Skip to main content

Research Repository

Advanced Search

A comparison of the Fear of Childbirth Scale with the Tilburg Pregnancy Distress Scale to identify childbirth-related fear in a sample of Dutch pregnant women: a diagnostic accuracy comparative cross-sectional study

Kuipers, Jacoba; Henrichs, Jens; Evans, Kerry


Jens Henrichs

Kerry Evans


Background: Because of the considerable negative effects of women’s childbirth-related anxiety, fear and worries, and the time constraints that midwives perceive to assess women’s antenatal emotional wellbeing, it is important that midwives can identify women with a more severe fear of birth with an easy to administer, validated tool.

Objective: To investigate the ability of the two-item Fear of Childbirth Scale (FOBS) to discriminate between pregnant women with and without birth-related fear, compared with the 16-item Tilburg Pregnancy Distress Scale (TPDS).

Methods: A diagnostic accuracy comparative cross-sectional study was performed, comparing two screening tests. Sensitivity, specificity, positive and negative predictive values and accuracy and discriminant
property of the FOBS were determined and compared with the TPDS and with the negative affect 11-items TPDS (TPDS-NA) subscale. The TPDS and TPDS-NA were treated as reference standard to establish
the discriminative potential of the FOBS for the presence or absence of antenatal birth-related fear.

Participants: A sample of 396 Dutch women with uncomplicated pregnancies.

Results: When compared with the 16-items TPDS, the FOBS showed a higher specificity (95%) than sensitivity (70%) to detect fear of childbirth. The FOBS items had a good predictive ability for fear and worries about the forthcoming birth (79%) and a conclusive ability for negative case-finding (92%). The FOBS showed good accuracy (89%). The FOBS discriminated women who were or were not classified as being fearful according to the TPDS (AUC .86). When compared with the 11 items TPDS-NA subscale, the FOBS validity and accuracy decreased: sensitivity: 51%; specificity 92%; positive predictive ability 65%; negative predictive ability 88%; accuracy 83%; AUC .82.

Conclusion: When compared with the 16-items TPDS, the two-item FOBS shows to be an accurate tool for identifying the he presence of antenatal birth-related fear in a sample of Dutch women with uncomplicated pregnancies.

Journal Article Type Article
Acceptance Date Apr 15, 2020
Online Publication Date May 19, 2020
Publication Date 2020-09
Deposit Date Jan 10, 2022
Journal International Journal of Nursing Studies
Print ISSN 0020-7489
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 109
Article Number 103615
Keywords Antenatal, Anxiety, Birth, Childbirth-related fear, Fear of Birth Scale, TPDS, Tocophobia
Public URL