“A normal birth does not require medical intervention” – in conversation with obstetrician-gynaecologist Balázs Bálint

It is common knowledge that your vocation and promotion of natural births comes from your family. Was your choice of career evident from the start?
“I had other plans as well: I also wanted to be an attorney, minister of religion and archaeologist, but obstetrics-gynaecology always remained a priority. My father and uncle are in the profession and one of my sons is also studying to be a doctor. Perhaps my fate worked out as it did because my father, who is a role model for me, frequently took me along with him to hospital where I could see new-born babies. This left a lasting impression on me.”

You started working at Szent Imre Hospital, the same place as your father. Did you immediately take on his attitude?
“At that time, even in Szent Imre there was a strong tendency towards medicalization, which is still common elsewhere – there is a need for this, too, just not to such an extent. Thus I learnt about conventional obstetrics as well, but in the meantime at home I heard a lot about different kinds of birthing techniques and the importance of the mind during pregnancy and birth.

“In fact, natural births were never a driving force in the hospital, only from outside did it appear that ‘alternative’ births were occurring here day and night. There were not more than two or three doctors and midwives working with this approach, and there are not many more of us today. But this little yet highly professional team is ready to undertake breech births, for instance, and natural births after caesarean sections.

“So I’ve seen both sides and this is why it came as no surprise when evidence-based research founded on statistics confirmed: undisturbed childbirth is good and not dangerous. By the way, I would question the omnipotence of this research somewhat, because in the case of a given birth for a given person, we have to listen not only to the statistics but also to our feelings. At the same time, it is extremely important because it shows:

“If a birth starts spontaneously, if the mother can choose her own body position, if a companion of her choice can be by her side, if there are no routine interventions (if the first three conditions are met, then these are rarely invoked), and if the baby can be with his/her mother as long as possible immediately after birth and in the next few days and weeks, then the birth will in all probability take place without complications, a healthy baby will come into the world and the mother’s recovery will be rapid.

“And there will be the kind of birth experience that means afterwards, the mother will be all the more likely to have another child. In other words, this is a serious demographic factor.”

If undisturbed childbirth is such an unambiguously and verifiable good thing, why is it not practised everywhere?
“In the Hungarian system, the responsibility lies with the doctor. And if during university training they are conditioned to save lives, that is, to intervene, and then they see this live during professional practice, then they will also assume this approach. According to my father’s very telling simile, for the mother pregnancy and birth are like a flower-filled meadow, while for the doctor they are like a minefield. It is very difficult to harmonize these differences of approach. Particularly when doctors are taught nothing other than to go around as though with a mine detector.

“Naturally, in an emergency situation it is vital to intervene, but no medical intervention is required in a normal birth.

“A good example of the development of the conventional obstetrician attitude is that at the beginning of my training as a specialist, my colleagues were still interested to hear of my ‘alternative’ birthing stories at Szent Imre. Five years later, their comment on the same thing was ‘how dangerous’. Another example: a talented young colleague who had not yet started their residency with us wanted to tear the just then dilating cervix sheath but couldn’t say why.

“At a birth there are midwives as well, who are in effect trained and used as medical assistants. This is no good. This is why I recommended that there should be more practical work in the training of doctors, and midwifery training should become dual tier, in the second tier of which (master training) there should be exclusively hands-on teaching.”

You have made many recommendations, for example with regard to family-friendly childbirth and outpatient childbirth.
“I’ve been saying the same thing for close on two decades and it now appears that my efforts are not in vain: my proposals are increasingly falling on fertile ground. Most recently, that a hospital should only get funding for equipment procurement in family-friendly childbirth tenders when a high proportion of staff have been sent for extension training needed for a change of attitude: not courses on epidural blocker drugs, not communication training, not perinatal and breastfeeding specialist consulting courses.

“Only in this way is there any hope that not only women giving birth at Szent Imre Hospital can live through the experience of natural childbirth, but everyone in this country.

“The reason I submitted an application for the post of inspector was because aside from what is prescribed officially, in effect I have to do what I formerly did voluntarily: proposals to change the conventional attitude towards childbirth.”

Many view the opportunity for mother- and baby-friendly births to lie in outpatient childbirth.
“I support the introduction of outpatient childbirth as a way to reduce obstetric medicalization. Medical policymakers support this but paediatricians are rightly concerned about babies coming out of hospital care earlier because there are some settlements where they don’t even have a paediatric GP. This could be resolved with compulsory training and neonatologists making visits to family homes, but this still lies in the future. In addition, I consider it important to provide information, which is why I regularly accept invitations to speak about this, abroad as well. Women underwent a massive loss of skill since they do not live in large families where birth and caring for infants is a natural part of life. An increasing number are getting informed about their opportunities and rights, but there are still too many who even now don’t know how babies are conceived.”

You are prepared to accept this much ‘fieldwork’ in order to promote natural childbirth? How do you reconcile your many activities?
“Kata Kondor, who in my eyes is the world’s best midwife, once said:

“We cannot allow ourselves the luxury that only 100–120 women a year experience natural childbirth.

“That is why I became an inspector and I also undertook the establishment of the professional background of gynaecology in the Buda Sisters of Mercy Hospital and the reference obstetrics being formed in Bethesda Children’s Hospital, the future management of which I have been commissioned with. If these get off the ground (in all likelihood in two years’ time), I will have to rethink my commitments, but until then I’ll do my thing everywhere, including in the Gólyafészek /Stork’s Nest/ Birth Centre founded with my father and uncle. Of course, there can be situations where scheduling clashes force a decision; babies don’t arrive when it is convenient for me, but I never push for a birth just because I have matters to attend to elsewhere, so sometimes I have to cancel a surgery or I even miss another birth… It is not always easy to decide but once I have made up my mind, I stick to it and allow the other opportunity to pass. I am a devout Christian, which also helps in reaching decisions and staving off burnout.”

Talking of faith and burnout, you are one of the few gynaecologists who has never carried out an abortion. Is this possible?
“Yes.

“Under current legislation, in each state hospital it is sufficient to set up just a single team that carries out abortions. The liability to ensure this sort of provision does not exist at all in church-funded hospitals.”

And we haven’t even spoken about the family, the scouts and your parish work...
“Nor about my wife, without whom none of this would function. I met Zsuzsa at university and we married 23 years ago. Alongside giving birth to our three children, she chose to work in children’s radiology, which provides her with the joy of medical work and the role as mother of the family. We both work in Gólyafészek Birth Centre, but along with others we also founded the Páty scout troop, which today has 155 members. In all probability, sooner or later we will once again find another new joint project. It is very important for us to be able to work together, to listen to each other, to talk things through, because this is the basis of a good marriage.”