Having a baby in Hungary

by Réka Morvay on March 23, 2009

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.

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