Pre-course survey

The purpose of this survey is for us to get to know you a little better. Many of the questions feed directly into the course content, so please answer as fully as possible.Your answers are entirely confidential and we will not use any of them openly in the class setting, they will simply help us support your individual needs to the best of our ability.
Mum's name*
First Last
Mum's email address*
Will your birth partner attend the class?*
- Yes - my partner (dad / mum)
- Yes - a friend
- Yes - a family member
- No
Birth partner's name*
First Last
Partners email address (mum or dad)*
We will use this email to send them weekly class emails - some information will need to be completed separately.
Mum: What industry do you work in?*
Mum: What do you do for a job?*
Partner (Mum or Dad): What industry do you work in?*
Partner (Mum or Dad): What do you do for a job?*
What is your average combined household income?
How did you hear about New Life Classes?*
Select all that apply
- Select All
- Social media (Facebook, Instagram etc)
- Midwife or GP (provide name below)
- Friend or Family (provide name below)
- Pregnancy class (e.g. Yoga)
- Web search (Google or Bing etc)
- Online portal (Netmums or Mumsnet etc)
- Poster or Flyer
- Event (Mothercare, Mamas & Papas etc)
- Other (provide details below)
Midwife's name*
Friend/Family's name*
Please provide details of how you heard about New Life Classes:*

Please rate how important each of the following factors was in your decision to choose New Life antenatal classes.*

	Not at all important	Of little importance	Somewhat important	Important	Very important	Not sure
Location
To improve my knowledge
Opportunity to meet other parents
Price
To build my confidence
Midwife-led classes
To prepare for labour and birth
Range of topics covered
Weekly evening classes
Evidence-based information
Group size
My partner is included in all sessions
Non-judgmental environment
To feel confident feeding my baby
To prepare for parenthood
For the support network

Are you attending any other pregnancy-focused classes?*
- Select All
- No
- Pregnancy Yoga
- Pregnancy Pilates
- Hypnobirthing
- Aquanatal
- NHS antenatal classes
- Pregnancy & labour massage
- Other (please state)
Which other pregnancy-focused classes are you attending?*
Please let us know if you're having a singleton or multiple birth*
- Singleton
- Twins
- Triplets
What's your estimated due date?*
Where are you planning to give birth?*
- Home
- Free-standing Midwife Unit (ie Cossham Birth Centre)
- Midwife-led Unit in hospital
- Hospital (Central Delivery Suite)
- Not sure yet
What type of birth do you have planned?*
- Vaginal birth
- Waterbirth
- Elective caesarean section
- Not sure yet
Do you know if you are having a boy or girl?*
How are you planning to feed your baby?*
- Exclusively breastfeed
- Mix of breastfeeding and formula feeding
- Formula feeding
- Not sure yet
What support do you have for when your baby is born?*
- Select All
- Mums parents in town and willing to help with childcare
- Partners parents in town and willing to help childcare
- Mums parents within an hour and willing to help childcare
- Partners parents within an hour and willing to help childcare
- Parents not available to help with childcare
- Strong social support network locally
- Social support network is willing to help with childcare
- Paid in-house support (nanny or au pair etc)
- Mum and partner (mum/dad) are responsible for childcare
- Mum is solely responsible for childcare
- Partner (Mum or Dad) is solely responsible for childcare

Your expectations from the course
Are there any topics not listed in our course programme you'd like us to cover?*
If you've not seen the course programme please click here: http://newlifeclasses.com/classes-and-events/antenatal-class-programme/
Do you have any worries or concerns you'd like to discuss with your course leader?*
These can be topics you'd like to speak privately about (before or during the classes) or within the group setting. Just let us know what you'd prefer within your comment.

	I don't regularly exercise	Once a week	2-3 times a week	4-5 times a week	Every day	Not applicable
Mum
Partner

	Yes	Not yet	No
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Whooping cough

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Your expectations from the course

About you and your birth partner

Testimonial

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