Mother of a Baby Who Unexpectedly Died during Birth or Shortly after Birth

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* 1. Was it a surprise that your baby died during birth or shortly after birth?

Yes

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* 2. How many weeks pregnant were you when you delivered? If you are not sure then type "Unknown", also feel free to comment.

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* 3. What delivery situations did you experience? (Please check any that apply)

This was expected to be a normal delivery.

The doctor chose to deliver because the baby was in distress

The doctor chose to deliver because I was in distress

I had to deliver early because my baby needed treatment outside of the womb.

I knew this delivery was high risk.

I carried my baby to term.

I carried our baby 40+ weeks.

I carried our baby 38+ to 40 weeks

I carried our baby 36+ to 38 weeks

I carried our baby 34+ to 36 weeks

I carried our baby 30+ to 34 weeks

I carried our baby 26+ to 30 weeks

I carried our baby 22+ to 26 weeks

I carried our baby less than 22 weeks

I was able to hold my baby within 20 minutes after birth.

My baby needed immediate medical attention which prevented me from holding him/her within 20 minutes of birth.

I chose to deliver my baby early and let him/her die due to his/her medical problems

I chose to carry my baby with serious medical issues to term.

I was able to prepare with perinatal/pediatric hospice, Loss Doula, or loss professional.

Other

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* 4. Did you have a perinatal or pediatric hospice involved?

Yes

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* 5. What experiences apply to you when finding out from the doctor that your baby had died, or had a fatal prognosis? (Please check any that apply)

The doctor looked concerned

The doctor was cold

The doctor was kind and empathetic

The doctor was very supportive

I changed doctors because of how I was treated

I was happy with how the doctor handled the situation

I was not happy with how the doctor handled the situation

None of these apply to my experience

Other

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* 6. What type of information did your doctor share with you? (Please check any that apply)

I was informed about delivery options/benefits and dangers (pros and cons)

I was allowed to make choices in type of delivery (vaginal or C-section).

I was told labor and vaginal delivery could be dangerous

I was told I needed a C-section

I was told my breast milk may come in after birth and how it could be handled

I wish I had been given more information.

I wish I had been given less information

I am happy about the amount of information I was given

I don’t remember

Other

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* 7. What term did the doctor use when referring to the baby’s death? (Please check any that apply)

Miscarriage

Stillbirth

Preemie death

Infant death

Spontaneous abortion

I do not recall what tern the doctor used

Other

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* 8. What term did the doctor use when referring to your baby? (Please check any that apply)

The doctor referred to my baby as a baby

The doctor referred to my baby as a fetus

The doctor referred to my baby as "it"

The doctor called my baby by his/her name

The doctor referred to my baby as “product of conception”

Other

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* 9. Where did you deliver your baby? (Please check any that apply)

A regular labor and delivery room in the hospital

A special labor and delivery room in the hospital

On a different floor than labor and delivery in the hospital

Emergency Room

Birth clinic/center

Home

Other (Please explain where in the comment section)

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