Beliefs in pregnancy: the psychometric properties of the German version of the birth beliefs scale (BBS)

Objective To evaluate the psychometric properties of the German Birth Beliefs Scale (G-BBS) in a large sample of pregnant women in Germany, and its potential utility for women-centred birth counselling, and respectful maternity care. Methods In this cross-sectional study pregnant women were recruited across antenatal care settings in Bremen, Germany ( n = 602). We assessed item performance, internal consistency, structural validity using confirmatory factor analysis of the original two-factor model, and post hoc split-sample exploratory analyses with confirmatory testing. Construct validity was examined using correlations with self-efficacy, life satisfaction, desire for control, and general anxiety. Known-groups validity was tested by women's preferred place of birth. Methodological quality and interpretation followed Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) criteria for measurement properties. Results Internal consistency was acceptable for both subscales. Hypothesis testing supported construct validity: natural birth beliefs were associated with higher self-efficacy and life satisfaction, whereas medicalised birth beliefs were associated with lower self-efficacy and life satisfaction; associations with general anxiety and desire for control were small. Known-groups validity was strong, with clear gradients in subscale scores by preferred place of birth. However, structural validity was not established: confirmatory analyses did not support the original two-factor structure, and a shortened structure derived from exploratory analyses could not be confirmed either. Conclusions The G-BBS showed promising evidence for construct and known-groups validity, but insufficient structural validity according to COSMIN. Refinement informed by qualitative work and independent psychometric re-testing are needed before routine clinical use or standardised subscale scoring in Germany.