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.


METHODS
a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005.


METHODS
a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned.


METHODS
two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis.


RESULTS
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.


CONCLUSIONS
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.


CONCLUSIONS
to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so.
Lindgren
Helena E
HE
Division for Reproductive and Perinatal Health, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden. helena.lindgren@mdh.se
Rådestad
Ingela J
IJ
Christensson
Kyllike
K
Wally-Bystrom
Kristina
K
Hildingsson
Ingegerd M
IM
D000328:Adult; D002755:Choice Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006700:Home Childbirth / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D008880:Midwifery / Q000379:methods / Q000458:organization & administration*; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018570:Risk Assessment; D012308:Risk Management; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult