Swedish Women's Interest in Home Birth and In-Hospital Birth Center Care

Authors

  • Ingegerd Hildingsson RN, RM, MA,

    1. Ingegerd Hildingsson is at the Department of Caring and Public Health Sciences, Mälardalen University, Västerås and in the Department of Nursing, Karolinska Institutet, Stockholm;
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  • Ulla Waldenström RN, RM, BA, PhD,

    1. Ulla Waldenström is Professor in the Department of Nursing, Karolinska Institutet, Stockholm; and
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  • Ingela Rådestad RN, RM, PhD

    1. Ingela Rådestad is Associate Professor in the Department of Caring and Public Health Sciences, Mälardalen University, Västerås, Sweden.
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  • Funding for this study was provided by Mälardalen University, Västerås, and the Vårdal Foundation and Karolinska Institutet, Stockholm, Sweden.

Address correspondence to Ingegerd Hildingsson, Gamla Karlebyvägen 22 E, S-87133 Härnösand, Sweden.

Abstract

ABSTRACT:Background: In Sweden, few alternatives to a hospital birth are available, and little is known about consumer interest in alternative birth care. The aim of this study was to determine women's interest in home birth and in-hospital birth center care in Sweden, and to describe the characteristics of these women.

Methods: All Swedish-speaking women booked for antenatal care during 3 weeks during 1 year were invited to participate in the study. Three questionnaires, completed after the first booking visit in early pregnancy, at 2 months, and 1 year after the birth, asked about the women's interest in two alternative birth options and a wide range of possible explanatory variables.

Results: Consent to participate in the study was given by 3283 women (71% of all women eligible). The rates of response to the three questionnaires were 94, 88, and 88 percent, respectively. One percent of participants consistently expressed an interest in home birth on all three occasions, and 8 percent expressed an interest in birth center care. A regression analysis showed five factors that were associated with an interest in home birth: a wish to have the baby's siblings (OR 20.2; 95% CI 6.2–66.5) and a female friend (OR 15.2; 95% CI 6.2–37.4) present at the birth, not wanting pharmacological pain relief during labor and birth (OR 4.7; 95% CI 1.4–15.3), low level of education (OR 4.5; 95% CI 1.8–11.4), and dissatisfaction with medical aspects of intrapartum care (OR 3.6; 95% CI 1.4–9.2). An interest in birth center care was associated with experience of being in control during labor and birth (OR 8.3; 95% CI 3.2–21.6), not wanting pharmacological pain relief (OR 2.3; 95% CI 1.3–4.1), and a preference to have a known midwife at the birth (OR 2.2; 95% CI 1.6–2.9).

Conclusion: If Swedish women were offered free choice of place of birth, the home birth rate would be 10 times higher, and the 20 largest hospitals would need to have a birth center. Women interested in alternative models of care view childbirth as a social and natural event, and their needs should be considered. (BIRTH 30:1 March 2003)

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