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1. Did your baby die when it was younger than ten weeks?

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2. How many weeks pregnant were you when you found out that the baby died?

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3. How many weeks gestation was the baby when it passed away?

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4. Did your doctor or nurse explain to you why the baby was still inside of you after it died? (Please check any that apply)

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5. How did you find out that the baby died? (Please check any that apply)

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6. If you had an ultrasound, please check any that apply to your ultrasound experience.

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7. Please check all that apply to your experience of finding out from your doctor that the baby had died. (Please check any that apply)

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8. What term did the doctor use when referring to the baby’s death? (Please check any that apply)

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9. What term did the doctor use when referring to your baby? (Please check any that apply)

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10. Were you given information to make a choice on miscarriage at home versus hospital procedure? (Please check any that apply)

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11. Would you have liked to have received a miscarriage kit to take home that would include a colander to catch the baby, picture of what the baby would look like, a vessel to place the baby in, and written instructions for home miscarriage?

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12. Were you given information on how the miscarriage would progress? (Please check any that apply)

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