Identifying pregnant women with severe fear of childbirth using the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire: A cross‐sectional study

Aim This study aimed to investigate, separately among primiparas and multiparas, whether qualitatively distinct groups based on fear of childbirth (FOC) could be identified using the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire (JW‐DEQ), and to identify groups characterized by severe FOC. It also aimed to determine JW‐DEQ cut‐off scores for severe FOC and associated factors. Methods A cross‐sectional online survey was conducted between May 2019 and January 2020. Pregnant women at ≥35 weeks of gestation were recruited from 26 obstetric facilities in Japan. Two‐step cluster analysis was performed using four JW‐DEQ subscales. Multiple logistic regression identified factors associated with severe FOC. Results Data from 642 women were analyzed. Four clusters were identified among primiparas and two among multiparas, with one cluster in each parity group characterized by severe FOC. The severe FOC cluster comprised 17.2% of primiparas and 44.0% of multiparas and had lower health‐related quality of life. Optimal JW‐DEQ cut‐off scores were 77/78 for primiparas and 61/62 for multiparas. In both groups, poor maternal bonding, more severe depression, and a lower sense of coherence were associated with severe FOC. In multiparas, less satisfaction with a previous childbirth experience and less favorable perceptions of midwifery care were also associated with severe FOC. Conclusion Qualitatively distinct FOC groups, including a group characterized by severe FOC, were identified separately among primiparas and multiparas. The proposed parity‐specific JW‐DEQ cut‐off scores may facilitate the identification of severe FOC; however, further validation in independent samples is warranted.