1. How many children do you have?

* 2. Which category below includes your age?

3. Where did you have your children?

4. If a birthing center was available to you would you utilize it?

5. Did you plan on using medication during delivery?

6. What was your reason for choosing a hospital for delivery?

7. Would you be interested in a water birth if available?

* 8. 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?

10. Why would you not choose a birth center if applicable?