of pain is intensified. The mother is made ready to fight or flee when adrenalin levels are high, not to have her baby.

Much of the midwife’s (or husband’s or doula’s or labor coach’s — Réka’s note) responsibility during early labor is to give the mother so much positive, loving attention (and to encourage the baby’s father, if present to do likewise) that the mother’s endorphin levels are as high as possible. I learned humor could be a great help, in that it seemed impossible for a woman to be amused and afraid at the same time. The challenge then became (and still is) how to amuse a woman in labor. Naturally, this is a much easier task if you and she know each other well. It’s not easy to know what will be amusing to a stranger during the intensity of labor. Some women simply won’t think anything is funny, in which case, the main rule is to be soothing, sympathetic and encouraging.

The key to having a good labor experience is state of mind. Learning to relax and focus inward, to allow your body to submit to the sensations, and trusting that the process is a good one – that is key. I’m constantly trying to think of ways to prepare pregnant women – especially first-time moms – for the experience of labor. They are all very curious about what labor will be like, and many of them are apprehensive about the pain, and want to know about their pain relief options. From my very own labor experiences, I know that being preoccupied with controlling the situation, and being preoccupied with how many centimeters open one is (because epidurals are only given between 4 and 8 cm at most hospitals), greatly detracts from one’s ability to accept the pain and enter into that almost trance-like state of mind that allows labor to proceed most optimally.

At some point during labor, you have to make a conscious decision to allow labor to proceed, or to ask for anesthesia. This point usually comes around 4-6 cm for most women, when labor goes from the latency (early) stage to the active stage, and then contractions become more powerful and more regular.

If you make the choice at this point to proceed, it helps if the environment and the people in it can help you stay relaxed, feeling safe and loved. It also doesn’t hurt if they can make you laugh – though at this point, that may be a bit too much to ask.

These days, natural childbirth seems to be becoming more popular again, which gives it a kind of crunchy trendiness like doing yoga or being vegetarian. (Both worthy and healthy endeavors – just like aiming for natural childbirth – under the right circumstances.)

Fact of the matter is that there have been trends in childbirth, and in western societies, this trend has been leading towards more medicalized births actively managed by doctors, to the point where now fully one third of births in the United States are surgical births (C-sections), and it’s hard to spot any birth in a hospital that hasn’t been meddled with in some way.

So what’s wrong with that, you rightly wonder. What’s wrong with “meddling” if it means that the birth is safer, faster, or the mother feels less pain?

The problem is, it means none of those things. It just means that medical interventions are introduced as a matter of routine (as opposed to necessity) into a well-oiled process, and in the majority of cases, these interventions increase the number of complications, not decrease them, and even introduce new ones. Interventions interfere in the natural process, which then necessitates more interventions. It’s like the first intervention just starts the slide down a slippery slope, at the end of which is a C-section. 

What’s wrong with a C-section, you ask.

It’s major surgery, with all the associated risks. At base, it’s a lot more risky to both mom and baby than a vaginal birth. For mom, there are all the post-surgery complications, potential infections, and so on. It also means that the number of children a woman can have is instantly numbered, and the frequency at which she can have them, already determined for her. Because after a C-section, it is recommended that a woman wait at least 3 years before giving birth again, and the second birth after a C-section is likely to also be a C-section, and I believe few doctors will be willing to administer more than 4 C-sections on anyone.

The baby is also at risk for infections , and for respiratory difficulties after a surgical delivery. C-sections tend to make breastfeeding more difficult (though primarily only because moms tend to receive babies later, and thus attempt to nurse them later). And not lastly, it deprives both mother and child of going through a rite of passage, psychologically and spiritually. All fine and well, if the child’s life is in danger, because obviously, a living baby is far more important than being able to go through a rite of passage. But C-sections are used far more “liberally” than just in life-threatening situations, and most often, they are the last intervention in a line of interventions in what otherwise could have been a natural birth.

Physicians these days routinely use interventions for three primary purposes: to trigger labor,  to speed up labor,  and to reduce pain. 

Each of these interventions carries a risk (=increased probability of C-section), and each of them can produce situations that necessitate further interventions.

