Father of a Stillborn or Miscarried Baby Delivered in the Hospital

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* 1. After finding out that your baby had died, did your wife/partner deliver at the hospital?

Yes

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* 2. How many weeks pregnant was your wife/partner when you found out that the baby died?

Weeks:

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* 3. How many weeks gestation was the baby when he/she passed away?

Weeks:

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* 4. Were you with your wife/partner when she found out the baby had died?

Yes

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* 5. How did you find out that the baby died? (Please check any that apply)

We found out there was no heartbeat at the doctor’s office.

We found out there was no heartbeat at the regular ultrasound.

I was not there when she found out. My wife/partner told me that my baby died.

We went to the emergency room and found out our baby had died.

I don’t remember

Other

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* 6. Please check all that apply to your experience in dealing with health care workers while dealing with your loss experience. (Please check any that apply)

The health care workers appeared cold and uncaring.

The health care workers were kind and empathetic.

It depended on the health care worker.

I do not 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 term 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 tissue

The doctor referred to my baby as a product of conception.

The doctor referred to my baby as "it'

The doctor called my baby by his/her name

Other

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* 9. After learning of your baby’s death, how much time passed before your wife/partner was admitted to deliver the baby?

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* 10. Who made the decisions concerning admission? (Please check any that apply)

My wife/partner made all the decisions.

I wanted to make all the decisions.

I made all the decisions.

We made the decisions together.

My wife/partner wanted me to make all the decisions.

The doctor made all the decisions.

My wife was not medically able to make any decisions.

Other

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* 11. Please comment on the timing of your hospital admission. (Please check any that apply)

I felt the timing of the hospital admission was right for us

I regret we did not wait longer to be admitted and induced into labor

I regret waiting to be admitted and induced into labor

I am glad we waited until labor began to be admitted into the hospital

I regret we waited until labor began to be admitted to the hospital

Other

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