Background: Assessment of childbirth fear, in advance of pregnancy, and early identification of modifiable factors contributing to fear can inform public health initiatives and/or school-based educational programming for the next generation of maternity care consumers. We developed and evaluated a short fear of birth scale that incorporates the most common dimensions of fear reported by men and women prior to pregnancy, fear of: labour pain, being out of control and unable to cope with labour and birth, complications, and irreversible physical damage.Methods: University students in six countries (Australia, Canada, England, Germany, Iceland, and the United States, n=2240) participated in an online survey to assess their fears and attitudes about birth. We report internal consistency reliability, corrected-itemto-total correlations, factor loadings and convergent and discriminant validity of the new scale. Results:The Childbirth Fear -Prior to Pregnancy (CFPP) scale showed high internal consistency across samples (α >0.86). All corrected-item-to total correlations exceeded 0.45, supporting the uni-dimensionality of the scale. Construct validity of the CFPP was supported by a high correlation between the new scale and a two-item visual analog scale that measures fear of birth (r >0.6 across samples). Weak correlations of the CFPP with 2 scores on measures that assess related psychological states (anxiety, depression and stress) support the discriminant validity of the scale. Conclusion:The CFPP is a short, reliable and valid measure of childbirth fear among young women and men in six countries who plan to have children. Highlights• Fear of childbirth can precede pregnancy and is associated with preferences for cesarean section among young men and women who plan to have children in the future.• Assessing fear of birth and associated factors for young adults in different countries is an important first step in understanding why some young women and men are afraid of childbirth and how this issue might be addressed.• We developed a 10-item fear of birth scale that incorporates the main dimensions of fear reported by young adults in the literature, including fear of: labour pain, bodily damage, and complications.• The Childbirth Fear -Prior to Pregnancy (CFPP) scale had high internal consistency reliability across samples, measured one underlying construct, was highly correlated with another measure of childbirth fear, and was weakly correlated with measures of depression, anxiety and stress.

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Introduction: Midwifery care is associated with positive birth outcomes, access to community birth options, and judicious use of interventions. The aim of this study was to characterize and compare maternity care preferences of university students across a range of maternity care systems and to explore whether preferences align with evidence-based recommendations and options available. Methods: A cross-sectional, web-based survey was completed in 2014 and 2015 by a convenience sample of university students in 8 high-income countries across 4 continents (N = 4569). In addition to describing preferences for midwifery care and community birth options across countries, this study examined sociodemographic characteristics, psychological factors, knowledge about pregnancy and birth, and sources of information that shaped students' attitudes toward birth in relation to preferences for midwifery care and community birth options. Results: Approximately half of the student respondents (48.2%) preferred midwifery-led care for a healthy pregnancy; 9.5% would choose to give birth in a birthing center, and 4.5% preferred a home birth. Preference for midwifery care varied from 10.3% among women in the United States to 78.6% among women in the United Kingdom. Preferences for home birth varied from 0.3% among US women to 18.3% among Canadian women. Women, health science students, those with low childbirth fear, those who learned about pregnancy and birth from friends (compared with other sources, eg, the media), and those who responded from Europe were significantly more likely to prefer midwifery care and community birth. High confidence in knowledge of pregnancy and birth was linked to significantly higher odds of community birth preferences and midwifery care preferences. Discussion: It would be beneficial to integrate childbirth education into high school curricula to promote knowledge of midwifery care, pregnancy, and childbirth and to reduce fear among prospective parents. Community birth options need to be expanded to meet demand among the next generation of maternity service users.