The WA+ER scale: measuring women's experience of water for labour and birth

Research output: Contribution to journalMeeting Abstractpeer-review


Immersion in warm water during labour and birth seems to facilitate an environment where women are able to experience greater trust in the birth process and therefore, their ability to give birth. As such, evidence suggests that women who labour and/or birth in water report a positive experience. To date, there has been no way to measure women’s experiences of using water for labour and birth.

To develop, and undertake preliminary psychometric evaluation, of the Water immersion Agency plus Expectations and Relief (WA+ER) scale for measuring women’s experiences of using water for labour and/or birth.

Items for the WA+ER scale were informed by a thorough review of the literature. A total of 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 via an online survey.

The initial exploratory factor analysis determined the initial structure of the scale while a confirmatory factor analysis revealed that the initial 17-items were not a ‘good fit.’ A good fit was achieved with 11-items following further statistical exploration - a confirmatory factor analysis confirmed good model fit (CFI=.93; GFI=.91; AGFI=.85; TLI=.90). Three factors were identified with good reliability by Cronbach’s Alpha: Sense of Agency (4 items; α = .87;), Expectations (3 items; α = .85) and Relief (4 items α = .82).

Until now, there has not been a tool or scale to measure women’s experience of using water immersion during labour and/or birth. The WA+ER scale is a statistically and theoretically sound tool for measuring women’s experiences of labouring and/or birthing in water. Results suggests that the final WA+ER 11-item scale reliably measures the identified dimensions of the water immersion experience - agency, expectations, and relief. Additional testing is required to further assess the validity and reliability of the scale.
Original languageEnglish
Pages (from-to)S39-S39
Number of pages1
JournalWomen and Birth
Issue numberSupplement 1
Publication statusPublished - Sept 2023
EventAustralian College of Midwives National Conference: Be the Change - Adelaide Convention Centre, Adelaide, Australia
Duration: 12 Sept 202314 Sept 2023

Bibliographical note

Poster presentation P21 by Megan Cooper, Wednesday 13th September 2023.


  • Water immersion
  • Birth
  • Labour


Dive into the research topics of 'The WA+ER scale: measuring women's experience of water for labour and birth'. Together they form a unique fingerprint.

Cite this