Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy

Abstract

Background: Assessment of childbirth fear, in advance of pregnancy, and early identification of modifiable factors contributing to fear can inform public health initiatives and/or school-based educational programming for the next generation of maternity care consumers. We developed and evaluated a short fear of birth scale that incorporates the most common dimensions of fear reported by men and women prior to pregnancy, fear of: labour pain, being out of control and unable to cope with labour and birth, complications, and irreversible physical damage.Methods: University students in six countries (Australia, Canada, England, Germany, Iceland, and the United States, n=2240) participated in an online survey to assess their fears and attitudes about birth. We report internal consistency reliability, corrected-itemto-total correlations, factor loadings and convergent and discriminant validity of the new scale. Results:The Childbirth Fear -Prior to Pregnancy (CFPP) scale showed high internal consistency across samples (α >0.86). All corrected-item-to total correlations exceeded 0.45, supporting the uni-dimensionality of the scale. Construct validity of the CFPP was supported by a high correlation between the new scale and a two-item visual analog scale that measures fear of birth (r >0.6 across samples). Weak correlations of the CFPP with 2 scores on measures that assess related psychological states (anxiety, depression and stress) support the discriminant validity of the scale. Conclusion:The CFPP is a short, reliable and valid measure of childbirth fear among young women and men in six countries who plan to have children. Highlights• Fear of childbirth can precede pregnancy and is associated with preferences for cesarean section among young men and women who plan to have children in the future.• Assessing fear of birth and associated factors for young adults in different countries is an important first step in understanding why some young women and men are afraid of childbirth and how this issue might be addressed.• We developed a 10-item fear of birth scale that incorporates the main dimensions of fear reported by young adults in the literature, including fear of: labour pain, bodily damage, and complications.• The Childbirth Fear -Prior to Pregnancy (CFPP) scale had high internal consistency reliability across samples, measured one underlying construct, was highly correlated with another measure of childbirth fear, and was weakly correlated with measures of depression, anxiety and stress.

Negative impressions of childbirth in a North-West England student population

“…Students were asked to use 4-point severity/frequency scales to rate the extent to which they had experienced each state over the past week: higher scores indicate more anxiety. The psychometric properties of the scale are well-supported in clinical and community samples [38,40,41]. The anxiety subscale had adequate internal consistency for the current sample (Cronbach's alpha=0.81).…”

“…The reliability and validity of the scale has been evaluated across six countries including the UK [38]. Response options ranged from (1) strongly disagree to (6) strongly agree (scale range 10-60).…”

“…The internal consistency reliability of the scale was high (Cronbach's alpha=0.86). All item-to-total correlations exceeded 0.5, suggesting the items 8 measure one underlying construct and the scale is uni-dimensional [38]. To create scales scores, we summed scale items for women who completed all items of the scale.…”

Anxieties Related to Delivery and Postpartum Period of Pregnant Women Acording to Pregnancy Periods

“…Gebeler, doğum eyleminde yaşanacaklar veya yaşananlar hakkında yeteri kadar bilgi sahibi olmadıkları veya bunu kavrayamadıkları için endişe ve anksiyete hissederken, doğum endişe-leri 3. trimesterde en üst düzeye çıkmaktadır (5,(9)(10)(11)(12) . Primipar gebeler genellikle gelecekte olacaklara karşı bilinmezlik korkusu, multipar gebelerde ise gebelik sürecinde bazı durumların kötü gidebileceği korkusuyaşanmaktadır (13)(14)(15) . Doğum ağrılarıyla baş etmek için kullanacakları yöntemleri ve tepkileri bilemediği, bebeğinin ve kendisinin yaşamsal tehlikelerinin olup olmayacağı, duygusal ve fiziksel olarak bireysel kontrol kaybı yaşandığı için gebeler endişe hissedebilirler (6,16) .…”

A Survey of University Students’ Preferences for Midwifery Care and Community Birth Options in 8 High‐Income Countries

“…An overall response rate could not be established as 2 universities (one in Canada and one in the United Kingdom) did not have central mechanisms for distributing the online survey link, and recruitment occurred through university websites and individual departments. The recruitment of students is described in more detail elsewhere …”