Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth

Abstract

Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.

Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e)

“…The total score can therefore range from 0 to 160 points (the higher the score, the greater the fear). These items are grouped into 9 subscales, which represent different dimensions or constructs of the fear of childbirth [ 17 , 25 ].…”

“…To obtain each subscale’s score, the scores of the items in each subscale are added up, and the sum was divided by the number of items within each subscale. This made it possible to compare the different subscale scores [ 17 , 22 , 25 ].…”

“…Other multidimensional tools have thus been developed to measure FOC. One example is the Slade–Pais Expectations of Childbirth Scale (SPECS) [ 24 ], or more recently, the Fear of Childbirth Questionnaire (CFQ) [ 17 , 22 , 25 ].…”

“…The CFQ’s creators designed the instrument so that it could both measure FOC symptom severity and be used as a screening tool for clinically significant symptoms. To do this, the CFQ includes a wide range of fears related to childbirth that can be perceived by women, reflected in 40 items and organised into 9 dimensions or subscales [ 17 , 22 , 25 ]. This feature is important, as it allows one to detect and determine the domains in which health professionals should further educate and/or intervene when addressing a pregnant woman with FOC.…”

“…The CFQ was validated in a sample of 643 pregnant women from different English-speaking countries (Canada, the United States and the United Kingdom). A Cronbach’s alpha of 0.94 was obtained for the general 40-item scale and 0.85 for the interference scale [ 17 , 25 ].…”