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* 1. After finding out that your baby had died, did you have a D & C?

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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 a hospital procedure?

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* 11. Why did you choose a surgery instead of a miscarriage at home? (Please check any that apply)

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* 12. How prepared did you feel for what you experienced during your D & C?

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* 13. Did they try to have your miscarry with medication before deciding on a D & C?

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* 14. Did you request your baby’s remains from the D & C surgery?

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