Parents' Birth Report (English)

Thank you for taking the time to answer this questionnaire regarding your birthing experience.

This is a secure website and all responses are encrypted for transmission over the internet in order to protect your privacy. You can rest assured that your response will only be used by HypnoBirthing® Institute administrators, and not shared with anyone else without your expressed permission.

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* In what country was your baby born?

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* Please indicate how you prepared for this birth:

I took a HypnoBirthing course.

I took one or more HypnoBirthing sessions as a refresher.

I prepared on my own.

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* If you took a HypnoBirthing class or refresher sessions, please list the name of your HypnoBirthing practitioner (instructor.)

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* This is mother's

First baby

Second baby

Third baby

Fourth baby

Fifth or more

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* What was mother's age at time of this birth?

19 or under

20-24

25-29

30-34

35-39

40-45

Over 45

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* Did you have a surgical (Cesarean) birth before this baby?

Yes, just one

Yes, two or more

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* How many weeks was your pregnancy at the time of this birth? (gestational age)

Less than 37 weeks

37 weeks to 37 weeks 6 days

38 weeks to 38 weeks 6 days

39 weeks to 39 weeks 6 days

40 weeks to 40 weeks 6 days

41 weeks to 41 weeks 6 days

42 weeks or more

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* Was this a multiple birth (twins, triplets, etc.)?

Yes