Fear Of Childbirth In Pregnant Women And Its Influencing Factors

ObjectiveTo evaluate the reliability and validity of the Childbirth Attitude Questionnaires(CAQ)for measuring the fear of childbirth(FOC)in Chinese pregnant women,and to analyze the incidence of the fear of childbirth in Chinese pregnant women and identify its associated factors based on CAQ.MethodsA multi-center cross-sectional study was conducted in four cities in China during the period from May to July 2018,and 1039 pregnant women were recruited.The CAQ was employed to measure the incidence of FOC in this study.The reliability of CAQ was evaluated by internal consistent reliability and split-half reliability.Pearson correlation analysis and confirmatory factor analysis were used to measure the validity of the CAQ.The factors associated with the FOC in pregnant women were identified by t test,F test,simple linear correlation and multiple linear regression.Data analysis was performed by SAS 9.2 and AMOS 17.0.Results1.The reliability and validity of CAQ.The overall Cronbach's ? coefficient of the CAQ was 0.92,and the split-half coefficient was 0.89.The Pearson correlation analysis showed that the correlation coefficients between the scores of the four dimensions of thescale and the total score were 0.91,0.89,0.90,and 0.76,respectively.Confirmatory factor analysis showed that theory factor structure of CAQ is matched with the sample data,which implied robust construct validity.Results showed that the goodness of fit index(GFI),the adjusted goodness of fit index(AGFI),the comparative fit index(CFI),the normed fit index(NFI)were 0.938,0.909,0.944 and 0.934,respectively,and the root means square error of approximation(RMSEA)was 0.068.2.Current situation of FOC in pregnant women.The average score for CAQ was31.30,and the standard deviation was 8.43.According to the definition of CAQ scores,the proportion of pregnant women with mild,moderate,and severe fear of childbirth was 50.24%,13.67%,and 2.31%,respectively.The items that were rated with higher fear were the “fear of uterine contractions”(84.89%)and “fear of baby being injured during the childbirth”(84.60%).3.Influencing factors of FOC in pregnant women.Univariate analysis showed that there were no significant difference in FOC among different group of ages,education levels,working status,place of residence,hospital level,and gestational age.Women who used pregnancy-related smartphone Apps scored higher on the CAQ than those who did not(P<0.05).Those who received prenatal education,and those with low self-rated health,and poor self-rated economic situations had higher CAQ scores(P<0.05).The self-efficacy score was negatively correlated with the FOC score,and the correlation coefficient was-0.25(P < 0.001).Multiple linear regression analysis showed that the correlation between self-rated economic status,prenatal education and the FOC was no longer significant.Higher CAQ scores were significantly associated with higher education levels,poorer self-rated health,lower levels of self-efficacy,and the use of pregnancy-related smartphone Apps,and their partial regression coefficients were 2.26,2.06,-0.79,and 2.42,respectively(P<0.05).ConclusionsThe CAQ has good reliability and validity in this study,which could be used as an appropriate tool to measure FOC.FOC was common in Chinese nulliparous women.In the pre-pregnancy health-care,we should focus on those women who with high level ofeducation,poor self-evaluation and low self-efficacy.In addition,we need to pay attention to the negative impact of the use of pregnancy-related smartphone Apps on FOC.For primary health-care provider,it is necessary to identify Chinese pregnant women who exposed to FOC,and implement targeted interventions.Highlights and limitationsThis multi-center cross-sectional study recruited a large sample of pregnant women in four cities,and the representative of this study was better than that of previous studies which involved pregnant in the third trimester at one hospital or city only.Additionally,this was the first study to explore the association between the use of pregnancy-related smartphone Apps and FOC.There are three limitations.Firstly,this study recruited nulliparous only,and the impact of parity and history of pregnancy on the FOC is needed to be further verified by future research.Secondly,the character of pregnancy-related smartphone Apps was not assessed at present,and the relationship between Apps and FOC needs further in-depth research.Thirdly,the present study is a cross-sectional study,which limits the possibility of establishing causal relationship among study variables.