Παρασκευή, 8 Μαρτίου 2013

"Are home births being targeted?" Written Question of Greek Green's MP at the EU Parliament


Are home births being targeted?
Written Question of N. Chrysogelos concerning the rights of a new mother to handle her own placenta


Nikos Chrysogelos,  Member of the European Parliament of the Greens/European Free Alliance, brings forth to the European Commission in a written question the issue of the management of the placenta by home births, which recently prompted an unprecedented profiling of persons and health care professionals in Thessaloniki that are associated to home births.

The region of Central Macedonia adopted a Directive on home births, where the placenta is characterised as a Hazardous Medical Waste and therefore the placenta should be handled by entities that have an approved license. It is noted that women who choose to give birth at home usually want to handle their own placenta, respecting the fact that it symbolizes the connection of the mother with the infant. Also, the incineration of the placenta from a private company costs 100-150 Euros, putting extra strain on the overall cost of birth at home, while control of what happens after delivery towards incineration is inadequate, a fact that raises issues of bioethics.

In connection with this Directive, in December 2012 a midwife who undertook births at home was sentenced in Thessaloniki with the basic charge of contaminating the environment with «hazardous medical waste» (meaning the placenta from the new mother) that is produced at home births, resulting in the removal of her license for one year. The conviction of the midwife followed in February 2012 by the Court of Justice in Thessaloniki on the basis of a perineal rupture at a home birth (to the point that women are typically, as a precaution, subject to a perineotomy when they are in a maternity ward).

Extensive research was preceded by public institutions, through the processing of birth certificates that clearly state (even though not specifically required by law) whether the birth was carried out at home or in a maternity ward, so as to identify by name all health care professionals and parents who attended home birth and to examine these individuals by the judicial authorities on suspicion of committing offenses. Prosecutions of 79 individuals (5 doctors, 1 midwife and 73 parents) then followed with the charge of, amongst others, repeated environmental pollution by not “delivering” the placenta to the authorised management companies. None of the citizens who were finally prosecuted had been informed concerning the research that was conducted. 

It is noted that in countries, such as Germany, Britain, the Netherlands, Spain, Romania and Canada it is perfectly legal for a new mother to keep the placenta and bury it in her garden. In the Beth Israel Medical Center in New York and in accordance to the health regulations of the state hospitals, when requested by the new mother, the placenta is returned so that she can decide on what to do with it. New legislation was also recently introduced in Hungary under which midwives must contact companies that specialise in the removal of medical wastes with a key difference compared to the Greek case: when there is written request of the parents wanting to bury their own placenta, they are granted permission to do so. It is also noteworthy that in the Netherlands 30% of women choose home birth.

Nikos Chrysogelos stated:

"Giving birth at home is a natural and perfectly legitimate process that millions of women opt for around the world. Women have every right to manage their own placenta in other European states, always respecting the rules of ethics and practice, from which there is no risk to the environment and public health. The management of the placenta exclusively as a hazardous medical waste is incomprehensible, as it also leads to additional significant financial burden at a time of economic crisis. If the state is genuinely interested in environmental pollution and is not targeting home births in general, it does not need to re-invent the wheel. It can follow proven examples of other European countries."

(The entire content of the written question follows. Note that this is NOT the official translation by the Commission)  

Subject: «Management of the placenta by home births»

The Region of Central Macedonia adopted a Directive on home births, where the placenta is characterised a Hazardous Medical Waste of Infectious Character (HMW-IC). According to the JMD (Joint Ministerial Decision) 37591/2031/03 ΚΥΑ (FEK 1419/Β - Hellenic Government Gazette) the "management of HMW-IC must be carried away by institutions which hold an authorized permission."
It is noted that women choosing to give birth at home usually wish to manage their placenta by themselves, with respect to the fact that it entails a mother-baby connection. Furthermore, the placenta's incineration by a private company costs around 100-150 Euros further burdening the giving birth at home, while there is no control as to what happens following the placenta's delivery for incineration, a fact that brings up bioethics issues. As a result of this Directive, in December 2012 in Thessaloniki, a midwife was disciplinary sentenced for undertaking home births based on the charge of environmental contamination by "hazardous medical waste" (referring to the new mother's placenta) which are produced over the births at home, resulting to the withdrawal of her practicing license.

The Disciplinary Board accepted as the main disciplinary offense that the midwife had not managed the placenta as a hazardous infectious medical waste giving it for incineration to a health unit.

A public research preceded the conviction in order for all health care professionals and parents who attended births at home to be identified and examined by the judicial authorities on suspicion of committing offenses. A prosecution of 79 individuals (5 doctors, 1 midwife and 73 parents) followed with the primary offense of environmental pollution by not "delivering" the placenta to the authorised management companies [1].

The Commission is being asked:

1.      Does it consider that new mothers should be given the option to manage the placenta by themselves, instead of the imposed specific way?

2.      Does it consider the Directive issued by the Region of Central Macedonia on home births, as well as on the creation of a file of persons involved in home birth, compatible with EU legislation?

3.      Does it have any information on relevant legislation in other Member States?

4.      Does it have at its disposal any statistics for the percentage of women who give birth at home in other Member States?