This study has presented the stages of preparing the short form of Iranian women's childbirth experience questionnaire based on Goetz psychometric and conceptual criteria [18]. This process resulted in a questionnaire with five subscales: staff support, competence, baby bonding, empowerment, and family support.
The researchers examined the psychometric properties of the questionnaire in terms of model fit (factor analysis), item fit indices, and reliability (all values > 0.70). The short form demonstrated a good fit with the data without applying the correlated errors; these results illustrate the favorable psychometric status of the shortened Iranian women's childbirth experience questionnaire. For the short form of this questionnaire, we decided not to reduce it to fewer items because the main aspects (different aspects and high specificity) of this questionnaire would be spoiled. It was almost impossible to select fewer items without compromising the level of information.
This study reduced the number of subscales to five, and the "fear" domain was omitted. Some studies have shown that ignorance, unrealistic expectations, and lack of feeling of security cause fear [22]. This fear increases the negative experiences of childbirth examined in other domains of these issues in the short form of the questionnaire. The five-subscale short form of the questionnaire includes items for all six remaining subscales. However, some items were removed because they overlapped, and the research team renamed the remaining domains according to the related questions.
Staff support subscale
In this study, items 1 and 2 conceptually overlapped items 4 and 5. The results demonstrated that the service providers created appropriate interactions using proper verbal and non-verbal communication. Moreover, they could understand the needs of women. In this regard, Olubunmi et al. have shown that women have unique needs during labor and delivery, and the service providers must understand them through an appropriate relationship. They should take action to meet these needs considering the acceptable cultural and social norms [22, 23].
Furthermore, items 3 and 8 conceptually overlapped. The results revealed that providing information and increasing the women's awareness helped them better control childbirth during the delivery process because it created realistic expectations, which led to a better understanding and pleasant delivery experience [23, 24].
Correspondingly, items 13, 14, and 15 conceptually overlapped, and all were related to the psychosocial factors affecting the childbirth experience. In line with this issue, Goldkuhl et al. have demonstrated that interaction, organizational factors, and physical environment are related to the delivery environment [25]. As a result, creating the right environment for childbirth reduces women's stress during childbirth, and they will have physiological childbirth and a better understanding of delivery. Therefore, the service provider can play an efficient role in creating a feeling of security, control, and knowledge of delivery through proper interaction, optimal implementation of organizational policy, and providing a safe delivery environment [23].
Competence subscale
In this subscale, items 16, 17, 18, and 20, items 24 and 26, and items 44 and 47 were related to preparation, positive perception, and control subscales, respectively. In this study, the EFA and CFA integrated them and created the concept of competence. Competence is the application of knowledge, skills, attitudes, and values in a given situation [26]. In childbirth, it is the women's understanding of various delivery factors, such as knowledge, motivation, skills, and other factors.
Family support subscale
Item 39 was deleted due to the high conceptual correlation with item 40, indicating the efficient role of the spouse in the labor and delivery stages. Moreover, item 42 overlapped item 41 in terms of concept; i.e., both showed encouraging the woman for vaginal delivery by her companions.
Empowerment subscale
The items existed in the original form of the article. Item 31 conceptually overlapped item 28, and both showed concepts of empowerment. Empowerment includes a sense of satisfaction, contentment, independence, improved interaction with others and the environment, and better adaptation to physical and psychological changes [27]. According to the World Health Organization, empowerment is a process by which individuals will have more control over factors that affect health, such as decisions, lifestyles, and activities. According to the above definitions, high capability indicates pleasant delivery experiences, which can assess one's delivery experiences by evaluating items in this dimension.
Bonding subscale
All items in this subscale remained in the short form of the questionnaire. These items demonstrate the importance of early contact between mother and baby after birth or bonding. In line with this issue, Seefeld et al. have revealed that bonding reflects the childbirth experience. If one has a positive delivery experience, good bonding happens. Hence, the childbirth experience can be determined by knowing the bonding [28]. Since mother–child bonding is a risk factor for impaired child's emotional, behavioral, and cognitive development [29], we can create an appropriate emotional mother-baby bonding and enhance the child's emotional, behavioral, and cognitive growth through a positive delivery experience.
Strengths and weaknesses
One of the limitations of this study is judging the conceptual content based on the authors' opinions. Other limitations include using statistical methods to shorten the instrument and not using the viewpoint of a gynecologist. On the other hand, this study has used a large sample size and analyzed the data in different stages on samples independent of each stage.