Perceptions of risk and risk management among 735 women who opted for a home birth

Objective: home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe women's perceptions of risk related to childbirth and the strategies for managing these perceived risks. Design and setting: a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. Participants: a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. Measurements: two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. Findings: regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. Conclusion: women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. Implications for practice: to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so. (C) 2008 Elsevier Ltd. All rights reserved.