Prenatal Survey Question Title * 1. As best as you know, what is the recommended number of months to exclusively breastfed a baby, meaning the baby is only fed breast milk? Question Title * 2. Do you plan on breastfeeding your baby? Yes No Unsure Question Title * 3. When is your baby's due date? Question Title * 4. How many weeks pregnant were you when you got into prenatal care? Question Title * 5. If you did not enter prenatal care during your first trimester (0-12 weeks) why? Does not apply, I entered care in the 1st trimester Insurance Issues Transportation Issue I didn't know I was pregnant I just moved here Schedule conflicts with work/school The doctor wouldn't see me Language barrier Cultural Norms Scare to go to the doctor Question Title * 6. What method do you plan to use to feed your new baby in the first few weeks? Breastfeed only (baby will not be given formula) Formula feed only Both breast and formula feed Don't know yet Question Title * 7. Where do you plan to have your baby sleep? Crib Bed Bassinet Side Car Question Title * 8. Has anyone asked you about any emotional changes you are experiencing during your pregnancy? Yes No Question Title * 9. Did you experience any challenges with getting to your prenatal visits? Yes No Question Title * 10. How often did you see your doctor during your pregnancy? Question Title * 11. Please describe any additional issues you encountered during your pregnancy as a result of COVID-19. Question Title * 12. Zip Code Question Title * 13. Ethinicty White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 14. Age Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 15. Is this your first pregnancy? Yes No Question Title * 16. Would you like to be further interviewed to help us better serve the mothers and babies in our community? Name Email Address Phone Number Done
