Heartland Breastfeeding Survey

1. Are you currently breastfeeding?

Are you currently breastfeeding? Yes

2. If you are currently breastfeeding, how long have you been breastfeeding?

If you are currently breastfeeding, how long have you been breastfeeding? Less than a month

1-3 months

3-6 months

6-12 months

over 12 months

3. Where did you obtain information about breastfeeding?

Where did you obtain information about breastfeeding? mother/family member

friend

Television

Web-Site

Doctor/Mid-Wife

Magazine

Hospital Class

4. If you are not currently breastfeeding, how long did you breastfeed?

If you are not currently breastfeeding, how long did you breastfeed? Less than a week

Less than a month

1-3 months

3-6 months

6-12 months

1 year or more

(never breastfed/thinking about/have questions)

5. If you stopped breastfeeding prior to 6 months, why?

If you stopped breastfeeding prior to 6 months, why? Back to work/school

Childcare Issues

Lack of Support

Other

Other (please specify)

6. If you stopped breastfeeding prior to 6 months, what may have helped you continue?

If you stopped breastfeeding prior to 6 months, what may have helped you continue?

7. Please rate the support you received with breastfeeding.

	very helpful	helpful	somewhat helpful	not helpful	N/A
My doctor/primary health-care provider	*Please rate the support you received with breastfeeding. My doctor/primary health-care provider very helpful	My doctor/primary health-care provider helpful	My doctor/primary health-care provider somewhat helpful	My doctor/primary health-care provider not helpful	My doctor/primary health-care provider N/A
The hospital nurses	The hospital nurses very helpful	The hospital nurses helpful	The hospital nurses somewhat helpful	The hospital nurses not helpful	The hospital nurses N/A
My spouse/significant other	My spouse/significant other very helpful	My spouse/significant other helpful	My spouse/significant other somewhat helpful	My spouse/significant other not helpful	My spouse/significant other N/A
WIC office personnel	WIC office personnel very helpful	WIC office personnel helpful	WIC office personnel somewhat helpful	WIC office personnel not helpful	WIC office personnel N/A
Childbirth educator	Childbirth educator very helpful	Childbirth educator helpful	Childbirth educator somewhat helpful	Childbirth educator not helpful	Childbirth educator N/A
Lactation Consultant	Lactation Consultant very helpful	Lactation Consultant helpful	Lactation Consultant somewhat helpful	Lactation Consultant not helpful	Lactation Consultant N/A

Heartland Breastfeeding Survey
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1. Default Section

1. Are you currently breastfeeding?

2. If you are currently breastfeeding, how long have you been breastfeeding?

3. Where did you obtain information about breastfeeding?

4. If you are not currently breastfeeding, how long did you breastfeed?

5. If you stopped breastfeeding prior to 6 months, why?

6. If you stopped breastfeeding prior to 6 months, what may have helped you continue?

7. Please rate the support you received with breastfeeding.

Heartland Breastfeeding SurveyExit this survey

1. Default Section

1. Are you currently breastfeeding?

2. If you are currently breastfeeding, how long have you been breastfeeding?

3. Where did you obtain information about breastfeeding?

4. If you are not currently breastfeeding, how long did you breastfeed?

5. If you stopped breastfeeding prior to 6 months, why?

6. If you stopped breastfeeding prior to 6 months, what may have helped you continue?

7. Please rate the support you received with breastfeeding.

Heartland Breastfeeding Survey
Exit this survey