The development and validation of an antenatal expectations of labour and birth measurement tool: EXPECTBirth Tool

Background A mismatch between birth expectations and experience has been linked to lower satisfaction with birth alongside increasing post-traumatic stress symptoms. We aimed to design and validate an instrument to measure birth expectations (EXPECTBirth). Methods We performed (1) a systematic review of birth expectations to identify instrument content, (2) think aloud interviews to iteratively develop the instrument, (3) an online pilot survey for exploratory analysis and initial item reduction. Using data from an antenatal education intervention development study we performed (4) a Rasch analysis to select best functioning items and (5) responsiveness to change test. We then returned to the data from (3) to undertake (6) test-retest reliability and finally (7) external validity compared to existing gold standard. For element 3,6,7, we carried out a National online survey, for element 4 and 5 we performed a single site implementation development study at large maternity service in Southwest England. Eligible participants were pregnant/postnatal women. Results An initial 45 item questionnaire was developed based on the systematic review and modified in 14 think aloud interviews. Two hundred and thirty four women completed the pilot online questionnaire (elements 3,6,7) and 143 women completed the antenatal education study and the initial survey (element 4) and 110 of these completed the questionnaire at baseline and follow up and therefore contributed to the responsiveness to change (element 5). The applied statistical procedures led to a 12-item tool for measuring birth expectations that presents satisfactory overall responsiveness to change (Cohen’s average effect size 0.35, showing small-moderate responsiveness), test-retest reliability (Spearman Co-efficient 0.83 p<0.001) and performs well against the existing gold standard Slade-Pais tool, all subscales being at least moderately correlated (rho 0.25 and 0.71). Conclusions The EXPECTBirth tool can be used to assess expectations of birth quickly and in a neutral manner and investigate whether antenatal interventions alter expectations of birth. Further work is need to understand whether there is an correlation between EXPECTBirth scores and perinatal mental health outcomes.