1st Breath Honor Card

This survey is a way of evaluating the 1st Breath Honor Card program, the impact it has on those who receive the card in honor of a loved baby who was born still, and the participant's understanding of stillbirth in the USA. Please share your experience and thoughts. Your identity will not be shared, and your comments will only be shared with your permission. Thank you for caring enough to let us know about your 1st Breath Honor Card experience.

* 1. Prior to receiving this 1st Breath Honor Card, were you aware that babies may be stillborn?

(Stillbirth defined as the death of a baby just prior to, or during it's birth, that is at least 20 completed weeks gestation.)

* 2. Please share your experience of receiving your 1st Breath Honor Card. Include where and when you received the card.

* 3. How did this experience affect you? (Honored, Pleased, Sad, Repulsed, other?)

* 4. What action was taken by the person leaving the 1st Breath Honor card? (Bought coffee at drive thru, did a caring deed anonymously, left a gift, picked up the cost of a purchase, etc. Please provide details.)

* 5. Have you, or will you be telling others about your experience?

* 6. Were you aware that approximately 30,000 babies in the USA are born still every year? (Over 70 per day)

* 7. Prior to receiving this card were you aware of the nonprofit 1st Breath helping families and caregivers who deal with the stillbirth of a baby, and of 1st Breath's work to potentially prevent future infant deaths?

* 8. Have you ever heard of "kick counting?"

9. Please write what you would be willing to have us share with others. Only what you put as an answer to this question may be shared outside of statistical data gathering. By answering this question you are giving us permission to share anything you place in this one answer box. We reserve the right to not share or post for public view any message or contact information we think best not shared.

* 10. Have you ever been touched by the stillbirth of a baby? If so, please provide your relationship to the baby or parents, and any details you would like to share with 1st Breath. What has been most helpful or hurtful to you. What would you like to make sure others are made aware of when working with others touched by the stillbirth of a baby.

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