Pre-Orientation-Birthing Person

Pre-Orientation – Birthing Person

This assessment is for the student who is currently pregnant. There will be a separate survey for your partner. This assessment is to be taken ideally before your first class with your instructor. The assessment will help your instructor understand where you are in your knowledge of birth and what you would like to learn. You will be asked similar questions at the end to determine whether all your learning goals were met. A copy of this completed assessment will be sent by email to your own email address (to save for your own records), to your EBB Instructor (so that they can individualize your class), and to the EBB administrative team (for program evaluation).

Name(Required)
Name of your Support Person
Address
Name of your EBB Instructor(Required)
CO-INSTRUCTOR: Name of your EBB Instructor
If your class has 2 instructors, list the second instructor’s name here. If you have only 1 instructor, leave it blank.
If your class has 2 instructors, list the second instructor’s email here. If you have only 1 instructor, leave it blank.

Interest in Participating in Research

The responses on this survey may potentially be used for research. If used for research, your answers will be de-identified. This means that we will remove your name and all identifying information.
Do you give us permission to use your de-identified answers for research purposes in the future?(Required)

Special Info About YOU!

Your Highest Level of Education

What type of provider do you plan on having at your birth? (Select all that apply)
Have you given birth before?

What kind of births have you had in the past?
Are you hiring a doula for this birth?

Your Thoughts, Feelings and Knowledge

On a scale of 1 to 10, how do you feel right now about the approaching birth?
On a scale of 1 to 10, how do you feel right now about the approaching birth?
Which statement best describes the purpose of birth plans?
A pregnant person has arrived at the hospital in labor and is six centimeters dilated. The nurse says, "You're not allowed to eat or drink anything." Which statement below is true?
What are the parts of evidence based care? (Select all that apply)

You and Your Childbirth Class

Have you attended the first class yet? (virtually or in-person)

Comfort Measures

How confident are you in your ability to use the following comfort measures during labor?
How do you think your partner/support person will advocate for you during the birth? "My partner/support person would…" (Select all that apply)
Typing my name below will serve as my signature. I understand that my results will be sent by email to the Evidence Based Birth® administration team, my personal EBB Instructor, and my own email address.(Required)