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Informed Birth Questionnaire
Informed Birth Questionnaire
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What would you like the main focus of our visit/visits to be?
Comfort Measures
Medical Interventions
Normal progression of childbirth
All of the above
Other (please let Abbey know what you would like to focus on)
Please select all of the elements of pregnancy/labor/birth that you would like to know more about:
Gestational Diabetes
Group B Strep
Eating Healthy During pregnancy
Breathing techniques during Labor
Home Birth
Midwives
Hospital Birth
Cesarean Birth
VBAC Birth
Natural Birth
Medical Birth
Visualization and meditation
Emotional Aspects of birth
Informed Consent
Effects of the birth environment on labor and birth
Nitrous Oxide gas in labor and birth
Epidurals
Spinning Babies
Opioids
Effects of Movement on labor and birth
Effects of Position changes on labor and birth
Water birth
Eating and drinking during labor
Hypnobirthing
Massage and reflexology for coping
TENS unit
Pitocin for induction
Postpartum Pitocin
Breaking water
Effects of being an abuse survivor on labor and birth
Cervical Checks
Membrane sweeping
Checking your own cervix
Fetal scalp monitor
Fetal blood sampling
Continuous fetal monitoring
Intermittent Fetal monitoring
Directed Pushing
Spontaneous Pushing
Forceps and Vacuuming Extraction
Optimal cord clamping
Placenta
Lotus birth
Donating or banking my baby’s cord blood
Immediate skin to skin
First bath
Breastfeeding
Formula feeding
IV Fluids or Saline Lock during labor
Saline Lock
Vitamin K injection
Oral Vitamin K
Episiotomy
Circumcision
Eye ointment
Hepatitis B injection
Please check all of the items you would like to learn more about or would like to discuss with Abbey at a prenatal visit.
Your Name
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Best email to reach you at
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Best phone number to reach you at
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