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IF HISTORY were a guide, obstetrics in Hungary should be wonderful. In 1847 Ignac Semmelweis pioneered mother-friendly childbirth, insisting that doctors should wash their hands between autopsy and delivery rooms (they objected to this slur on gentlemanly cleanliness).

Obstetric care in Hungary is indeed excellent today. It is tightly run by skilled doctors, with low mortality rates. But those who challenge the medical profession still face problems. Agnes Gereb, a pioneer of home births, is facing up to eight years in jail. Prosecutors are going after her over one fatality in childbirth, one case in which a baby died some months after birth and two births that ended up as emergency hospital admissions. In the eyes of many Hungarians, such incidents show that home births are insanely risky and that those who promote them are little more than irresponsible cranks.

That view may seem outdated in the West, but not in the ex-communist East, where birth is a medical problem not a natural process, and where abortion has long been commonplace. Such procedures as episiotomy (cutting the vulva) are standard, whereas Ms Gereb says she has performed it in just ten out of 3,000 home births. She criticises hospitals for their frequent use of drugs to induce labour, which suits doctors’ timetables rather than nature’s. Women in Hungary also expect to pay, formally or informally, to be looked after in hospital, and especially for pain relief.

Outsiders who unsettle the obstetric cartel meet clannish (and even self-interested) opposition. Ms Gereb’s supporters are inviting international experts to testify that home births can be quite safe and that her record is commendable. But the court may choose to take expert opinion only from the obstetricians’ trade body, which dislikes home births—and also Ms Gereb. An obstetrician herself, she has often clashed with her colleagues. In 1997 she was suspended for the outrageous act of allowing a father into the birthing room. Things have changed, but in Hungary only one birth in a hundred happens without some form of medical intervention. Ms Gereb thinks that many more could be natural, given a bigger role for midwives and a smaller one for bossy doctors.

Semmelweis went mad and died (of an infection) after being beaten up by warders in an asylum. Ms Gereb does not face that fate—and she flinches modestly at any comparison to the great man. But, she notes, he might have sympathised with her over one big problem: the surprising difficulty of changing medical routine.