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.

* Please indicate how you prepared for this birth:

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

* This is mother's

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

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

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

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

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