Cross-Cultural Validation and Psychometric Evaluation of the Birth Beliefs Scale Among Portuguese Pregnant Women

BACKGROUND: Beliefs about childbirth shape women's expectations, decisions, and experiences. Although several tools assess related constructs such as fear or self-efficacy, few instruments focus specifically on childbirth beliefs. The Birth Beliefs Scale (BBS) addresses this gap by measuring 2 dimensions: beliefs in childbirth as a natural event and as a medical event. OBJECTIVE: We sought to adapt the BBS to the Portuguese context and evaluate its psychometric properties. METHODS: This methodological study involved cross-cultural adaptation and psychometric testing. The adaptation followed internationally recognized guidelines, including translation, synthesis, back-translation, expert review, and pretesting. Psychometric evaluation included exploratory and confirmatory factor analysis. The sample comprised 241 pregnant women enrolled in childbirth preparation programs in central Portugal. FINDINGS: The original two-factor structure was partially confirmed following the removal of 3 items with low psychometric performance, including 2 related to labor pain. The Portuguese version (BBS-pt) demonstrated acceptable internal consistency for the Natural subscale (α = 0.68) and lower consistency for the Medical subscale (α = 0.58), suggesting cultural and contextual nuances in how birth beliefs are expressed. CONCLUSION: The BBS-pt is a promising instrument for assessing birth beliefs among Portuguese women. While further refinement is needed, particularly regarding pain-related items, the scale provides a valuable foundation for both research and clinical practice. It may assist nurse-midwives and other maternity care providers in tailoring antenatal education and intrapartum support to women's individual belief patterns, thereby contributing to more personalized and woman-centered care.