Title: Does the birth plan match what is relevant to women? Preferences of spanish women
when giving birth
Version: 1 Date: 10 Nov 2023
Reviewer:  Héctor González-de la Torre
Reviewer's report:
Dear Authors:
Thank you for allowing me to review your manuscript, which deals with a topic that I consider
very important. I am coming in at an advanced stage in this review, as I have not had the
opportunity to review the original manuscript from the beginning, but I can appreciate that many
changes have been requested and made. I will make a few comments with the aim of clarifying
certain issues raised with me and being able to improve the manuscript:
Method:
-According to the method of selection of participants that you indicate, it is a non-probability
consecutive sampling. But to be considered as such, the flow chart of participants should be
presented, in order to know how many women could participate ( you indicate how many were
invited and how many wanted to participate, which is not the same concept), and an additional
snowball sampling was carried out.) As I see it, in this study, in my opinion, a convenience
sampling has been carried out, which has important limitations (it is pointed out in the discussion
in reference to snowball sampling and is accepted by me). This is linked to another important
aspect that I must point out: no sample calculation was performed. This is a very important
limitation, since it affects the power of the study and its external validity. This should appear as
a limitation. Why was no sample calculation performed?
-Were any exclusion criteria established?
--you refer to a questionnaire designed and validated in a sample of 250 women with adequate
characteristics of reliability, validity and usability. you must present references or values that
support this statement.
-Currently in Spain there are two validated instruments to measure fear of childbirth (CFQ-e and
the W-DEQE-A/B), three if we count the Birth Anticipation Scale (BAS). I am familiar with
the W-DEQ-A. It is an instrument with adequate psychometric properties. You should indicate
in methods some data to support its validity (e.g. the internal consistency values obtained by
Ortega-Cejas CM et al). Therefore, I do not understand why  you have performed a confirmatory
factor analysis. This has already been done by Ortega-Cejas CM et al. It is usual to calculate the
internal consistency in the sample, but why perform a factor analysis? The communication of the
factor analysis performed is very scarce (both in methods and results). No data are given on what
approach was used (linear or nonlinear), what type of correlation matrix was used (polychoric or
pearson), method of factor extraction or rotation used.  The sample size is too small to perform
a factor analysis, how was the sample adequacy of the factor analysis evaluated, was the kaiser
meyer olkin index or barlett's statistic used? The following indices should always be provided:
(a(a) fit of the solution per se (for example, the Goodness-of-Fit Index GFI), (b) comparative fit
of the proposed solution against the null model of independence (Non-Normed Fit Index (NNFI)
or Comparative Fit Index (CFI)) and (c) relative fit of the model according to its complexity
(Root Mean Square Error of Approximation (RMSEA).
In my opinion, it does not make sense to perform a factor analysis in this design: the W-DEQ-A
has appropriate psychometric properties and can be used to measure fear of childbirth in Spanish
women.
In the results in Figures 1 and 2, the percentage that appears is not clear what it corresponds to.
The figures should be understood without the support of the main text.
I hope you take these comments as an opportunity for improvement.