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2. Are you planning on becoming pregnant in the next:

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3. What is your postal code?

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4. How far would you be willing to travel for prenatal care and/or to birth at a birth centre?

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5. Would you consider giving birth in a freestanding birth centre with a midwife for your next pregnancy?

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6. What is your order of preference for birth location?

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7. Who would you prefer to manage your maternity care and birth?

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8. How important is it for you to meet every provider that may be taking care of you during your labour/birth?

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9. What amenities are important to you in a birth setting?

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10. Do you feel your community could benefit from a birth centre staffed by midwives?

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11. Please leave your name and email address if you would like to be informed with updates on the WOMB Birth Centre Project (optional):

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