gms | German Medical Science

Background: Obesity is considered to be one of the most commonly occurring risk factors in obstetric practice. But even though obese women are widely regarded as high-risk patients, there still remain blind spots in understanding of the best care management for them over the childbearing continuum. Women’s satisfaction with care provision is highly influenced by their expectations regarding the quality of care they will receive. Nevertheless, there are currently no quantitative data available focusing only on obese women’s expectations during childbirth; neither is there a suitable instrument for assessing these expectations.

Aim/Research question: The aim of this study was to develop a suitable instrument to assess the expectations of women with obesity during childbirth.

Methods: The pre-existing Childbirth Expectation Questionnaire (CEQ) was translated from English into the German language and culturally adapted according to the ISPOR-Guidelines. The pre-testing was performed by conducting cognitive interviews with a total of nine pregnant women with and without obesity. The subsequent initial validation of the CEQ was carried out using a content analysis including a content-validity-index (CVI) of each item determined by a panel of experts.

Results: The cognitive interviews led to the replacement of 17 single-item wordings, the addition of four new items and the removal of two items. During the interviews, the topics “informed choice” and “obesity stigma” emerged as very significant for the women in relation to their expectation during childbirth and served as a foundation for the creation of two new items. In all, 38 Items were retained for the CVI analysis. Of them, 10 Items had a CVI <0.78. After an evaluation, six items were revised and resubmitted to experts for another CVI. The final S-CVI/Ave was 0.93 for relevance and 0.97 for clarity, which shows excellent content validity. The German-CEQ consists now of 37 Items with the four dimensions “Support by partner”, “Care by the medical staff”, “Coping with pain” and “Interventions”.

Relevancy: Being able to deliver good quality of birth care for pregnant women with obesity requires a deeper understanding of what matters to them during childbirth. It is essential for health care professionals to identify the pregnant woman’s expectations about her childbirth in order to encourage realistic expectations and to determine their wishes and needs concerning the care they will receive. This translated and adapted survey questionnaire will help women to develop more realistic expectations, thereby positively influence their birth experience and will help to cope more successfully with labor. Additionally, the survey questionnaire could be especially valuable for women who do not know their attending midwife in advance. By understanding individual women’s expectations, midwives are able to provide woman-centered care.

Recommendations/Conclusion: The CEQ has been translated and adapted to the sociocultural and obstetric conditions of pregnant women in Switzerland and now consists of 37 items and four dimensions. The German-CEQ is currently a suitable instrument for assessing expectations of pregnant women during childbirth, especially for women with obesity. Further research will be conducted to comprehensively test the psychometric properties followed by the implementation of the CEQ.

Ethics and conflicts of interest: A clarification of competence was submitted to the cantonal Ethics committee of Bern. They reviewed the study protocol (Req-2020-00920) and granted a waiver for the study, since that research project does not fall under the Swiss Human Research Act (Art. 2, Abs.1). The research was financed by own resources. There are no conflicts of interest.