Introduction
Fear of childbirth (FOC) is a significant psychological factor that can influence both the birthing experience and maternal mental health outcomes. To provide a standardized and psychometrically robust measurement of this fear, Klaas Wijma, Barbro Wijma, and M. Zar developed the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A) in 1998. With more than 1100 citations, the W-DEQ-A was specifically engineered to move beyond simple anxiety scales by capturing the unique multidimensional nature of childbirth-related fear. Today, it is recognized globally as the "gold standard" for measuring fear of childbirth.
This guide explores the details of the W-DEQ-A, by focusing on its use in assessing prenatal expectations.
Key Features of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A)
Purpose and Use
The primary purpose of the W-DEQ-A is to assess the level of fear of childbirth (FOC) in pregnant women. By measuring their cognitive and emotional expectations of the upcoming delivery, the W-DEQ-A allows clinicians to identify women who may be experiencing clinical levels of fear (tokophobia) and provide appropriate psychological support or birth planning.
Target Population
The W-DEQ-A assesses fear of childbirth in:
Young pregnant women (18-24 years old)Middle aged pregnant women (25-44 years old)It's suitable for both Parous and nulliparous women.Structure
The W-DEQ-A is a comprehensive 33-item questionnaire. Therefore, it has the ability to capture various facets of the birthing experience, including:
Lack of positive anticipation.Fear (general and specific to the baby/self).Lack of self-efficacy.Loneliness and isolation.The 33 items cover cognitive and emotional expectations of delivery through six key psychological dimensions (sub-domains), as identified in factor analyses:
Fear: Items assessing general fear, tension, panic, and physical symptoms (e.g., "tense", "afraid", "panicky")Negative appraisal: Items on negative feelings toward birth (e.g., "not happy about childbirth", "hopeless", "desolate", "abandoned").Loneliness: Items capturing isolation and lack of support (e.g., "deserted", "lonely during delivery", "misunderstood by staff").Lack of self-efficacy: Items on anticipated helplessness and loss of control (e.g., "weak", "out of control", "incapable of coping").Lack of positive anticipation: Items measuring absence of joy/confidence (e.g., "not glad", "no longing for birth", "not proud").Concerns for the child: Items worrying about baby’s safety/harm (e.g., "afraid baby will be hurt", "concerns for child’s wellbeing").Scoring Method
The W-DEQ-A utilizes a 6-point Likert scale (ranging from 0 to 5) for each item, and the total score (the summation of the scores of each item) ranges from 0 to 165. A higher score is an indication of a greater fear of childbirth.
It should be noted that positively worded items have their scores reversed in the final calculation (reverse scoring), this is done to make sure that higher scores always reflect greater fear. The cutoff score of 85 or higher is used in many studies to define severe fear of childbirth, whereas the categorization of lower scores into mild, moderate, or significant fear may vary between studies.
Administration Format
The W-DEQ-A is a self-administered tool designed for ease of use in clinical settings, and it is available in the following formats:
Paper formsDigital platformsIn‑person interviewsPhone/Video callsThe questionnaire takes 10 to 15 minutes to complete, and requires no specialized training.
Applications of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A)
The W-DEQ-A is widely used for:
Screening: Identifying women with severe fear who may require referral to specialist perinatal mental health services or obstetric counseling via the W-DEQ-A.Monitoring: Tracking changes in fear over time or during interventions.Treatment Planning: Helping midwives and obstetricians understand a patient's specific fears as identified by the W-DEQ-A to tailor the labor and delivery plan.Research: Serving as the primary outcome measure in studies investigating the efficacy of interventions like cognitive behavioral therapy (CBT) or prenatal education on reducing fear of childbirth.Languages and availability
As the international benchmark for FOC research, the W-DEQ-A has been translated and validated in numerous languages, including:
EnglishMandarin ChineseSpanishPortugueseGermanTurkishOther languagesThe W-DEQ-A is Proprietary (Author-owned), the English version is free for researchers. However, clinical and commercial use as well as translated versions need permission.
Reliability and Validity
The W-DEQ-A is Highly Reliable/Valid, with a Cronbach's alpha between 0.87 and 0.93.
