| Summary: | Doctoral committee: Ólöf Ásta Ólafsdóttir; Alexander Kr. Smárason; Ingegerd Hildingsson. Background: Hospitalization of childbirth in Iceland in the 20th century reduced home birth rates to less than 0.1% in 1990. Icelandic home birth rates have risen rapidly in the new millennium and were 2.2% in 2014. Recent studies in other Western countries have consistently shown lower rates of interventions and maternal morbidity in planned home births than in planned hospital births, while neonatal outcomes are dissimilar in different countries. These study results have been met with scepticism in a prevailing atmosphere of conflict and a heated debate on home birth, which complicates advocacy for women’s right to informed decisions. Aim: The aim of the study was to explore and define women’s autonomy in place of birth, compare the outcome of planned home and hospital birth in Iceland, and evaluate the effect of contraindications and women’s attitudes on birth outcomes in different places of birth. The purpose of the study was to facilitate women’s informed choice in place of birth, support future development of Icelandic childbirth services, and add to the growing body of Icelandic midwifery knowledge and international knowledge on planned home birth. Methods: This thesis is based on four original publications. Study 1, presented in article I, was a concept analysis of the concept “autonomy in place of birth”. The defining attributes of the concept, its antecedents, and its consequences were extracted from current literature and synthesized to create a model of the concept and representative cases. Studies 2 and 3, presented in articles II and III, were retrospective cohort studies on the total population of 307 planned home births in Iceland in 2005–2009 and a purposive matched sample of 921 planned hospital births in a comparable study group. Study 2 compared the outcome of planned home and hospital births. Study 3 examined the effect of contraindications on outcomes in different places of birth. Study 4, presented ...
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