ArticleActa obstetricia et gynecologica Scandinavica2026
Psychometric and clinical validation of the fear of childbirth questionnaire in a UK population.
Article in Acta obstetricia et gynecologica Scandinavica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSevere fear of childbirth (FOC) during pregnancy holds significant implications for maternal mental health, decisions about mode of birth, and potentially infant development. Until recently, there were no tools available to measure FOC within a UK population that assessed the full construct using acceptable phraseology. A new tool, the Fear of Childbirth Questionnaire, has been developed but requires full psychometric evaluation. This study aimed to assess the validity and reliability of the Fear of Childbirth Questionnaire and examine possible threshold scores indicating clinical severity. MATERIAL AND
methodsPregnant women (N = 540) completed the Fear of Childbirth Questionnaire online alongside additional measures for current/previous obstetric history, anxiety, and depression to test dimensions of validity (ISRCTN62032021). Most women (N = 360) then completed the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 5th Edition (Research Version) Module F (phobia) with trained interviewers over the telephone. Sensitivity and specificity were calculated. A subsample (N = 61) repeated Fear of Childbirth Questionnaire completion 2 weeks later to inform test-retest reliability. Internal consistency, validity (convergent, discriminant, and criterion-related), unidimensionality, and factor structure were examined.
resultsInternal consistency was excellent (α = 0.89; ω = 0.89) and test-retest reliability was good (r = 0.87). Strong association with the Fear of Birth Scale (r = 0.69) indicated convergent validity. Discriminant validity was indicated via moderate correlations with general measures for anxiety (r = 0.40-0.53), and less so with those of depression (r = 0.35). Scores were higher for those with current/previous mental health difficulties, previous birth trauma, those preferring an epidural, and those preferring a planned cesarean section, indicative of criterion-related validity. An optimal cut-off value of ≥33 total score and ≥4 current impact score is recommended to initiate further exploration of support/intervention needs (ROC Area under the curve = 0.80, 95% CI 0.75:0.85; sensitivity 71.9, specificity 85.4, positive predictive value 39.0, negative predictive value 95.9).
conclusionsThe Fear of Childbirth Questionnaire is psychometrically robust and can identify FOC at levels commensurate with a clinical phobia. It is the only tool purposefully developed and clinically validated to identify FOC in a UK population.
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