The development of the W A + E R (water immersion agency plus expectations and relief) scale

Megan Cooper, Danielle Pollock, Jane Warland, Sarven McLinton

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Some research attention has been paid to women's experiences of water immersion for labour and/or birth. Development of a psychometric scale specific to water immersion may provide further insight into women's experiences. Aim: The objective of this paper is to share the development, and preliminary psychometric evaluation, of the Water immersion Agency plus Expectations and Relief (WA+ER) scale for assessing women's experiences of using water for labour and/or birth. Methods: Items for the WA+ER scale were informed by a thorough literature review, and review by midwifery experts. An online survey was conducted, and 17 items were rated on a 7-point Likert scale (from entirely disagree to entirely agree) by 740 women who had used water immersion for labour and/or birth. Results: An initial exploratory factor analysis was conducted to determine the initial structure of the scale. A confirmatory factor analysis showed that the initial 17-items were not a ‘good fit’ but with further statistical exploration, a good fit was achieved with 11-items. Results identified three factors with good reliability: Sense of Agency (4 items; α = 0.87;), Expectations (3 items; α = 0.83) and Relief (4 items α = 0.82). A confirmatory factor analysis confirmed good model fit (CFI=0.93; GFI=0.91; AGFI=0.85; TLI=0.90). Conclusions: The WA+ER scale is a statistically and theoretically sound tool for measuring women's experiences of labouring and/or birthing in water. Additional testing is required to further assess the validity and reliability of the scale and to determine the appropriateness of its use in other populations.

Original languageEnglish
Article number103298
Number of pages7
Publication statusPublished - Jun 2022


  • Childbirth
  • Choice
  • Experience
  • Scale development
  • Water immersion
  • Waterbirth


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