New 2017 MOM Stillbirth and Late Miscarriage at a hospital Question Title * 1. After finding out that your baby died, did you deliver at the hospital? Yes No If your answer is no, you should probably be answering a different survey. Question Title * 2. How many weeks pregnant were you when you found out that the baby died? Less than 10 weeks 11-12 weeks 13-14 weeks 15-16 weeks 17-18 weeks 19-20 weeks 21-22 weeks 23-24 weeks 25-26 weeks 27-28 weeks 29-30 weeks 31-32 weeks 33-34 weeks 35-36 weeks 37-38 weeks 39-40 weeks 41-42 weeks Other (please specify) Question Title * 3. How many weeks gestation was the baby when he/she passed away? Less than 10 weeks 11-12 weeks 13-14 weeks 15-16 weeks 17-18 weeks 19-20 weeks 21-22 weeks 23-24 weeks 25-26 weeks 27-28 weeks 29-30 weeks 31-32 weeks 33-34 weeks 35-36 weeks 37-38 weeks 39-40 weeks 41-42 weeks Other (please specify) Question Title * 4. How did you find out that the baby died? (Please check any that apply) I found out there was no heartbeat at the doctor’s office. I found out there was no heartbeat at the regular ultrasound. They found no heartbeat at the doctor’s office and confirmed the baby had died with an ultrasound. They found no heartbeat at the midwife visit and confirmed the baby had died with an ultrasound. I went to the emergency room and found out my baby had died. I began to miscarry at home without any idea that my baby had died. My baby died during birth. My baby died after it was born Other Comment Question Title * 5. If you had an ultrasound, please check any that apply to your ultrasound experience. I did not have an ultrasound I could see that there was no heartbeat. The ultrasound tech said there was no heartbeat. The ultrasound tech looked concerned. The ultrasound tech was cold. The ultrasound tech was kind and empathetic. The ultrasound tech hinted that there may be a problem. The ultrasound tech gave me no indication that there may be a problem. None of these apply to my experience. Other Comment Question Title * 6. Please check all that apply to your experience of finding out from your doctor that the baby had died. (Please check any that apply) They could not find a heartbeat with the doppler They confirmed there was no heartbeat with an ultrasound. I could see that there was no heartbeat. The doctor said there was no heartbeat. The doctor told me the baby had died. The doctor looked concerned. The doctor was cold. The doctor was kind and empathetic. The doctor told me in person that the baby had died. The doctor told me over the phone that the baby had died. The doctor did the ultrasound and said there was no heartbeat. None of these apply to my experience. Other Comment Question Title * 7. What term did the doctor use when referring to the baby’s death? (Please check any that apply) Miscarriage Stillbirth Preemie death Infant death Spontaneous abortion I do not recall what tern the doctor used Other Comment Question Title * 8. What term did the doctor use when referring to your baby? (Please check any that apply) The doctor referred to my baby as a baby The doctor referred to my baby as a fetus The doctor referred to my baby as tissue The doctor reffered to my baby as "it" The doctor called my baby by his/her name I don’t remember Other Comment Question Title * 9. After learning of your baby’s death, how much time passed before you were admitted to deliver the baby? I was admitted right away I was admitted from the ER I was admitted 1 day later I was admitted 2-3 days later I was admitted 4-6 days later I was admitted 7-14 days later I waited until I went into labor naturally Other (please specify) Question Title * 10. What decisions did you make concerning your admission? (Please check any that apply) I was given options on when to be admitted I was not given options on when to be admitted I was instructed to be admitted immediately I asked to be admitted immediately I waited until going into labor before being admitted I went into the hospital unaware that my baby had died so this is not applicable to me Other Comment Next