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Page One

1. Age
2. Gender
3. Education
4. Income
5. Do you personally know the midwifery student who asked you to complete this survey? (pick only one answer)
6. Have you heard about the following types of midwives in the United States before viewing the information on my blog (you may mark more than one answer)?
7. What do you know about certified nurse-midwives (mark one answer)?
8. What do you know about freestanding (not in a hospital) birth centers (mark one answer)?
9. Do you think the option of nurse-midwives is a good idea for women in your community?
10. Do you think a freestanding birth center is a good idea for your community?
11. Imagine that you (or your partner/wife if you are a male) are pregnant, that you are healthy, and that you are considering the options for your care during this pregnancy and birth, and that all options are available in your community and covered by your insurance: Who would you want to take care of you for your pregnancy and birth? (pick one)
12. Imagine that you (or your partner/wife if you are a male) are pregnant, that you are healthy, and that you are considering the options for your care during this pregnancy and birth, and that all options are available in your community and covered by your insurance: Where would you like to labor and give birth? (pick one)
13. Birth Centers and midwives usually offer services in addition to the "routine" prenatal care, birth, and postpartum care found in most hospitals. In thinking of a future pregnancy, choose up to 10 services that would be most important to you.
15. If you have been pregnant and given birth, please complete the following sections. Mark one column for each birth; complete only for your first 5 births: Where did you give birth?
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Hospital
Freestanding Birth Center
Home
Other
16. Who provided your care during pregnancy? (pick one)
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Certified nurse-midwife
Direct entry midwife
Obstetrician
Family Physician
Other
17. Who provided care at the birth?
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Certified nurse-midwife
Direct entry midwife
Obstetrician
Family Physician
Other
18. Did you use a tub or medication to reduce labor pain? (check all that apply)
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I had no pain medication
I had pain medication but not an epidural
I had an epidural
I labored in water in a tub
19. Type of birth (pick one)
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Vaginal birth, spontaneous
Vaginal birth, forceps or vacuum
Vaginal birth after cesarean section
Cesarean section
20. How did you feel about the care with your doctor/midwife? Answer the following on a scale of 1-4
4 I had great care3 I had good care2 My care could have been better1 I was dissatisfied with my care
21. How did you feel about the care regarding your place of birth? Answer the following on a scale of 1-4
4 I had great care3 I had good care2 My care could have been better1 I was dissatisfied with my care
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