"How do you know this woman had this child?"

Three children have been born without professional involvement in Iceland so far this year, and there were six in the last year according to mbl.is, but the number could be higher as there are examples of parents choosing not to register their children in the system and thus there are no records of their existence.

The popularity of births without professional involvement has been increasing in Iceland in recent years and midwives are concerned about the development. This is due to the fact that there is no procedure for registering these children and therefore midwives who have been interviewed by mbl.is consider it a matter of time when a case of human trafficking of this kind comes up. They are also concerned about the health of the mother and the child in the birth itself and ask what is the right of a child to health care in situations like this.

These are socalled freebirths, which means that parents choose to give birth in their own environment without the involvement of midwives or other health care professionals.

“How do you know that this woman had this child?”

Births without professional involvement began to become popular in Iceland around 2019, Hulda Hjörvarsdóttir, chief physician at Landspítali's maternity team, describes that fathers have started calling the maternity ward with a request for help in registering newborns into the system.

It is clear that a large number of women have given birth without the involvement of professionals, but in the past it has been mainly because women do not get to the maternity ward on time, or for other specific reasons. Hjörvarsdóttir says that at first the staff at the hospital believed that the women had not been able to get to the hospital in time and have therefore complied with the request of these fathers.

“I think it was our social workers who thought about this one step further and asked ‘wait, how do you know this woman had this child?’” Hjörvarsdóttir explains that it was clear at that time that some of the women who choose to go down this path also choose not to seek maternity care during pregnancy.

In such cases, midwives do not have any information about the mother's pregnancy and thus it becomes more complicated to verify that the child is actually the child of those who claim it.

“This does not mean that the hospital refuses to admit these women to the system, it just has a broad obligation and needs to look at more aspects. Therefore, midwives are calling for the procedure to be clear,” she says.

Between a rock and a hard place

“Even though a woman has been in maternal care, and calls in and says she has given birth, you can’t be entirely certain that the child that is being sought to register is hers,” says Guðlaug Erla Vilhjálmsdóttir, head of midwifery at Landspítali.

“Was it someone else who had the child and gave it to them? Did they go abroad and get it? These are things we don’t know anything about,” says Hjörvarsdóttir to underline the concerns of midwives.

They also state that a decision has been made that the maternity department at Landspítali will no longer be able to service these requests and there is no obvious way to register the children in question in the system.

However, mbl.is has a record of home-nurses going to these families shortly after birth and registering newborns in the system. This is only done after a careful examination of the mother and child.

“I think the health care system is a bit between a rock and a hard place because there is really no procedure,” Vilhjálmsdóttir says when a reporter asks how to register children born without the involvement of professionals.

“It seemed so farfetched that this would happen that no one thought of this possibility,” Hjörvarsdóttir says, adding that in the past year, efforts have been made to find other ways to register the children in question, but according to a regulation, notifications of the birth of children must be received from healthcare institutions or self-employed midwives, and the healthcare professionals involved must be present at the birth to be able to report the birth of a child.

It should be noted that there is no provision in Icelandic law or regulations that denies a woman the right to give birth without the involvement of professionals. Similarly, there is no provision in Icelandic law to specify how to register children born without the involvement of health care professionals.

“If there is a loophole in the system, it is used”

More midwives and health care workers have expressed their concerns about this development in conversation with mbl.is. One of them is Helga Sól Ólafsdóttir, leader of social workers at the health care center in the capital area. Ólafsdóttir worked for a time at the women’s department at Landspítali and has, among other things, been involved in finding other ways to register children born into the system without the involvement of professionals.

Ólafsdóttir shares the same concerns that Hjörvarsdóttir and Vilhjálmsdóttir have expressed, and she wonders how to ensure for certain that a woman has given birth to a child, when there are no witnesses to the fact.

“If there’s a loophole in the system, it is used, and there we have a way for surrogacy completely unsupervised. Although you don't expect it."

Waiting for there to be a case of human trafficking

From these conversations with midwives and health care workers, one can hear that their concerns about the development of births without the involvement of professionals are high. One of them said, for instance, “I’m just waiting for there to be a case of human trafficking. It’s just a question of when it will happen here in Iceland, not if”.

As stated above, the last year, the Registers Iceland has been working to find ways to register the children in question. This work began following the fact that the institution raised the matter with the Ministry of Infrastructure, Health and Justice, a request that is still in the works.

Eyrún Magnúsdóttir, a lawyer at the Registers Iceland, says that they raised the issue in light of the role of the institution, which is to register children into the system after data received from healthcare institutions or self-employed midwives.

“If we don’t get any data about the birth of a child, either from a doctor or a midwife, we can’t register the child because we don’t have any criteria to assess whether the woman in question has the child in question,” says Magnúsdóttir, to underline the importance of clarifying the procedures for registering children born without the involvement of professionals.