ORIGINAL RESEARCH – QUALITATIVE| Volume 29, ISSUE 3, e44-e49, June 2016

Pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale

Published:December 19, 2015DOI:



      Fear of childbirth is common during pregnancy but rarely assessed in clinical practice. The Fear of Birth Scale has been proposed as a valid measure suitable for assessing fear of birth in an antenatal clinical context. To make sure that the scale makes sense in relation to the known constructs of fear of birth, it is important to find out what women think when responding to the Fear of Birth Scale.


      To report what women in mid-pregnancy think when assessing fear of birth on the Fear of Birth Scale.


      A qualitative design using semi-structured interviews with a think aloud technique was used. Thirty-one women were recruited in gestational week 17–20. Content analysis was conducted to describe the different dimensions of fear of birth.


      Worry was described as unspecific feelings and thoughts, often with a negative loading. Fear was described as a strong feeling connected to something specific. Furthermore, the women thought about aspects that influence their worries and fears and explained the strategies that helped them to cope with their fear of birth.


      Women could clearly assess, describe, and discuss fear of birth using the Fear of Birth Scale. This supports the use of the Fear of Birth Scale in clinical settings as a starting point for further dialogue about women's fear of birth. The dialogue may identify women's need for information, treatment, and referral when necessary.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Saisto T.
        • Halmesmäki E.
        Fear of childbirth: a neglected dilemma.
        Acta Obstet Gynecol Scand. 2003; 82: 201-208
        • Högberg U.
        • Lynöe N.
        • Wulff M.
        Cesarean by choice? Empirical study of public attitudes.
        Acta Obstet Gynecol Scand. 2008; 87: 1301-1308
        • Sjögren B.
        Fear of childbirth a challenge in health care. Cesarean section not the only way out, professional support during pregnancy and planned delivery a relief to many.
        Läkartidningen. 2003; 100: 2932-2935
        • Areskog B.
        • Uddenberg N.
        • Kjessler B.
        Fear of childbirth in late pregnancy.
        Gynecol Obstet Invest. 1981; 12: 262-266
        • Zar M.
        • Wijma K.
        • Wijma B.
        Pre- and postpartum fear of childbirth in nulliparous and parous women.
        Scand J Behav Ther. 2001; 30: 75-84
        • Ternström E.
        • Hildingsson I.
        • Haines H.
        • Rubertsson C.
        Higher prevalence of childbirth related fear in foreign born pregnant women – findings from a community sample in Sweden.
        Midwifery. 2015; 31: 445-450
        • Wijma K.
        • Wijma B.
        • Zar M.
        Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth.
        J Psychosom Obstet Gynecol. 1998; 19: 84-97
        • Rouhe H.
        • Salmela-Aro K.
        • Gissler M.
        • Halmesmäki E.
        • Saisto T.
        Mental health problems common in women with fear of childbirth.
        BJOG Int J Obstet Gynaecol. 2011; 118: 1104-1111
        • Storksen H.T.
        • Eberhard-Gran M.
        • Garthus-Niegel S.
        • Eskild A.
        Fear of childbirth; the relation to anxiety and depression.
        Acta Obstet Gynecol Scand. 2012; 91: 237-242
        • Rubertsson C.
        • Hellström J.
        • Cross M.
        • Sydsjö G.
        Anxiety in early pregnancy: prevalence and contributing factors.
        Arch Womens Ment Health. 2014; 17: 221-228
        • Barlow D.H.
        Anxiety and its disorders, second edition: the nature and treatment of anxiety and panic.
        2nd ed. The Guilford Press, New York2004
        • Bruhn J.G.
        The two sides of worry.
        ET J. 1990; 83: 557-562
      1. Lewis M. Haviland-Jones J.M. Barrett L.F. Handbook of emotions. 3rd ed. The Guilford Press, New York2010
        • Borkovec T.D.
        • Robinson E.
        • Pruzinsky T.
        • DePree J.A.
        Preliminary exploration of worry: some characteristics and processes.
        Behav Res Ther. 1983; 21: 9-16
        • Almström E.
        • Björklund U.
        • Ellis J.
        • Ryding E.L.
        • Sundell G.
        • Werner A.