Take, for example, the topic of episiotomies. Episotomy is the cut performed on the woman’s perineum (the tissue between the vagina and the anus) to allow the baby’s head to emergy more quickly during pushing. If you know your anatomy, you also know that a baby whose head is already pushing on the mother’s soft tissues on the perineum has cleared the bony pelvic passage, and is thus minutes away from being born.

According to the WHO (World Health Organization), there is not need to routinely administer this cut, which severs skin, nerves and muscles in this sensitive area, and is the equivalent of a third-degree tear. The prevalence of third-degree tears in home births or birth centers with minimalized medical intervention is 0.3%. That’s 3 women in 1000. By contrast, in Hungary, 70% of first-time mothers receive this cut. The rationale: to prevent fourth-degree tears (despite the fact that scientific studies have shown that routine administration of an episiotomy actually increases, rather than decreases, the incidence of fourth-degree tears.)

So why does a woman receive an episiotomy? Because by the time she is pushing, the baby’s heartbeat is uneven, or too low, and because she is lying on her back, with the diameter of her pelvis at its narrowest. She is trying to push against gravity, and push with her pelvis locked in a narrow configuration due to her prostrate position, and her tissues appear on the verge of tearing, especially as the doctor bears down on the laboring woman’s belly with each contraction to help the uterus push the baby out. The doctor decides to speed things up, and makes the cut, both to make sure the baby is all right and to prevent the fourth-degree tear that the aggressive external pushing can cause. Had she been laboring in an upright position at her own speed, her tissues would have had an opportunity to adjust to the pressure of the baby’s head, she would have felt when her tissues stretched too far, and paused to give them a chance to adjust, and would probably have gotten away with no tears, or a first-degree tear (the equivalent of a bruise). And had she not been lying on her back and receiving both pain medication and artificial oxytocin, the baby would probably have been under much less strain, removing the pressure for a speedy exit.

So how did she end up pushing in this position? She ended up in this position because she was receiving an epidural and artificial oxytocin, the former to decrease her pain, the latter to keep her contractions strong (because the epidural tends to slow down labor). Because she had IVs in her arms, hospital protocol required her to be on her back, even though moving around during labor and an upright position during pushing are associated with best outcomes. Also, doctors prefer women to be on their backs and presenting their vaginas at eye level so the entire crotch area is clearly visible and accessible for the doctor.

Why was she receiving an epidural and artificial oxytocin? Because her physician decided to induce labor after she passed her due date, even though the average length of pregnancy is 38-42 weeks, even though the baby’s heart rate, as indicated by an NST, was fine, and flowmetrics as seen on an ultrasound of the placenta and the umbilical cord, indicated that the placenta was still functioning perfectly. He decided to induce because maybe the weekend was coming up, or maybe because he truly believed (despite all evidence to the contrary) that babies should leave the uterus when the doctor decides. So the doctor attempted to induce labor by mechanically dilating her cervix and breaking her water, neither of which succeeded in triggering her labor within the allotted time, thus she ended up receiving oxytocin in an IV, which produces far more painful contractions than ones driven by a woman’s own natural oxytocin, so to help her endure the pain of these artificial contractions, and of having to labor on her back (the most uncomfortable position for enduring labor pains), she was given an epidural. 

So the woman ended up with several interventions during her labor that could have most likely been avoided had she been allowed to go into labor on her own, been allowed to labor at her own speed, and been allowed to choose her own position for pushing. 

Now, she may be glad that she escaped the specter of having a C-section, has a surgical cut between her vagina and her anus that will take a week or so to heal (though it can leave a scar that lasts a lifetime), is convinced the doctor saved her baby’s life, and simultaneously convinced that she could not have birthed a child without medical intervention.

When in truth, the first intervention, the act of attempting to trigger her labor when her body was clearly not yet ready for it, resulted in a cascade of interventions ending with the baby’s faltering heartbeat and her episiotomy. And had she been actually encouraged to trust her body’s signals and follow her instincts during birth, she would have had an empowering experience that carried far fewer risks for either her or her baby.

More information:

What accounts for the rising rates of C-sections in the States?