* 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?

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