Welcome!

By completing this anonymous questionnaire you will be helping us to learn more about what mothers think and feel about being a mother in 'today's United States'.

We recommend you allow approximately 20-30 minutes to complete the questionnaire, which is divided into four distinct sections.



Section 1 of 4: Demographic Questions

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* 1. How many children do you have?

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* 2. What is the age of your youngest child?

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* 3. Please fill in the chart below across all questions for each of your natural children.

  Gender? Age of child? Bottle or Breast Fed? Attend(ed) Child Care? Current no. of Days in Child Care? A special needs child? Extended hospital stay at birth? Type of birth
Child No. 1
Child No. 2
Child No. 3
Child No. 4
Child No. 5
Child No. 6
Child No. 7
Child No. 8
Child No. 9
Child No. 10

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* 4. Your year of birth? (e.g., 1980)

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* 5. Age at which you had your first child?

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* 6. What best describes where you live?

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* 7. What state/territory do you live in?

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* 8. What best describes your ethnicity?

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* 9. Education - Highest level completed?

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* 10. Your personal annual income level prior to motherhood (in US dollars)?

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* 11. Your current personal annual income level (in US dollars)?

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* 12. Your current total annual household income level (in US dollars)?

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* 13. Relationship status?

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* 14. What best describes you?

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* 15. Which best describes where your close family members live? (check one)

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* 16. Which best describes where you were born and raised? (check one)

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* 17. Do you attend church? (check one)

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* 18. Did you have problems breastfeeding? (check one - if applicable)

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* 19. Do you smoke cigarettes?

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* 20. How often do you drink alcohol? (check one)

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* 21. How many cups of coffee do you drink each day?

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* 22. How many hours per week of in-home help with household or child-related duties do you get?

  0 1-2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 16+
Spouse/Partner
Children
Other family member(s)
Friend(s)
Cleaner
Nanny
Babysitter
Other

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* 23. Do you receive in-home help?

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* 24. Do you live with extended family?

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* 25. If you do live with extended family, please choose the most appropriate box below.

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* 26. Did you experience, or are you currently experiencing any post-natal depression? (check one)

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* 27. If yes, were you diagnosed professionally?

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* 28. Have you been, or are you currently on medication specifically for your post-natal depression? (check one)

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* 29. Have you had, or are you currently getting counseling for post-natal depression?

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* 30. Have you experienced any of the following? (Tick all that apply)

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* 31. For the question above, where did you go for information, help, diagnosis, and/or treatment?

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* 32. I find sex better now than before I was pregnant.

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* 33. For your last pregnancy, mark how often did/do you take part in a daily total of 30 minutes (or more) of ANY type of vigorous physical activity, such as doing 10 minutes of vigorous housekeeping + 20 minutes walking with the baby stroller or going to the gym?

  Most days of the week 3-4 times per week Once a week Hardly ever
Before Pregnancy
During Pregnancy
Now After Pregnancy

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* 34. For your last pregnancy, mark how often did/do you take part in exercise classes and/or sport training sessions - such as an aerobics class, team sport or going for a jog (this does not include incidental activity such as housework)

  Most days of the week 3-4 times per week Once a week Hardly ever
Before Pregnancy
During Pregnancy
Now After Pregnancy

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* 35. On average how many hours do you currently sleep each night?

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