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

• Childbirth fear precedes pregnancy and is associated with preferences for caesarean section among young men and women who contemplate pregnancy.
• We developed a short childbirth fear scale that incorporates three dimensions of fear: fear of: labour pain, bodily damage, and complications.
• The Childbirth Fear - Prior to Pregnancy (CFPP) scale had high internal consistency reliability across samples, and measured one underlying construct.
• The CFPP was highly correlated with another measure of childbirth fear, and was weakly correlated with measures of depression, anxiety and stress.

BackgroundAssessment 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.MethodsUniversity 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-item-to-total correlations, factor loadings and convergent and discriminant validity of the new scale.ResultsThe 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 analogue scale that measures fear of birth (r > 0.6 across samples). Weak correlations of the CFPP with scores on measures that assess related psychological states (anxiety, depression and stress) support the discriminant validity of the scale.ConclusionThe CFPP is a short, reliable and valid measure of childbirth fear among young women and men in six countries who plan to have children.