Margarete Wana (pictured) is an Austrian homebirth midwife who worked in the community in and around Vienna independently since 2007. https://deinehebamme.at/
In March 2023 she attended a planned HBAC for a woman (A.) who had had comprehensive antenatal care during the pregnancy. She had been under the care of an obstetrician as well as under midwifery care. A. decided at the beginning of the pregnancy that she wanted to have a home birth this time as she was not happy with the care during her previous birth. During the pregnancy, Margarete referred this woman to the hospital for additional scans as on palpation, the baby felt small. Each time after the ultrasound the conclusion was that the baby’s growth was normal and placental function was normal.
When A. went into labour, she called Margarete to look after her at home. Soon after Margarete’s arrival, a second midwife (A.F.) was called to attend as previously agreed.
A. laboured spontaneously, mobilising and using the birth pool to her liking. Margarete and A.F. monitored and documented labour progress and fetal wellbeing regularly. FHR remained normal.
Soon after A.’s cervix became fully dilated, Margarete and A.F. heard a fetal deceleration on auscultation. They immediately took steps to improve FHR and Margarete carried out a VE assessment to ascertain if birth was imminent. Fetal deceleration recovered. Birth was not imminent at that point, Margarete informed A. and recommended urgent transfer to maternity hospital for fetal distress. Further deceleration was heard. A. agreed to the transfer.
Margarete together with A.F. prepared A. for transfer, called an ambulance and called the local delivery suite to inform them about transferring in. They inserted a cannula and administered tocolysis as is standard in fetal distress situations in Austria.
Margarete handed over care to the ambulance team (which included a doctor) and instructed them for an urgent transfer. Further dose of tocolysis was administered prior to transfer and at that point, FHR was in normal range and stable, with contractions being very mild and short.
Second midwife A.F. went home while Margarete made her own way to the hospital.
There was busy traffic en route.
On arrival at the hospital, Margarete was present and handed over care to the multidisciplinary team. Margarete stayed alongside A. A. was treated unkindly by the hospital staff. The multidisciplinary team was abrupt and judgemental towards A. and Margarete but they acted in a timely manner.
Decision was made by the attending doctor to perform a forceps delivery. Fundal pressure was used to deliver the baby.
Baby was born in poor condition. Mother A. wanted optimal cord clamping to allow placental transfusion and expressed this to the hospital team but her wish was dismissed. The cord was cut immediately and the baby was taken for resuscitation to another room.
Baby C. was taken to NNU for cooling and died a few days later.
Placenta histology showed that the placenta was small (266g) and there was significant placental infarction (ischemic necrosis) on 40% of the surface. Overall the histology showed placental insufficiency.
Margarete continued to look after A. and her partner.
After these events, Margarete was informed by the hospital that the case is going for further investigation. This is standard for all neonatal death cases.
In March 2024 Margarete was informed that charges will be brought against her. Her licence was limited to working under direct supervision in hospital and teaching antenatal and other classes. She had to hand over her caseload of 22 women to her colleagues. This resulted in significant reduction of income for Margarete and put her in a financially difficult situation. She has two young children who she looks after by herself.
Margarete is a member of the Austrian Midwifery Chamber (Hebammengremium https://hebammen.at/ ) and the Chamber should be providing support and legal aid to Margarete. However the Chamber did not provide support.
Margarete commissioned her own legal help. She received a formal charge of negligent manslaughter on 26/11/2024 and was summoned to attend a criminal court hearing on 17/02/2025. She was found guilty and handed a prison sentence. She appealed and the case is ongoing. She left midwifery and now works in real estate.
In reaction to her case, the president of Austrian society of Obstetricians and Gyneacologists claimed that homebirth is dangerous and a ban should be considered. This sparked a wave of protests in Vienna for autonomy in childbirth and for the end of obstetric violence. The protesters also gave their support to Margarete.
Midwifery by Lenka 