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Maternity Review Questionnaire

1. Do you have private health insurance? *This question is required.
2. In deciding where to have your baby - rate how important the following are to you.

1 being less important and 10 being very important *This question is required.
1 less important
5
10 more important
Room decor and room furnishings
Obstetrician of choice
Midwife of choice
Reputation of facility
Price and out of pocket expenses
Birthing education and breast feeding support offered
Choice of birthing options
Length of stay in hospital
3. Please rate how important the following are to you
1 being less important and 10 being very important
1 less important
5
10 more important
Room - Room decor
Room - Bed for my husband/partner
Room - Double bed for me and my husband/partner
Room - Free WiFi
Room - Music and speakers
Room - Plenty of seating in the room
Room - Air conditioning control
Birth Suite - Birthing baths
Birth Suite - Comfortable bed
Birth Suite - Music
Birth Suite - Room heating
Birth Suite - One person to support me through my delivery
Birth Suite - My obstetrician at the birth
Birth Suite - Pain relief
Birth Suite - Choice of birthing options
Non-judgmental midwifery support
Birth Suite - Cordless fetal heart monitoring
4. Is this your first pregnancy? *This question is required.
5. If not, how many children do you have? *This question is required.
7. What sort of birth do you want for this pregnancy?
8. Where will you choose to have this baby?
9. What are the reasons for your decision - please rank in order of importance Order the items from the following list. First select an item with the spacebar to show a menu of possible ranking positions. Next, click a ranking position to order it in the ranked list. Note the menu will display more ordering options as you add items to the ranked list.
10. Who/what influenced your decision most?
  • * This question is required.
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