title: Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort.
abstract: BACKGROUND
  The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice.
  
  
  OBJECTIVE
  To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women.
  
  
  METHODS
  Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics.
  
  
  RESULTS
  1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean.
  
  
  CONCLUSIONS
  This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia; Northeast Health, Green St, Wangaratta, Victoria, Australia. Electronic address: hhaines@unimelb.edu.au.
authors.forename: H M
authors.initials: HM
authors.lastname: Haines
authors.affiliation: Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia.
authors.forename: J F
authors.initials: JF
authors.lastname: Pallant
authors.affiliation: Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia; Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Fenwick
authors.affiliation: Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Gamble
authors.affiliation: Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: D K
authors.initials: DK
authors.lastname: Creedy
authors.affiliation: Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Toohill
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Hildingsson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000175:diagnosis*; D019540:Area Under Curve; D001315:Australia; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology*; D003863:Depression / Q000150:complications; D005239:Fear; D005260:Female; D006801:Humans; D010298:Parity; D036801:Parturition; D010698:Phobic Disorders / Q000175:diagnosis; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D037841:Pregnant People / Q000523:psychology*; D012372:ROC Curve; D012016:Reference Values; D057566:Self Report / Q000592:standards*
keywords: Antenatal care; FOBS; Fear of birth; Pregnancy; Screening; WDEQ