JILEMNICE, Czech Republic - Sarka Dubska gave birth to both of her sons on a twin bed at home with the help of her husband - but no midwife. She would have preferred otherwise.
The Czech Republic prevents midwives from assisting in home births, a law that the 29-year-old has challenged all the way to the European Court of Human Rights (ECHR).
Dubska had her first child, a daughter, at the hospital in 2007. Forced to lie in an uncomfortable position and undergo unwanted hormone injections, the experience was "stressful", she says.
"You argue with the doctors and you can't focus on the delivery and then it hurts," she told AFP at her flat in the northern town of Jilemnice.
She decided to deliver her next child at home in 2011 but could not find a willing midwife. Together with another mother, Alexandra Krejzova, she filed a lawsuit against the Czech state with the ECHR.
Last December, however it ruled that their rights were not violated - a "disappointment and surprise" for Dubska.
"I know that in most EU countries, home births enjoy legal backing, but now the ECHR has ruled that we are not entitled to those perks," she told AFP.
Health ministry lawyer Denisa Kopkova said the law is focused on "the protection of the mother and her foetus".
Home births themselves are not banned in the Czech Republic.
But a dissenting ECHR judge said that for women who wish to deliver at home, forcing them to do so without a midwife only increases the risk.
The case will now be referred to the court's highest authority, the Grand Chamber.
"Unfortunately, paternalism and efforts to restrict patients' choices in the Czech health system are still very visible," said Zuzana Candigliota, a lawyer for the Czech Human Rights League.
"The high-ranking doctors also have financial interests: they get large sums from health insurers. If there was an alternative, they would lose money."
'Midwife to myself'
Since 2012, most healthcare has been restricted to licensed medical institutions. Anyone providing care without a licence can be fined up to one million koruna (36,000 euros, US$45,000).
Obtaining a licence requires having the appropriate equipment, including an operating room, effectively barring midwives.
They have also been scared away by the case of Ivana Koenigsmarkova, an experienced midwife who assisted in a 2009 delivery without a licence. The baby died.
She got a suspended five-year sentence and 100,000-euro fine but was later acquitted by the Supreme Court.
"I was a midwife to myself," Dubska said, as her sons played with a toy train nearby. "When the woman is okay and feels safe, the body's hormones do what they're supposed to do and the delivery goes smoothly." But Jaroslav Feyereisl, head of both the largest Czech maternity hospital and the national obstetrical society, said that even with a doctor or midwife on hand, home births are risky.
"There could be a problem I won't be able to resolve in a living room, and I'll end up standing there waiting to sign the death certificate," he told AFP.
He conceded that some hospitals may provide worse care - a legacy of communist rule - but added: "We're trained to save lives, and home births are not the way."
One court, two verdicts
The ECHR ruled that since "there is no European consensus in the matter... the authorities did not exceed their wide margin of discretion." The European Union leaves family policy-making up to member states.
The Netherlands tops the 28-member bloc with 16.3 per cent of births occurring at home, according to the 2010 European Perinatal Health Report, followed by Wales with 3.7 per cent.
"These are rare in most European countries," often making up less than one per cent of total births, it said.
The figure is 0.2 per cent for the Czech Republic, according to Feyereisl.
In 2010, the ECHR issued a verdict in the case of Anna Ternovszky, who sued Hungary for the same reason as the Czech mothers - and won.
Two years later, Hungary passed new legislation making it legal for midwives to help with home births if they have obtained the necessary licenses from national health authorities.
However, midwives have complained that the licenses are difficult to get as they require costly insurance coverage and several years' prior experience in a hospital.
In the Czech case, Dubska and Krejzova are pinning their hopes on a ruling by the ECHR Grand Chamber, the decisions of which are final.
It "should come up with a single ECHR judgement and provide direction for the future," Krejzova's lawyer, Richard Horejsi, said.