Home birth is not included in the Swedish health care system and the rate for planned home births is less than one in a thousand. The aim was to describe women’s perceptions of risk related to childbirth and the strategies for managing these perceived risks. Design and setting A nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. Participants A total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. Measurements Two open questions regarding risk related to childbirth and two questions answered by using a scale were investigated by content analysis. Findings Regarding perceived risks in a hospital birth, three categories, all related to loss of autonomy, were identified: 1) being in the hands of strangers; 2) being in the hands of routines and unnecessary interventions and 3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help; 1) worst case scenario and 2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour and by avoiding discussions concerning risks with health care professionals. Conclusion Women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health care professionals. Implications for practice To understand why women choose to give birth at home, health care professionals must learn about the perceived beneficial effect of doing so.