Prenatal Questionnaire

This questionnaire is a place to start to figure out how you feel about different options regarding the birth. We'll use this form at our prenatal to talk about any questions you have and any preferences you have, both for and agaisnt. 

Mother's Name *
Mother's Name
Partner's Name
Partner's Name
Mother's Phone Number
Mother's Phone Number
Partner's Phone Number
Partner's Phone Number
Address
Address
Estimated Due Date
Estimated Due Date
Inductions and Interventions
Check the boxes of what induction methods to both start labor and to augment labor and/or interventions you are open to.
Coping Techniques
Check the boxes of coping techniques that you feel might be helpful or would like to try during labor
Doula Support
Check off what boxes you feel are ways I can best support you
Pushing and Beyond
Check boxes of positions you are open to during pushing and interventions that may be introduced
First Hour After Birth
Check preferences for the first hour after birth
When picturing your upcoming labor and birth, what are you excited about?
When thinking about your upcoming birth and labor, are there any things that you are nervous about?
In the event of an unanticipated cesarean, what things would be most important to you?
Besides partner and doula, will there be anyone else present at the birth?
Is there anything else that you feel is important for me to know or that you have questions about?