Cross-cultural Adaptation and Validation of the Childbirth Fear Prior to Pregnancy Scale in Brazil

Background: The fear of childbirth can range from apprehension to intense fear (tokophobia), with serious consequences for maternal health. Therefore, a standardized scale is needed to measure the fear of childbirth before pregnancy. Objective: This study aimed to adapt the Childbirth Fear Prior to Pregnancy (CFPP) scale to the Brazilian context and analyse its validity and reliability. Methods: A cross-sectional survey was completed by 146 nursing students at two Brazilian universities. A committee of experts evaluated the cross-cultural adaptation of the CFPP scale. Construct validity was verified using item-total correlations and Exploratory Factor Analysis (EFA). The validity of divergent concurrent criteria was evaluated by associating the score obtained using the Brazilian CFPP with the Depression, Anxiety, and Stress Scale (DASS-21). Reliability was analysed using Cronbach’s alpha coefficient and test-retest. Results: Correlation analysis revealed a predominance of moderate inter-item correlation and strong item-total correlation (>0.62). The EFA indicated that all items related to a single factor, with factor loadings and communalities >0.5. These results reinforced the one-dimensionality of the Brazilian CFPP. The validity of divergent concurrent criteria was confirmed via weak correlations with DASS-21 scores (r = 0.32, p < 0.001). The Cronbach’s alpha (0.86) and the intra-class correlation coefficient (0.99) indicated reliability and strong temporal stability, respectively. Conclusion: The Brazilian version of the CFPP provides evidence of validity and reliability to measure fear of childbirth before pregnancy in young adults in Brazil.

The Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth

Background 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. Methods The CFQ’s psychometric properties were evaluated through two studies. Participants were 643 pregnant people residing in English speaking countries for study one, and 881 pregnant people residing in Canada for study two. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Results Exploratory factor analysis in study one resulted in a 40-item, 9-factor scale which was well supported in study two. Both studies provided strong evidence of high internal consistency and as well as convergent and discriminant validity. Study one 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 is generalizable across parity groups). Conclusions The CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth currently 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.

Fear of Childbirth and Associated Factors Among Pregnant Mothers Who Attend Antenatal Care Service at Jinka Public Health Facilities, Jinka Town, Southern Ethiopia

BACKGROUNDWomen face many challenges from conception to postpartum, and fear of childbirth is one of the challenges the women encounter during pregnancy. This could have resulted from different perspectives and it could in turn lead to various pregnancy and childbirth problems. Thus, understanding childbirth fear and factors associated with this is of paramount importance and this study was aimed at addressing this issue.METHODOLOGYA facility-based cross-sectional study was done on 423 pregnant mothers who came for antenatal care services at Jinka hospital and Jinka health center. The study was conducted from June 1to 30, 2018. The sample size was calculated using the single population proportion formula and samples were taken after proportional allocation was done for the hospital and health center using the proportion allocation formula. Individual participants were selected with a systematic sampling technique using k-value of 2 for both the hospital and health center and the first participant was selected by the lottery method from the first two samples. Data were entered into epi-data version 3.1.1. and exported into statistical packages for social sciences version 21.0 for cleaning and further analysis. The level of significance was declared at a p value of less than 0.05 in multivariable logistic regression model. Narratives, figures, and tables were used to put the result.RESULTFrom 423 samples, two of the questionnaires were incomplete and thus 421 were used for analysis giving a response rate of 99.5%. Around a quarter of 102 (24.2%) mothers had fear of childbirth and the remaining 319 (75.8%) had no fear of childbirth. From the factors under consideration, history of previous pregnancy complications, previous history of labor and delivery complications, educational status, and depression status were significantly associated with a mother’s fear of childbirth.CONCLUSIONEven though it is physiological to have some fear of childbirth, the figure obtained is relatively higher. Factors found to have a significant effect on childbirth fear are those which could be tackled through improved health literacy and integrated maternal health services.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

Background: Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby’s health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears. Methods: In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research. Results: After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality. Conclusion: Pregnancy in adult age is better than adolescent age. The women’s fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

The effect of midwifery led counseling based on Gamble’s approach on childbirth fear and self-efficacy in nulligravida women

Background Studies show that childbirth fear is a common problem among Iranian women. Therefore, most Iranian women prefer caesarean section for giving birth. This study investigated the effectiveness of a psychoeducational intervention by midwives (birth emotions - looking to improve expectant fear (BELIEF)) on decreasing childbirth fear and self-efficacy among first-time pregnant women who were afraid of giving birth. Methods A number of 80 pregnant women participated in the study. They had received a score of ≥66 on the Wijma delivery expectancy/experience questionnaire. They were randomly assigned into two groups: intervention (n = 40) and control groups (n = 40). The intervention group received two face-to-face counseling sessions based on the BELEF protocol in the 24th and 34th weeks of pregnancy. Between these two sessions, it also received eight telephone-counseling sessions once a week. The control group only received the prenatal routine care. The outcome measures were childbirth fear, childbirth self-efficacy, and childbirth preference. Results The intervention group showed significantly more reduction in childbirth fear and more increase in childbirth self-efficacy compared to the control group. In addition, more women in the intervention group reported that they preferred to give normal vaginal birth than women in the control group. Conclusion The BELIEF protocol could be an effective approach in reducing childbirth fear and increasing childbirth self-efficacy among first-time pregnant women who are afraid of giving birth. Trial registration number IRCT20101219005417N3, Date of Registration: 19-12-2018.

The effect of midwifery led counseling based on Gamble's approach on childbirth fear and self-efficacy in nulligravida women

Background: Studies show that childbirth fear is a common problem among Iranian women. Therefore, most Iranian women prefer caesarean section for giving birth. This study investigated the effectiveness of a psychoeducational intervention by midwives (birth emotions - looking to improve expectant fear (BELIEF)) on decreasing childbirth fear and self-efficacy among first-time pregnant women who were afraid of giving birth.Methods: A number of 80 pregnant women participated in the study. They had received a score of ≥ 66 on the Wijma delivery expectancy/experience questionnaire. They were randomly assigned into two groups: intervention (n = 40) and control groups (n = 40). The intervention group received two face-to-face counseling sessions based on the BELEF protocol in the 24th and 34th weeks of pregnancy. Between these two sessions, it also received eight telephone-counseling sessions once a week. The control group only received the prenatal routine care. The outcome measures were childbirth fear, childbirth self-efficacy, and childbirth preference. Results: The intervention group showed significantly more reduction in childbirth fear and more increase in childbirth self-efficacy compared to the control group. In addition, more women in the intervention group reported that they preferred to give normal vaginal birth than women in the control group.Conclusion: The BELIEF protocol could be an effective approach in reducing childbirth fear and increasing childbirth self-efficacy among first-time pregnant women who are afraid of giving birth. Trial registration number: IRCT20101219005417N3, Date of Registration: 19-12-2018.