For many women having a generalized level of fear and anxiety about the childbirth experience is a normative response.This emotion, for some women, translated into a sense of fear that can become so overwhelming that it influences obstetric outcomes, as well as a woman’s ability to access and maintain medical care.Research has been constrained by a lack of a reliable and valid instrument that measures fear of childbirth (FOC) in the context of the maternity care system in the United States.The purpose of this study was to organize the phenomenon of FOC in the United States, and to adapt a gold-standard instrument to accurately measure it. The adaptation of the instrument was guided by Ecological Systems Theory. In the first part of this project a diverse sample of women were recruited to participate in three focus groups in order to conceptually organize the phenomenon of FOC and to develop language for use in instrument adaptation, the Revised Wijma Delivery Expectancy Questionnaire (R-WDEQ).The findings of the focus group indicated that FOC is a complex phenomenon grounded in fear at the individual, provider, birth setting, and societal level. Content validity of the revised instrument was determined using a panel of six experts resulting in a Content Validity Index of .93. Through item reduction and content validity testing the R-WDEQ was reduced to 10 items and renamed the WDEQ-US.Factor analysis was performed using principal component analysis with oblique rotation revealing three factors, identified as External Fears, Fear of Death, and Internal Fears. The three factor solution explained 63.1% of the variance.Further testing is needed to ensure that the instrument is accurately measuring FOC across a diverse population of pregnant women.
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