Post Partum Survey

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* 1. How was your baby delivered?

Vaginally and not induced

Vaginally and induced

A planned cesarean

An unplanned or emergency cesarean

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* 2. Where did you deliver your baby?

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* 3. In your opinion, which statement best describes the attitude of the following people about feeding your baby?

	Favored Breastfeeding Only	Favored Formula Feeding Only	Favored Mixed Formula and Breastfeeding	Had no Preference for Either Method of Feeding	Don't Know
Your Doctor	Your Doctor Favored Breastfeeding Only	Your Doctor Favored Formula Feeding Only	Your Doctor Favored Mixed Formula and Breastfeeding	Your Doctor Had no Preference for Either Method of Feeding	Your Doctor Don't Know
Baby's Doctor	Baby's Doctor Favored Breastfeeding Only	Baby's Doctor Favored Formula Feeding Only	Baby's Doctor Favored Mixed Formula and Breastfeeding	Baby's Doctor Had no Preference for Either Method of Feeding	Baby's Doctor Don't Know
Partner of Child	Partner of Child Favored Breastfeeding Only	Partner of Child Favored Formula Feeding Only	Partner of Child Favored Mixed Formula and Breastfeeding	Partner of Child Had no Preference for Either Method of Feeding	Partner of Child Don't Know
Extended Family and Close Friends	Extended Family and Close Friends Favored Breastfeeding Only	Extended Family and Close Friends Favored Formula Feeding Only	Extended Family and Close Friends Favored Mixed Formula and Breastfeeding	Extended Family and Close Friends Had no Preference for Either Method of Feeding	Extended Family and Close Friends Don't Know
Staff at Hospital or Birthcenter	Staff at Hospital or Birthcenter Favored Breastfeeding Only	Staff at Hospital or Birthcenter Favored Formula Feeding Only	Staff at Hospital or Birthcenter Favored Mixed Formula and Breastfeeding	Staff at Hospital or Birthcenter Had no Preference for Either Method of Feeding	Staff at Hospital or Birthcenter Don't Know
Your Employer (if applicable)	Your Employer (if applicable) Favored Breastfeeding Only	Your Employer (if applicable) Favored Formula Feeding Only	Your Employer (if applicable) Favored Mixed Formula and Breastfeeding	Your Employer (if applicable) Had no Preference for Either Method of Feeding	Your Employer (if applicable) Don't Know

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* 4. As best as you know, what is the recommended number of months to exclusively breastfeed a baby, meaning the baby is only fed breast milk?

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* 5. How old was your baby when you completely stopped breastfeeding and/or pumping milk?

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* 6. Were any of the following included in the gift pack received when leaving the hospital/birth center?

Infant Formula

Coupon for infant formula

Breastfeeding supplies (nursing pads, nipple cream, breastpump, etc.)

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* 7. Did you ever breastfeed or try to breastfeed your baby, either in the hospital or birth center, or after you went home?

Yes

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* 8. How important were each of the following reasons for your decision not to continue to breastfeed your baby?

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* 9. If you breastfed, did you breastfeed as long as you wanted to?

Yes

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* 10. If not, what were the obstacles you faced that prevented you from meeting your goal?

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* 11. If you decided to use a formula, how did you decide which formula to use?

I use formula provided by WIC

I chose a formula based on low price

A doctor or other health professional recommended the formula

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* 12. Did you formula feed you first baby and breastfeed your second?

Yes

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* 13. Does your baby sleep in a separate sleep space from you?

Yes

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* 14. Is the sleep space free of items?

Yes

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* 15. Is your child placed on it's stomach or back?

Stomach

Back

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* 16. Did anyone ask you about your postpartum emotions?

Yes

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* 17. Did you experience sadness, depression, anxiety or anger beyond 2 weeks postpartum?

Yes

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* 18. Were you referred to any provider for your postpartum mood (or depression, anger, anxiety, etc.) symptoms?

Yes

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* 19. Do you have access to childcare?

Yes

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* 20. Did you attend a childbirth education class?

Yes

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* 21. Did you attend a breastfeeding class?

Yes

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* 22. Did you feel supported during your birth?

Yes

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* 23. Did you feel respected and informed during your birth?

Yes

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* 24. Did you have a birth plan?

Yes

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* 25. If you had a birth plan, was it respected?

Yes

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* 26. Did you do skin to skin with your baby after delivering?

Yes

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* 27. What is your location / Zipcode

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* 28. What is your ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

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* 29. What is your age:

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 30. Was this your first pregnancy?

Yes

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* 31. Would you like to be further interviewed to help us better serve the mothers and babies in our community?

