Maternal health
Can a questionnaire capture how women experience childbirth?
Open access · cc by · source: Europe PMC
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.
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.
Key findings
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).
Methodology
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).
Limitations
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.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
Complicated or emergency births leave women with poorer experiences and more early breastfeeding difficulty.
How birth unfolds affects women's experience and early feeding: in 920 Swedish first-time mothers, operative births, oxytocin augmentation and long labours were linked to lower childbirth-experience scores, and in a Calgary cohort of 3,021 women almost 40% after emergency caesarean could not breastfeed on the first try versus about 25% after other births.
Evidence for the claim as stated.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
The African studies measure access (whether care is reached at all), while the Swedish and Canadian studies, in well-resourced systems where nearly all women receive care, measure experience and outcomes of that care; findings from one setting should not be transferred directly to the other.
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