You are invited to participate in this brief survey because you recently experienced a birth-related transfer to a hospital. As part of the evaluation of the Alaska Birth Transfer Initiative, all clients who transferred to a hospital from a planned birth center or home birth will be asked to complete this survey. The Alaska Birth Transfer Initiative seeks to improve the transfer/transport process, to enhance collaboration among community and hospital-based birth providers and staff, and to improve the client and family experience during transfers.

Your response to this survey will remain anonymous. Survey responses will be shared in summary format on a regional level with health care professionals participating in the initiative. Your participation in this survey is entirely voluntary and you may leave the survey at any time. Please do not provide any information in the comments that could potentially identify a client. We look forward to hearing about your recent birth transfer/transport experience and appreciate your honest feedback.

Please email akpqc@alaska.gov if you have any questions or concerns about this survey.

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* 1. In which region/community did you plan to give birth?

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* 2. In which region/community was the hospital that you transferred to?

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* 3. When did the transfer occur (MM/YY)?

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* 4. Did you originally intend to birth in the hospital and then seek out community-based midwifery care due to COVID-19?

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* 5. How do you describe your race/ethnicity? (check all that apply)

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* 6. Do you identify with one or more of the following groups? (check all that apply)

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* 7. Please check all outcomes or procedures that occurred at the hospital. 

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* 8. Did you experience any of the following mistreatment before, during, or after birth? (check all that apply) 

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* 9. Please indicate the health care provider that you feel had the most significant impact on your hospital experience (please choose only one).

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* 10. The next series of questions will ask about your experiences once you arrived at the hospital with the health care provider selected above. The questions assess your ability to participate in decisions about your care after you transferred to the hospital. 

Please respond to the following statements: 

Overall while making decisions about my care...

  Strongly agree Agree Somewhat agree Somewhat disagree Disagree Strongly disagree 
I felt comfortable asking questions 
I felt comfortable declining care that was offered 
I felt comfortable accepting the options for care that my doctor or midwife recommended
I felt pushed into accepting the options my doctor or midwife suggested
I chose the care options that I received
My personal preferences were respected
My cultural preferences were respected

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* 11. Please respond to the following statements: 

During my pregnancy I felt that I was treated poorly by the provider selected above because of...

  Strongly agree Agree Somewhat agree Somewhat disagree Disagree Strongly disagree 
My race, ethnicity, cultural background or language
My sexual orientation and / or gender identity
My type of health insurance or lack of insurance
A difference of opinion with my caregivers about the right care for myself or my baby

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* 12. Please respond to the following statements: 

During my care I held back from asking questions or discussing my concerns with the provider selected above because...

  Strongly agree Agree Somewhat agree Somewhat disagree Disagree Strongly disagree
My provider seemed rushed
I wanted maternity care that differed from what my provider recommended
I thought my provider might think I was being difficult

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* 13. Would you like to reflect on your experience with another health care provider?

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