Maternal confidence for physiologic childbirth: Instrument development and testing

Abstract

Maternal confidence is associated enhanced birth experiences through a greater sense of control, feeling more informed, and less pain during labor. However, there is no current definition of maternal confidence for physiologic birth. Further, a valid and reliable measure of prenatal confidence for physiologic birth for clinical use to identify areas where confidence might be enhanced has not yet been developed. The objective of this research was to examine the construct of confidence for physiologic birth and to develop and test a valid and reliable instrument to measure maternal confidence for physiologic birth in the prenatal period. A five-phased instrument development study is presented. In the first section of this dissertation, the results of an in-depth concept analysis using Rodgers’ evolutionary concept analysis method are discussed and an evolving definition of confidence for physiologic birth is provided. This analysis advances the concept of maternal confidence for physiologic birth and contributes new knowledge regarding how confidence for physiologic birth might be enhanced prenatally. The second section describes the development and testing of an instrument to measure prenatal maternal confidence for physiologic birth. Qualitative analysis from a previous study with 14 women who birthed physiologically, along with concept analysis on maternal confidence, informed the development of a 25-item Likert scale. Content validity and face validity were established by a panel of 10 experts. Psychometric testing of the instrument was performed with a sample of 206 women from five Midwestern prenatal clinics. In the third section, prenatal characteristics and birth outcomes are examined in relationship to maternal confidence for physiologic birth. The development of a valid and reliable instrument to measure confidence for physiologic birth during the prenatal period will help to guide interventions to enhance women’s confidence and preparation for childbirth. This may lead to better birthing experiences and improved outcomes for women and infants.