Parents Birth Report Survey

Welcome to our Parents Birth Report Survey

Name
How many weeks was your pregnancy at the time of this birth? (gestational age)
Was this a multiple birth (twins, triplets, etc.)?
What was your baby's birth weight?
Where did this birth take place?

Which birthing professional(s) attended your birth? Please select all that apply

Was the care provider who attended your birthing
Who were your birthing companions, the ones who were there primarily for your support? Select all that apply

Thinking about the time after surges became fairly regular, how long was your labor? (Not counting pre-labor warmups, practice labor or early labor.)
How did your labor start?
Here is a list of things that are sometimes done during labor. Please check all that apply to this birth.
Did you feel pressure from a medical professional to have any of these procedures or interventions?
Were any procedures or interventions done without your full understanding or permission?
Did you experience any perineal damage or tearing as a result of this birth?
Was this a surgical (Cesarean) birth?
What was the main position you used as your baby was coming out?
Was your baby born in water?
Please rate your comfort level during during early labor (up to 6 or 8 cm)
Please rate your comfort level during during late labor
Please rate your comfort level during during the birthing phase
Rate mother's comfort in first 48 hrs. after birthing
Rate mother's sense of well-being in first 48 hrs. after birthing
Rate health of mother in first 48 hrs. after birthing
Rate health of baby in first 48 hrs. after birthing
HypnoBirthing helped me be more confident in my ability to birth
HypnoBirthing helped me to be able to communicate better with my care provider
HypnoBirthing helped me to have a better understanding of my birthing options
HypnoBirthing helped me have a more gentle birth
HypnoBirthing helped me to have a more comfortable birth
HypnoBirthing helped me to have a shorter labor
HypnoBirthing helped me to have a safer birth
HypnoBirthing helped me to make good decisions for birthing
HypnoBirthing helped me to be adequately prepared for labor and birth
During the first hour after birth, was your baby primarily
Please pick the statement that best describes your baby's first breastfeeding
If your were to have another baby, would you use HypnoBirthing?
Will you recommend HypnoBirthing to others?
(Optional)If you had this birth opportunity again, what would you do differently?
(Optional)Please list any suggestions for improving the HypnoBirthing course:
Apart from meeting your new baby, what was the best thing about your experience of giving birth? We would appreciate knowing as much detail as you care to provide.
May we contact you for additional information or for permission to use your comments for educational purposes?
If you agree to be contacted for permission to use your comments please list your email address below.