Birth Preferences that Deviate from the Norm in Sweden: Planned Home Birth versus Planned Cesarean Section Ingegerd Hildingsson, RNM, PhD, Ingela Ra˚destad, RNM, PhD, and Helena Lindgren, RNM, PhD 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 expe- rience. 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 col- lected 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 mid- wife (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) Key words: cesarean section, home birth, maternal request In a society where women are expected to give birth vaginally, a woman who prefers to have a cesarean sec- tion deviates from the norm. This deviation is also true for women who prefer to give birth at home where the norm is for birth to occur in hospital. Acting on one’s own preferences, that is, opting for a home birth or a cesarean section without medical reason, can raise strong feelings among health care professionals and the Ingegerd Hildingsson is an Associate Professor in the Department of Health Sciences, Mid Sweden University, Sundsvall; Ingela Ra˚destad is a Professor at the Schoolof Health, Care and Welfare, Ma¨lardalens University, Eskilstuna; and Helena Lindgren is a Senior Lecturer at the School of Health and Social Sciences, Dalarna University, Falun, Sweden. The study was funded by Mid Sweden University, Dalarna University, Falun, Ma¨lardalen University, Eskilstuna, and the Swedish Research Council, Stockholm. Address correspondence to Ingegerd Hildingsson, RNM, PhD, Mid Sweden University, Holmgatan 10, SE 85170 Sundsvall, Sweden. Accepted April 23, 2010 Ó 2010, Copyright the Authors Journal compilation Ó 2010, Wiley Periodicals, Inc. 288 BIRTH 37:4 December 2010