Birth Center
1
. How many children do you have?
How many children do you have?
0
1-2
3-4
5+
*
2
. Which category below includes your age?
Which category below includes your age?
17 or younger
18-20
21-29
30-39
40-49
50-59
60 or older
3
. Where did you have your children?
Where did you have your children?
Hospital
Home Assisted Birth
Birthing Center
Other
4
. If a birthing center was available to you would you utilize it?
If a birthing center was available to you would you utilize it?
Yes
No
Most likely
5
. Did you plan on using medication during delivery?
Did you plan on using medication during delivery?
Yes and I did
No and I did
Yes and I didn't
No and I didn't
6
. What was your reason for choosing a hospital for delivery?
What was your reason for choosing a hospital for delivery?
safety
only option available
high risk pregnancy
comfort
n/a
7
. Would you be interested in a water birth if available?
Would you be interested in a water birth if available?
Yes
No
*
8
. What complaints if any do you have concerning your hospital birth?
What complaints if any do you have concerning your hospital birth?
9
. What is the highest level of school you have completed or the highest degree you have received?
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
10
. Why would you not choose a birth center if applicable?
Why would you not choose a birth center if applicable?
Powered by
SurveyMonkey
Check out our
sample surveys
and create your own now!
Javascript is required for this site to function, please enable.