Third Survey Post Birth Assessment Support Person

Post Birth Survey – Support Person

Please complete this post birth survey! There will be a separate survey for your partner. 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, and to the EBB administrative team (for program evaluation).

Name(Required)
Name of Birthing Person you were Supporting(Required)
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)

Your Satisfaction

On a scale of 1 to 10, how satisfied were you with this birth?
Which comfort measures did you use with your partner during the birth? Please select all that apply.
I felt in control of helping choose the techniques and procedures that were used during my partner's labor and birth.
After taking the Evidence Based Birth® Childbirth Class, but before my baby was born, I expected my partner's pain of labor and birth to be:
During the birth, I observed that my partner's pain of labor and birth was:

Your Thoughts About Your Birth Experience

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)