Birth Follow Up.

Name *

First Name

Last Name

1. What type of birth did you have? *

Vaginal Birth

Vaginal Birth Assisted

Vaginal Birth After Cesarean (VBAC)

Vaginal Breech

Planned Cesarean Birth

Unplanned/ Emergency Cesarean Birth

2. Where did you birth? *

Public Hospital/ Birth Centre

Private Hospital

Planned Home Birth

Free Birth

Other

3. Was the onset of labour spontaneous? *

If Yes progress to Q4, If No progress to Q5

Yes

No

4. Was your spontaneous labour augmented by any of the following?

select all that apply.

Artificial Membrane Rupture (breaking waters)

Oxytocin Drip

5. If your labour was induced, which of the following methods apply

Artificial Rupture of Membranes (breaking of waters)

Balloon Catheter

Prostaglandin gel/ tape

Oxytocin Drip

6. How long was your labour? *

From the time of regular contractions.

Less than 6 hours

6-12 hours

12-24 hours

24-48 hours

48hrs +

7. Did you use any of the following medical pain relief?

Epidural

Nitrus Oxide

Morphine, Pethidine

Paracetamol or Ibuprofen

Other

8. Did you use any of the following non-pharmacological pain relief

Select all that apply.

Tens Machine

Acupressure points

Birth Comb

Sterile Water Injections

Active Birth Positions

Water Submersion

Massage

10. Did you have a birth support person attend your birth? *

eg: a doula, birthkeeper, private midwife.

Yes

No

11. Your overall satisfaction with your birth? *

Very Unsatisfied

Unsatisfied

Neutral

Satisfied

Very Satisfied