Loss
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1.
Birth Loss Survey
I am wanting to collect as much information on losses as I can so we can see what the REAL statistics are!
1.
Who were you getting your prenatal care from?
Doctor
Certified Nurse Midwife
Direct Entry Midwife
Certified Professional Midwife
Licensed Midwife
Perinatologist
None at all
2.
What types of issues did you have during your pregnancy with your loss?
1. Gestational Diabetes
2. Multiple Gestation
3. Hypertension
4. Uterine Anomalies
5. Heart Condition
6. Incompetent Cervix
7. An STD
8. More than 5 previous pregnancies
9. Excess Amniotic Fluid
10. Intrauterine Growth Retardation
11. Unexplained bleeding in the first trimester
12. Unexplained second trimester bleeding
13. Unexplained third trimester bleeding
14. Pre-eclampsia
15. Placenta previa
16. Vasa Previa
17. Placenta Accreta
18. Advanced Maternal Age (over 35)
19. Young Maternal age (under 17)
20. Unlisted Issue
21. No issues at all
3.
Where did you deliver?
Hospital
Home
Birth Center
Other
4.
If you delivered in the hospital, what type of birth was it?
C-section
Vaginal
5.
If you had a vaginal hospital birth, what happened?
Water broke first
Contractions started first
Got induced
Augmented after water broke
Augmented after contractions weren't forming a good pattern
Had Electronic fetal monitoring and had to stay in bed
Had monitoring with just a doppler and was free to move about
Had to get an intrauterine pressure catheter
Had to have an electrode on baby's scalp
I had IV meds
I had an epidural
I delivered on my back
I delivered in my own way
I tore
Had an episiotomy
A Vaccum was used
Forceps were used
I was transferred from home
6.
If you had a c-section, how did it happen?
It was planned ahead of time
It was an emergency after I wasn't dilating
It was an emergency because baby's heart rate dropped
It was an emergency because labor had lasted too long
It was an emergency because I started having problems
It was a Homebirth Transfer
The Umbilical Cord had prolapsed
Other (Please Specify)
7.
What gestation was your baby?
20 weeks
21 weeks
22 weeks
23 weeks
24 weeks
25 weeks
26 weeks
27 weeks
28 weeks
29 weeks
30 weeks
31 weeks
32 weeks
33 weeks
34 weeks
35 weeks
36 weeks
37 weeks
38 weeks
39 weeks
40 + weeks
8.
Who delivered your baby?
Myself
My SO
CNM
DEM
LM
CPM
OB
9.
If your baby was born still, what reasons have you been given?
Cord Accident
Genetic Issues incompatible with life
A Trauma
Placental Abruption
Hyperstimulated Uterus
Other (Please Specify)
10.
If your baby passed after birth, are any of these a contributing factor?
Negligent Doctor
Negligent Midwife
Infection
Brain Damage from birth
Genetic Issues
NICU acquired illness
Premature
Unknown
Other (Please Specify)
11.
In what ways did you educate yourself on labor/childbirth??
Talked to DR
Talked to CNM
Talked to DEM
Talked to CPM
Talked to LM
Talked to family members
Talked to friends
Read books
Read articles
Read medical studies
Online Message Boards
Read Blogs
Have medical training already
Other (Please Specify)
Do you believe that had things been different, your baby would of lived?? If so, please explain.
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