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 transferring providers, receiving providers, registered nurses, clients, and emergency medical personnel (for emergent transports) who were involved in a transfer/transport in participating regions will be asked to complete an evaluation survey that asks about experiences with the transfer process. 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 patient experience during transfers.
 
Your responses to this survey will remain anonymous. Your participation in this survey is entirely voluntary and you may leave the survey at any time. Although your birth provider may have invited you to participate in this survey, they will not see your individual responses. Your survey responses will be combined with other responses and will be only be shared in summary format.
 
We look forward to hearing about your recent birth transfer/transport experience and appreciate your honest feedback.
 
Please contact Katy Krings at katy.krings@alaska.gov or 907-269-3418 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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