Can a questionnaire capture how women experience childbirth?
A new 22-item questionnaire captured four distinct parts of the birth experience and scored lower, as expected, for women with long, augmented or operative births.
Source
Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument
Study at a glance
- Design
- Cross-sectional — Questionnaire development (literature, midwife input, interviews, pilot) followed by a one-month postpartum postal survey analysed with exploratory factor analysis, multitrait scaling and known-groups comparisons
- N
- N=920 · 920 primiparous women returned evaluable questionnaires out of 1177 invited (78% response); 25 women took part in the face-validity pilot
- Population
- Healthy first-time mothers with spontaneous onset of active labour at term at two Swedish hospitals, 1998-2003
- Outcome
- Factor structure, internal consistency and known-groups validity of the Childbirth Experience Questionnaire
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The team drafted questionnaire items from the literature, midwives' expertise and interviews with new mothers, pilot tested them in 25 first-time mothers and ended up with 28 items. The questionnaire was mailed one month after birth to 1177 first-time mothers from a labour study at two Swedish hospitals. They used exploratory factor analysis to find underlying dimensions, tested reliability with Cronbach's alpha, and checked whether scores differed between groups expected to have worse experiences (labour over 12 hours, oxytocin augmentation, operative delivery).
What they found
Of those invited, 920 women (78%) returned usable questionnaires. After dropping items with extreme ceiling effects or weak loadings, 22 items formed four dimensions: Own capacity, Professional support, Perceived safety and Participation, together explaining 54% of the variance. Reliability was acceptable for all scales except Participation. Women with operative births, oxytocin augmentation or long labours scored lower on every scale, with effect sizes mostly small to moderate (largest for Own capacity, 0.72 for operative births).
The limits
What it doesn't show
The sample was only healthy first-time mothers with spontaneous labour in Sweden, so the questionnaire's validity in women with complicated pregnancies, repeat births or other cultures is untested. The factor structure came from an exploratory analysis in one sample and was not confirmed in an independent sample, and test-retest reliability was not assessed. The Participation scale had only 3 items and a low Cronbach's alpha, and Professional support showed strong ceiling effects, limiting the ability to detect differences. Data were collected 1998-2003, and the study validates a measurement tool rather than testing any change in care.
Key terms
- Exploratory factor analysis
- A statistical technique that groups questionnaire items into underlying dimensions based on how responses correlate.
- Cronbach's alpha
- A measure of internal consistency: how well items in a scale hang together; 0.70 or higher is usually considered acceptable.
- Ceiling effect
- When most respondents choose the highest possible score, so the item cannot distinguish between people who are doing well.
- Known-groups validity
- Evidence that a measure distinguishes between groups expected to differ, such as women with and without operative births.
- Cohen's effect size
- The difference between two group means divided by their pooled standard deviation, used to judge whether a difference is small, moderate or large.
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Quiz yourself
Which statistical method was used to identify the CEQ's dimensions?
Common questions
Why send the questionnaire one month after birth?
By then mothers have passed the immediate relief phase but still remember the birth clearly, and they have little contact with birth staff, which may reduce socially desirable answers.
Why were some items removed even though they seemed important?
Items about partner support and the baby's wellbeing had extreme ceiling effects, so almost everyone gave the top answer and the items could not tell women apart.
Does a lower score after caesarean prove caesareans cause worse experiences?
No. The comparison was used to check the questionnaire works; it is observational, and women with operative births may differ in other ways, such as longer or more complicated labours.
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