Cliniqapps

First Name *

Last Name *

Date of Birth *

Email *

Mobile Phone *

Post Birth Questionnaire

What was your due date *

When was your baby born *

Is this your first child *

Did you experience much pre-labour pain *

Yes
No

What was your length of labour at home? (once contractions were regular, painful, and about 5 minutes apart) *

What was your length of labour at the hospital *

How many centimeters dilated were you when you arrived at the hospital *

Were you induced *

Yes
No

Did you have your waters broken*

If you were induced, please elaborate on why and your experience

Did you deliver vaginally or by Caesarean Section? *

Vaginal
Caesarean Section

If you had a vaginal birth, please complete the rest of the survey. If you had a Caesarean Section, please skip to Birth Story below this text...

How long was the first stage (dilation stage)

How long was the second stage? (How long did you push?)

What was the total length of your labour

Did you require assistance during the pushing stage? (forceps or ventouse)

Where there any problems with the birth of the placenta? (third stage)

Did you have an epidural?

Was your baby breech or posterior?

Did you have any complications?

Birth story

How would you rate your birth experience? Please elaborate on any positive or negative aspects that have stuck with you, or anything in general that you wish to share

Did you use acupressure during your labour?

If yes, did you find it effective?

Pre-Labour Acupuncture - How many labour readiness treatments did you receive prior to the onset of contractions? *

Do you feel that the pre-labour acupuncture treatments were effective? *

Would you recommend us to a friend? *

Yes
No

If no, why not? Please help us to improve our service with your feedback