Name

Email Address

Phone Number

	Not at all Important	Not Very Important	Somewhat Important	Very Important
My baby was sick and not breastfeed	My baby was sick and not breastfeed Not at all Important	My baby was sick and not breastfeed Not Very Important	My baby was sick and not breastfeed Somewhat Important	My baby was sick and not breastfeed Very Important
My baby had trouble sucking or latching on	My baby had trouble sucking or latching on Not at all Important	My baby had trouble sucking or latching on Not Very Important	My baby had trouble sucking or latching on Somewhat Important	My baby had trouble sucking or latching on Very Important
My baby began to bite	My baby began to bite Not at all Important	My baby began to bite Not Very Important	My baby began to bite Somewhat Important	My baby began to bite Very Important
I thought I would not have enough milk	I thought I would not have enough milk Not at all Important	I thought I would not have enough milk Not Very Important	I thought I would not have enough milk Somewhat Important	I thought I would not have enough milk Very Important
I was sick or had to take medicine	I was sick or had to take medicine Not at all Important	I was sick or had to take medicine Not Very Important	I was sick or had to take medicine Somewhat Important	I was sick or had to take medicine Very Important
My baby lost interest in nursing or began to wean him or herself	My baby lost interest in nursing or began to wean him or herself Not at all Important	My baby lost interest in nursing or began to wean him or herself Not Very Important	My baby lost interest in nursing or began to wean him or herself Somewhat Important	My baby lost interest in nursing or began to wean him or herself Very Important
A health professional said I should not breastfeed for medical reasons	A health professional said I should not breastfeed for medical reasons Not at all Important	A health professional said I should not breastfeed for medical reasons Not Very Important	A health professional said I should not breastfeed for medical reasons Somewhat Important	A health professional said I should not breastfeed for medical reasons Very Important
I believe that formula is a good as breastfeeding or that formula is better	I believe that formula is a good as breastfeeding or that formula is better Not at all Important	I believe that formula is a good as breastfeeding or that formula is better Not Very Important	I believe that formula is a good as breastfeeding or that formula is better Somewhat Important	I believe that formula is a good as breastfeeding or that formula is better Very Important
I thought that breastfeeding would be too inconvenient	I thought that breastfeeding would be too inconvenient Not at all Important	I thought that breastfeeding would be too inconvenient Not Very Important	I thought that breastfeeding would be too inconvenient Somewhat Important	I thought that breastfeeding would be too inconvenient Very Important
I tried breastfeeding before and didn't like it or it didn't work out	I tried breastfeeding before and didn't like it or it didn't work out Not at all Important	I tried breastfeeding before and didn't like it or it didn't work out Not Very Important	I tried breastfeeding before and didn't like it or it didn't work out Somewhat Important	I tried breastfeeding before and didn't like it or it didn't work out Very Important
I wanted to be able to leave the baby for several hours at a time	I wanted to be able to leave the baby for several hours at a time Not at all Important	I wanted to be able to leave the baby for several hours at a time Not Very Important	I wanted to be able to leave the baby for several hours at a time Somewhat Important	I wanted to be able to leave the baby for several hours at a time Very Important
I wanted to go on a weight loss diet	I wanted to go on a weight loss diet Not at all Important	I wanted to go on a weight loss diet Not Very Important	I wanted to go on a weight loss diet Somewhat Important	I wanted to go on a weight loss diet Very Important
I wanted to go back to my regular diet	I wanted to go back to my regular diet Not at all Important	I wanted to go back to my regular diet Not Very Important	I wanted to go back to my regular diet Somewhat Important	I wanted to go back to my regular diet Very Important
I wanted to smoke again or some more than I should while breastfeeding	I wanted to smoke again or some more than I should while breastfeeding Not at all Important	I wanted to smoke again or some more than I should while breastfeeding Not Very Important	I wanted to smoke again or some more than I should while breastfeeding Somewhat Important	I wanted to smoke again or some more than I should while breastfeeding Very Important
I had too many household duties	I had too many household duties Not at all Important	I had too many household duties Not Very Important	I had too many household duties Somewhat Important	I had too many household duties Very Important
I planned to go back to work or school	I planned to go back to work or school Not at all Important	I planned to go back to work or school Not Very Important	I planned to go back to work or school Somewhat Important	I planned to go back to work or school Very Important
I wanted or needed someone else to feed my baby	I wanted or needed someone else to feed my baby Not at all Important	I wanted or needed someone else to feed my baby Not Very Important	I wanted or needed someone else to feed my baby Somewhat Important	I wanted or needed someone else to feed my baby Very Important
Someone else wanted to feed the baby	Someone else wanted to feed the baby Not at all Important	Someone else wanted to feed the baby Not Very Important	Someone else wanted to feed the baby Somewhat Important	Someone else wanted to feed the baby Very Important
I wanted my body back to myself	I wanted my body back to myself Not at all Important	I wanted my body back to myself Not Very Important	I wanted my body back to myself Somewhat Important	I wanted my body back to myself Very Important
The baby's father didn't want me to breastfeed	The baby's father didn't want me to breastfeed Not at all Important	The baby's father didn't want me to breastfeed Not Very Important	The baby's father didn't want me to breastfeed Somewhat Important	The baby's father didn't want me to breastfeed Very Important
I wanted to use contraception that cant be used while breastfeeding	I wanted to use contraception that cant be used while breastfeeding Not at all Important	I wanted to use contraception that cant be used while breastfeeding Not Very Important	I wanted to use contraception that cant be used while breastfeeding Somewhat Important	I wanted to use contraception that cant be used while breastfeeding Very Important
Other	Other Not at all Important	Other Not Very Important	Other Somewhat Important	Other Very Important