Original validation study linkValidation study of the Chinese version linkValidation study of the Spanish version linkPsychometric properties of the Portuguese version linkValidation study of the Italian version linkValidity and reliability of the Greek version linkThe reliability and validity of the Turkish version linkValidity and reliability of the Persian version linkLimitations and Considerations
Despite its strengths, the W-DEQ-A has some limitations:
Self‑report measure: Subject to recall and social desirability bias.Narrow focus: Focuses on fear of childbirth, without assessing broader aspects of pregnancy or the birthing experience.Age Restrictions: Only suitable for women in childbearing age.Social desirability bias: Pregnant women may respond in ways they believe are expected rather than reflecting their true feelings.Length: It may be perceived as too long by some respondents, because it contains 33 items.Cultural Bias: Some items may be interpreted differently due to cultural differences.Other Versions And Related Questionnaires
Other versions for W-DEQ-A are available:
Version B (W-DEQ-B): The post-partum version measuring the experience of childbirth.Additionally, the W-DEQ-A complements other tools, including:
Fear of Birth Scale (FOBS): A shorter, 2-item visual scale.Childbirth Attitude Questionnaire (CAQ)Pregnancy-Related Anxiety Questionnaire (PRAQ)Additional Resources
A direct link to the Original Validation StudyYou can access the questionnaire as a PDF from here.For more information, you can contact Klaas Wijma (Department of Obstetrics and Gynaecology, Linköping University, Sweden) by E-mail: wijma@liu.seFrequently Asked Questions (FAQ)
Who can use the W-DEQ-A?It is intended for use by pregnant women, typically aged 18–45, in clinical or research settings under the guidance of healthcare professionals like midwives or psychologists.
How long does it take to complete the W-DEQ-A?Approximately 10 to 15 minutes.
How is the W-DEQ-A administered?It is a self-administered questionnaire available via paper forms, online platforms, Phone/video calls, or in-person interviews.
IIs there any cost to using the W-DEQ-A?It is often available for research for free, users should consult the original authors or official distributors for licensing requirements in commercial or large-scale clinical use.
A Word from ResRef about the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A)
The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) is a foundational and robust instrument for quantifying fear of childbirth. Its extensive validation and widespread global use make it the primary tool for both clinical screening and high-quality research in perinatal psychology. Users should be mindful of its length and ensure they are using the appropriate version (A or B) for their specific timing (antenatal vs. postnatal).
References
Wijma, K., Wijma, B., & Zar, M. (1998). Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. Journal of psychosomatic obstetrics and gynaecology, 19(2), 84–97. LinkLai, T. H. T., Kwok, S. T., Wang, W., Seto, M. T. Y., & Cheung, K. W. (2022). Fear of childbirth: Validation study of the Chinese version of Wijma delivery expectancy/experience questionnaire version A. Midwifery, 104, 103188. LinkOrtega-Cejas, C. M., Roldán-Merino, J., Lluch-Canut, T., Castrillo-Pérez, M. I., Vicente-Hernández, M. M., Jimenez-Barragan, M., Biurrun-Garrido, A., Farres-Tarafa, M., Casas, I., & Cabrera-Jaime, S. (2021). Reliability and validity study of the Spanish adaptation of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-A). PloS one, 16(3), e0248595. LinkSouto, S. P. A. do, Prata, A. P., Albuquerque, R. S. de, & Almeida, S. (2024). Psychometric properties of the European Portuguese version of the Wijma Delivery Expectancy/Experience Questionnaire in pregnant women. Health Care for Women International, 45(6), 603–620. LinkFenaroli, V., & Saita, E. (2013). Fear of childbirth: A contribution to the validation of the Italian version of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). TPM-Testing, Psychometrics, Methodology in Applied Psychology, 20(2), 177-191. LinkVarela, P., Zervas, I., Vivilaki, V. et al. Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women. BMC Psychol 12, 165 (2024). LinkKorukcu, O., Kukulu, K., & Firat, M. Z. (2012). The reliability and validity of the Turkish version of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) with pregnant women. Journal of psychiatric and mental health nursing, 19(3), 193–202. LinkMortazavi F. (2017). Validity and reliability of the Farsi version of Wijma delivery expectancy questionnaire: an exploratory and confirmatory factor analysis. Electronic physician, 9(6), 4606–4615. Link