Adaptation of the Childbirth Experience Questionnaire (CEQ) in China: A multisite cross-sectional study

Abstract

Background The childbirth experience of women represents a significant aspect of quality care. Due to the lack of a reliable Chinese language tool for assessing childbirth experiences, examples must be adapted from other countries. The aim of this study was to translate an English version of the Childbirth Experience Questionnaire (CEQ) into Chinese and adapt this tool to the Chinese context. Methods A questionnaire validation study was conducted. A forward-backward translation procedure involving the developer of the CEQ was conducted. The data were collected in postnatal wards at 50 birth facilities in 4 regions of Zhejiang Province, China. Women who gave birth vaginally at the investigated facilities during the study period completed an online questionnaire that included the Chinese version of the CEQ (CEQ-C), demographic information and clinical information. Psychometric analyses were performed to assess the internal and content consistency. After subdividing the sample into subsamples, an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to examine the structural validity. Known-group comparisons were performed to assess the discriminant validity. Results Overall, 1747 women participated in this study. The content validity index (CVI) of the CEQ was 0.92. Based on the comments of the experts combined with the statistical results, we removed 3 items related to pain, sense of control and sense of security and changed 3 items to different dimensions. The CFA supported the four dimensions of the CEQ-C (standard root mean square residual (SRMR) = 0.037, root mean square error of approximation (RMSEA) = 0.036, comparative fit index (CFI) = 0.966, and Tucker-Lewis index (TLI) = 0.959). Cronbach’s alpha of the CEQ-C was 0.88, and McDonald’s omega value was 0.91. The duration of labor, delivery mode, parity, oxytocin augmentation, pain management, companionship, prenatal education and pain experienced exerted significant effects on the women’s childbirth experiences. Conclusions Although some items performed differently in our analysis comparing the English and Chinese versions of the CEQ, the CEQ-C is reliable and valid. Additionally, the CEQ-C is an easy-to-use and promising tool for measuring childbirth experiences among Chinese women in facility settings that can be used to improve the quality of intrapartum care. Efforts are needed to provide women with respectful, evidence-based intrapartum care to facilitate positive childbirth experiences.

Measuring women’s experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire

“…those with instrumental births, those in labour in excess of 12 h, and those who had their labours augmented with oxytocin). The CEQ has since been translated and validated in several languages [19][20][21][22][23], and has been successfully implemented in empirical studies including a large variety of culturally diverse samples [24][25][26][27][28][29][30]. However, measurement instruments always hold potential for improvement, and in validating the original Swedish version of the instrument, two domains showed weaker performance; Participation and Professional Support [18].…”

Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway

“…Studies regarding prolonged labor and birth experience show conflicting results. Some researchers have found that women with long labors had an increased risk of a negative birth experience [8][9][10][11][12][13], while others did not find such an association [14,15]. A negative birth experience might lead to women avoiding childbearing [12] or wanting an elective cesarean section in a subsequent pregnancy [16][17][18].…”

“…Active labor is usually defined as the period from 4 cm dilatation of the cervix until the baby is born [8,10,11,14]. However, there are other aspects of labor progression that may be of importance for the birth experience, such as the duration of early labor (cervix dilated 1-4 cm, often defined as the latent phase).…”

Finnish version of the Childbirth Experience Questionnaire (CEQ-FI): validity and reliability assessment

“…However, the results were in line with previous studies validating other translations of the CEQ. Other studies have increased the response rate using reminders (4, 7), use of a web questionnaire or administering the questionnaire during hospitalization immediately after delivery (8,9). However, sending reminders may result in delayed response, which in turn may affect the item responses (15).…”

“…Furthermore, three items in Chinese CEQ were moved to another domain. High ceiling effect was observed especially in items regarding labor pain, which the authors attributed to Chinese traditions of accepting intense labor pain as normal and lower analgesia use compared to Western countries (8). The Persian translation was not subject to structural changes, but the item evaluating midwife's support for partner was seen as irrelevant, as partners are not allowed in deliveries in Iran (9).…”