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* 1. Was it a surprise that your baby died during birth or shortly after birth?

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* 2. How many weeks pregnant was your wife/partner when she delivered? If you are not sure, please put "unknown". Also feel free to add any comments.

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* 3. What delivery situations did you experience? (Please check any that apply)

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* 4. Did you have a perinatal or pediatric hospice involved?

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* 5. What experiences apply to you when finding out, from the doctor, that your baby had died or had a fatal prognosis? (Please check any that apply)

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* 6. What type of information did the doctor share with you? (Please check any that apply)

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

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

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* 9. Where did your wife/partner deliver your baby? (Please check any that apply)

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* 10. Was your wife/partner given information to make choices on how the induction/labor/surgery would progress? (Please check any that apply)

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