Birth Survey

Thank you for taking the time to fill out our birth survey. Your responses will help us to improve Natural Birth and Baby Care for you as well as other women in the future!

Natural Birth Survey

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

E-mail Address*
E-mail Address*

State/Prov

Country*
Country*

Are you planning a natural birth?*
Are you planning a natural birth?*

	Yes
	I want to try
	No

Where are you going to give birth?*
Where are you going to give birth?*

	Hospital
	Birth Center
	Home

Are you taking childbirth classes?*
Are you taking childbirth classes?*

	yes
	no

If yes, what kind?

	Hospital Classes
	Lamaze Classes
	Bradley Classes
	Birthing From Within
	Other

If "other" please explain:

Are you going to have a doula?*
Are you going to have a doula?*

	Yes
	No

What kind of information are you looking for?*
What kind of information are you looking for?*

	Birth Stories
	Information on relaxation
	Information on doulas/labor support
	Homebirth information
	Information for my partner
	How to prepare for birth
	VBAC info
	Other

If "other" please explain:

Tell us what you'd like to see about pregnancy and natural birth:*
Tell us what you'd like to see about pregnancy and natural birth:*