Homebirth is legal and has been regulated by law in Hungary since 2012. Despite the obvious advantages of homebirth, it has not yet been broadly accepted, due to various opinions related to safety and risks associated with giving birth outside of a hospital. Our study aimed at exploring both real maternal and feto-neonatal characteristics associated with Hungarian homebirths. A total of 2997 cases were considered in support of our retrospective cohort study. In the examined period, there was a significant, continual rise in the number of homebirths by a rate of 0.22% on average per year. Aggregated maternal complications (primary uterine inertia, prolonged second stage labour, and third stage haemorrhage) were prevalent among homebirth cases (1.29% vs. 0.72%, p < 0.05) and were associated with an average of 11.77% rate of transfer to a health care institution. On the other hand, the rate of operative (vaginal or caesarean) delivery was 26.31% among institutionalized births. A slightly better Apgar score and relatively high rate (20%) of caesarean deliveries were correlated with institutionalized births (p < 0.05). However, the overall intervention rate was lower among homebirths (0.11% vs. 42.57%) than institutional birth cases (p < 0.001). Overall, homebirth is a reliable option for childbirth for healthy and low-risk mothers with uncomplicated pregnancies, which is reflected in the increasing number of deliveries at home in Hungary. Furthermore, utilizing the experiences of countries where homebirth is a long-established method may further improve the outcome of homebirths in Hungary.

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Összefoglaló. Egészséges terhességben mintegy két literrel nő a vér mennyisége. A vérvolumen növekedésének elmaradása, de extrém mértékű növekedése is súlyos következményekkel szövődhet. Ma már nem kétséges, hogy a praeeclampsia, mely a várandósság második felében magas vérnyomás és proteinuria együttes megjelenése, nem egységes kórkép. A korai kezdetű (34. hét előtt jelentkező), hypovolaemiával járó praeeclampsia placentaris eredetű, melyben az endothelium sérülése vezet a magas vérnyomásért és szervkárosodásokért felelős vasoconstrictióhoz és microthrombosisok megjelenéséhez. Magzati sorvadás, oligohydramnion alakul ki a lepényi elégtelenség miatt. A kórkép végső stádiumában magzati elhalás, eclampsia, lepényleválás várható. Az állapot kezelésében rendkívül korlátozottak a lehetőségek; a cél, körültekintő monitorizálás és az állapot stabilizálása mellett, várakozás a magzati tüdő érettségének fokozódása érdekében. A késői kezdetű, nagy perctérfogattal járó praeeclampsia anyai betegség: ebben az obesitasnak kockázati szerepe van, mivel önmagában is hajlamosít fokozott folyadék-visszatartásra, magas vérnyomásra és mérsékelt endothelkárosodásra. A kezdeti lábszár-, majd generalizálódó oedema mellett nemritkán jelentkezik magas vérnyomás és az esetek egy részében proteinuria is, mely ekkor már megfelel a praeeclampsia kritériumának. A magzat súlya normális vagy átlag feletti. Az extrém fokú folyadékretenció, valószínűleg a parenchymalis pangás miatt, asciteshez, eclampsiához, lepényleváláshoz vezethet. A hypervolaemiával járó praeeclampsia kezelésében a diuretikus furoszemidkezelés ígéretesnek tűnik. Orv Hetil. 2022; 163(17): 663–669. Summary. During normal pregnancy, blood volume increases by nearly two liters. Distinctively, the absence and also the extreme extent regarding the volume expansion are likely accompanied with serious conditions. Undoubtedly, preeclampsia, defined as the appearance of hypertension and proteinuria during the second half of pregnancy, is not a homogenous disease. The early onset which begins prior to the 34th week, is characteristically a hypovolemia-associated form and depicts the placental origination, in which endothelial damage leads to hypertension and organ damage due to vasoconstriction and microthrombosis. Fetal blood supply progressively worsens due to placental insufficiency. The outcome of this condition often leads to fetal death, eclampsia, or placental abruption. Management is confined to a diligent prolongation of pregnancy to accomplish improved neonatal pulmonary function. The late onset form, associated with high cardiac output, is a maternal disease, in which obesity is a risk factor since it predisposes individuals to enhanced water retention, hypertension, and a weakened endothelial dysfunction. Initially, low extremity edema oftentimes progresses to a generalized form and frequently results in hypertension. In several cases proteinuria appears. This condition entirely meets the preeclampsia criteria. Fetal weight is normal or frequently over the average. It is very likely, the increasing parenchymal stasis will lead to ascites, eclampsia, or placental abruption. During the management of this hypervolemia-associated preeclampsia, the administration of diuretic furosemide treatment seemingly offers promise. Orv Hetil. 2022; 163(17): 663–669.

Background Births can take place either at home or in healthcare institutions in Hungary. Until 2012, home birth was neither legal nor illegal. But as of today, home birth is legal and regulated by law in Hungary, however, it has not yet been broadly accepted since only criminal cases were reported in the media before 2012. Our study aimed at exploring both real maternal and foeto-neonatal characteristics associated with Hungarian home births compared with institutional births. Methods A total of 2,997 cases were considered in support of our comparative retrospective cohort study. Data regarding home birth cases (n = 1792 for years 2012–2020) was sourced from Hungarian Tauffer databases (2012–2020) and compared with its matched institutional birth data (n = 1205 for the year 2020) obtained from a university linked obstetrical department. Both descriptive and inferential statistics were conducted. Results In the examined period, there was a significant, continual incremental rise in the number of home births from 0.04 (2012) to 0.48% (2020) in Hungary, which represent a cc of 0.22% per year (95% CI, 0.02–0.25). The maternal age was 33.16 ± 4.71 and 29.69 ± 5.44 years for home births and institutionalized births, respectively (p < .001). Mothers choosing homebirth were multiparous and the majority have experienced spontaneous mode of childbirth compared with mothers who gave birth at a health care institution (p < .001). Some pathology (secondary uterine inertia, prolonged second stage labour and primary post-partum haemorrhage) were prevalent among homebirth cases (p < .05); and associated with a cc. 12% rate of transfer to a health care institution. But, the overall intervention rate was lower among homebirth (0.11% vs 42.57%) compared to institutional birth cases (p < .001). A slightly better Apgar score among institutionalized newborns correlated with a relatively high rate (20%) in Caesarean deliveries (p < .05). Conclusions The finding of our study demonstrates an increasing number of home births in Hungary. Strict criteria and requirements for midwives of homebirth provide an acceptable alternative in support of home childbirth for relatively healthy, low-risk mothers, even if it is not entirely free of charge.