        Work and reference group report no. 51. Childbirth fear. Linköping (Sweden): Svensk förening för obstetrik och gynekologi.
        Swedish Association of Obstetrics & Gynecology, 2004
        • Haines H.
        • Pallant J.F.
        • Karlström A.
        • Hildingsson I.
        Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample.
        Midwifery. 2011; 27: 560-567
        • Hildingsson I.
        • Johansson M.
        • Fenwick J.
        • Haines H.
        • Rubertsson C.
        Childbirth fear in expectant fathers: findings from a regional Swedish cohort study.
        Midwifery. 2014; 30: 242-247
        • Fisher C.
        • Hauck Y.
        • Fenwick J.
        How social context impacts on women's fears of childbirth: a Western Australian example.
        Soc Sci Med. 2006; 63: 64-75
        • Eriksson C.
        • Westman G.
        • Hamberg K.
        Content of childbirth-related fear in Swedish women and men – analysis of an open-ended question.
        J Midwifery Womens Health. 2006; 51: 112-118
        • Fenwick J.
        • Toohill J.
        • Creedy D.K.
        • Smith J.
        • Gamble J.
        Sources, responses and moderators of childbirth fear in Australian women: a qualitative investigation.
        Midwifery. 2015; 31: 239-246
        • Melender H.-L.
        Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women.
        Birth Berkeley Calif. 2002; 29: 101-111
        • Kvale S.
        • Brinkmann S.
        InterViews. Learning the craft of qualitative research interviewing.
        2nd ed. Sage Publications, Inc., Thousand Oaks, CA, US2009
        • Ericsson K.A.
        • Simon H.A.
        Protocol analysis, revised edition: verbal reports as data.
        MIT Press, Cambridge, Mass.1993
        • Graneheim U.H.
        • Lundman B.
        Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.
        Nurse Educ Today. 2004; 24: 105-112
        • Granskär M.
        • Höglund-Nielsen B.
        Tillämpad kvalitativ forskning inom hälso-och sjukvård.
        Studentlitteratur, Lund2008
        • Hsieh H.-F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Hildingsson I.
        • Thomas J.
        • Karlström A.
        • Olofsson R.E.
        • Nystedt A.
        Childbirth thoughts in mid-pregnancy: prevalence and associated factors in prospective parents.
        Sex Reprod Healthc. 2010; 1: 45-53
        • Eriksson C.
        • Westman G.
        • Hamberg K.
        Experiential factors associated with childbirth-related fear in Swedish women and men: a population based study.
        J Psychosom Obstet Gynecol. 2005; 26: 63-72
        • Nilsson C.
        • Lundgren I.
        • Karlström A.
        • Hildingsson I.
        Self reported fear of childbirth and its association with women's birth experience and mode of delivery: a longitudinal population-based study.
        Women Birth J Aust Coll Midwives. 2012; 25: 114-121
        • Stoll K.
        • Hall W.
        • Janssen P.
        • Carty E.
        Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students.
        Midwifery. 2014; 30: 220-226
        • Baumeister R.F.
        • Bratslansky E.
        • Finkenauer C.
        • Vohs K.D.
        Bad is stronger than good.
        Rev Gen Psychol. 2001; 5: 323-370
        • Georgsson Ohman S.
        • Waldenström U.
        Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample.
        Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2008; 32: 15-22
        • Schytt E.
        • Waldenström U.
        • Olsson P.
        Self-rated health – what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews.
        Scand J Caring Sci. 2009; 23: 711-720
        • Lincoln Y.S.
        • Guba E.G.
        Naturalistic inquiry.
        1st ed. SAGE Publications, Beverly Hills, CA1985
        • Elo S.
        • Kääriäinen M.
        • Kanste O.
        • Pölkki T.
        • Utriainen K.
        • Kyngäs H.
        Qualitative content analysis a focus on trustworthiness.
        SAGE Open. 2014; 4
        • Rouhe H.
        • Salmela-Aro K.
        • Halmesmäki E.
        • Saisto T.
        Fear of childbirth according to parity, gestational age, and obstetric history.
        BJOG Int J Obstet Gynaecol. 2009; 116: 67-73
        • Polit D.F.
        Nursing research: generating and assessing evidence for nursing practice.
        9th ed. Lippincott Williams & Wilkins, 2012