Maternal Confidence for Physiologic Birth: Instrument Development and Testing

Abstract

IntroductionMaternal confidence is associated with enhanced birth experiences through a greater sense of control, feeling more informed, and less pain during labor. A valid and reliable measure of prenatal confidence for physiologic birth for clinical use to identify areas where confidence might be enhanced has not yet been developed.MethodsThis was a multi‐phased instrument development study. Qualitative analysis from a study with 14 women who had a normal physiologic birth, along with concept analysis on maternal confidence, informed the development of a 22‐item Likert scale, the Preparation for Labor and Birth (P‐LAB) instrument. Content validity and face validity were evaluated by a panel of 10 experts including midwives, physicians, and women who had a normal physiologic birth. Psychometric testing of the instrument was performed with a sample of 206 women who were between 34 0/7 to 38 6/7 weeks’ gestation from 5 Midwestern clinics.ResultsThe P‐LAB demonstrated content validity, internal consistency, stability over time, and beginning construct validity. All items had content validity index (CVI) scores greater than or equal to 0.8 and total instrument CVI of 0.95. Four subscales were identified: planned use of pain medication, trusted relationship with care provider and care environment, confidence or fear for childbirth, and support (eg, partner, provider, environment). Cronbach's coefficients alpha for the 4 extracted factors were 0.93, 0.76, 0.73, and 0.74, accordingly. Intraclass correlation (95% CI) for the total questionnaire was 0.92 (0.88 ‐ 0.94).DiscussionExploratory findings demonstrate that the P‐LAB instrument exhibits beginning validity and reliability in the measurement of prenatal maternal confidence for normal physiologic birth. The P‐LAB instrument is a potentially clinically useful instrument to measure maternal confidence for normal physiologic birth, however, more testing is required for continuing to establish construct validity.