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Birth Preferences that Deviate from the Norm in Sweden: Planned Home Birth versus Planned Cesarean Section

Authors

  • Ingegerd Hildingsson RNM, PhD,

    1. Ingegerd Hildingsson is an Associate Professor in the Department of Health Sciences, Mid Sweden University, Sundsvall; Ingela Rådestad is a Professor at the School of Health, Care and Welfare, Mälardalens University, Eskilstuna; and Helena Lindgren is a Senior Lecturer at the School of Health and Social Sciences, Dalarna University, Falun, Sweden.
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  • Ingela Rådestad RNM, PhD,

    1. Ingegerd Hildingsson is an Associate Professor in the Department of Health Sciences, Mid Sweden University, Sundsvall; Ingela Rådestad is a Professor at the School of Health, Care and Welfare, Mälardalens University, Eskilstuna; and Helena Lindgren is a Senior Lecturer at the School of Health and Social Sciences, Dalarna University, Falun, Sweden.
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  • Helena Lindgren RNM, PhD

    1. Ingegerd Hildingsson is an Associate Professor in the Department of Health Sciences, Mid Sweden University, Sundsvall; Ingela Rådestad is a Professor at the School of Health, Care and Welfare, Mälardalens University, Eskilstuna; and Helena Lindgren is a Senior Lecturer at the School of Health and Social Sciences, Dalarna University, Falun, Sweden.
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  • The study was funded by Mid Sweden University, Dalarna University, Falun, Mälardalen University, Eskilstuna, and the Swedish Research Council, Stockholm.

Address correspondence to Ingegerd Hildingsson, RNM, PhD, Mid Sweden University, Holmgatan 10, SE 85170 Sundsvall, Sweden.

Abstract

Abstract:  Background:  Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience.

Methods:  This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated.

Results:  Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5–3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01–0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1–0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby’s life during birth (OR: 0.1; 95% CI: 0.03–0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3–10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2–7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6–6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7–5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3–4.1) compared with women who had a planned cesarean section on maternal request.

Conclusions:  Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section. (BIRTH 37:4 December 2010)

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