Birth Survey

How have you given birth?

Please select all that apply.

• Vaginal once
• Cesarean once
• Vaginal X2
• Cesarean X2
• Vaginal X3
• Cesarean X3
• Vaginal X4
• Cesarean X4
• Vaginal X5
• Cesarean X5
• Vaginal X6
• Cesarean X6
• Vaginal X7
• Cesarean X7

Have you ever been induced?

• No
• Once
• Twice
• Three times
• Four times
• Five times
• Six times
• Seven times

What reasons were given for an induction?

Please select all that apply.

• No induction
• Pre-Eclampsia
• Diabetes
• Infection
• Baby no longer growing
• Premature rupture of membranes
• Overdue
• Low amniotic fluid
• Placenta no longer functioning correctly
• Large baby
• Tired of pregnancy
• Toxemia
• Medical condition impacted by pregnancy
• Other

What reasons were given for a cesarean section?

Please select all that apply.

• Pre-eclampsia
• Failure to progress
• Fetal distress
• Multiples
• Placenta previa
• Placental abruption
• Large baby
• Breech
• Maternal infections
• Previous health problems
• No ceasareans
• Elective
• Other
• Presence of Meconium
• Induction failure

Have you ever had a VBAC?

• No, never had a cesarean
• No
• Yes one
• Yes two
• Yes three
• Yes four
• Yes five
• Yes six
• Yes seven

How many times have you utilized epidural anesthesia during labor?

• Once
• Twice
• Thee times
• Four times
• Five times
• Six times
• Seven times
• Never

How many times have you utilized narcotic pain relievers such as nubain, stadol, demerol, etc?

• Once
• Twice
• Three times
• Four times
• Five times
• Six times
• Seven times
• Never

How many times have you utilized Electronic Fetal Monitoring?

• Once
• Twice
• Three times
• Four times
• Five times
• Six times
• Seven times
• Never

How many times have you had to have either a vaccum or forcep assisted delivery?

• Once
• Twice
• Three times
• Four times
• Five times
• Six times
• Seven times
• Never

How many of your children had jaundice that required phototherapy?

• One
• Two
• Three
• Four
• Five
• Six
• Seven
• None

How many children were born with the umbilical cord around their neck??

• One
• Two
• Three
• Four
• Five
• Six
• Seven
• None

How many children had meconium staining?

• One
• Two
• Three
• Four
• Five
• Six
• Seven
• None

If you were induced, did you end up with a cesarean section?

• No induction
• Yes
• No

How many children have you delivered at home?

• None
• One
• Two
• Three
• Four
• Five
• Six
• Seven

How many children have you delivered in a hospital?

• None
• One
• Two
• Three
• Four
• Five
• Six
• Seven

How many children have you delivered in a Freestanding birth center?

• None
• One
• Two
• Three
• Four
• Five
• Six
• Seven

How do you view pregnancy itself?

• Completely natural, leave it alone
• Natural, but, let's keep an eye on it
• Not natural yet not exactly a medical condition
• A medical condition requiring as much testing as possible

How do you view childbirth?

• Leave mom and baby alone
• Let's standby
• Let's utilize the machines, they are there for that purpose
• We could die

How many episiotomies have you ever had?

• None
• One
• Two
• Three
• Four
• Five
• Six
• Seven

What do you think of this survey?

Please select all that apply.

• Very informative
• Needs more info
• Kinda stupid
• I needed to kill some time

Everyone is different, and so are their answers. What is your:

• ------------- Female Male Gender
• ------------- 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Birth Year