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.
Highlights
Worldwide, approximately 137 million births occur each year, with over 300,000 babies born in Canada alone [1]
Fear of body damage from a vaginal birth; Fear of pain to the RMSEA, and near-acceptable fit according to the TLI1; it was the most concepfrom a vaginal birth with Fear of insufficient pain medication and Fear of body damage tually interpretable of the three solutions we investigated in detail
Our confirmatory factor analysis (CFA) of the exploratory measurement model from Study 1 suggested that our model fit the data extremely well, (676) = 4300.63, p < 0.001, Comparative Fit Index (CFI) = 0.977, TLI = 0.974, RMSEA
Summary
Approximately 137 million births occur each year, with over 300,000 babies born in Canada alone [1]. Maternal mortality is lowest in high income countries [2]. 100,000 live births, and a measure of the overall quality of maternal health and reproductive care) was 11 per 100,000 live births in high income countries [2]. In low-income countries, maternal mortality is higher, with 462 death per 100,000 live births [2]. In recognition of the likelihood that the CFQ would include both a total scale score and subscale scores, we developed multiple items for each fear domain (a minimum of three items per subscale are needed to ensure a reasonable degree of internal consistency reliability). To be able to reduce the overall number of items, and develop subscales with high internal consistency and reliability, each content domain initially included five or more items
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