| Summary: | Background: The importance of promoting and protecting the normal physiologic processes of childbirth is supported by decades of research. Despite this, the use of obstetric interventions has increased rapidly over the past years. Hence, finding an effective balance to emphasize the normality of childbirth in an era of medical technology is one of the key challenges of modern day maternity care. Aim: The overall aim of this thesis was to provide knowledge and understanding of ways to promote normal birth among women in Iceland expecting their first child. Material and methods: In study I we used data from the Icelandic Medical Birth Registry to calculate the incidence of cesarean section, labour induction, epidural analgesia, and instrumental delivery for all births in 1995-2014 (N=86933). We used Poisson regression to study relative risk adjusted for maternal and pregnancy-related characteristics. In study II we used an internationally validated instrument to survey pre-pregnant women (N=410) about their attitudes towards birth and then used log binomial regression to calculate adjusted relative risk for natural birth intentions by high, moderate and low childbirth fear and confidence in birth knowledge. Study III was a systematic review of non-pharmacological antenatal interventions for childbirth related anxiety and fear. In study IV we designed and implemented an intervention, Enhanced Antenatal Care (EAC), which combines elements from one-to-one and group antenatal care models, to promote natural birth intentions. In Study V, we tested the effectiveness of the intervention in terms of lowering childbirth fear during pregnancy with a quasi-experimental design (N=92). Results: Study I: There were 81389 planned vaginal births and 5544 planned cesarean sections between 1995-2014. Among women having their first child in 1995-2014, we observed a marked increase across time for labour induction (12.0% to 26.3%; adjusted RR 1.78 [CI 1.67-1.91]) and epidural analgesia (37.2% to 56.9%; adjusted RR 1.40 [CI ...
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