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Pre-course survey

Step 1 of 3

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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)*
Mum: What do you do for a job?*
Partner: 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
- Facebook
- Twitter
- Instagram
- Midwife (provide name below)
- Friend/Family (provide name below)
- Web search
- Poster
- Netmums
- Mumsnet
- Other (provide details below)
Midwife's name*
Friend/Family's name*
Please provide details of how you heard about New Life Classes:*
Why did you choose this course?*
Are you attending any other pregnancy-focussed or antenatal classes?*
Do you have any pregnancy conditions or other information we should be aware of, so we can be more sensitive to your needs?*
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
Please tell us a little bit about the support network you have in place once your baby is born. Please include details of friends family or paid support.*

Your expectations from the course
What topics would you most like to learn about or discuss on this course?*
Do you have any concerns about pregnancy you want to discuss within the course?*
Do you have any concerns about labour you want to discuss within the course?*
Do you have any concerns about the early days with your baby you want to discuss within the course?*
What are your goals for this course?*

About you and your birth partner
Mum's age*
Birth partner's age*
How often do you exercise?*
I don't regularly exercise Once a week 2-3 times a week 4-5 times a week Every day Not applicable
Mum
Partner
Do you smoke?*
Yes No Not applicable
Mum
Partner
Does anyone in your family smoke?*
Yes No Don't know
Mum
Partner
Have you (mum) had/do you plan to have any of the following vaccinations?*
Yes Not yet No
Flu
Whooping cough
Have you ever suffered from depression?*
Yes No Not applicable
Mum
Partner
Has anyone in your family ever suffered from depression?*
Yes No Don't know
Mum
Partner
How knowledgeable do you consider yourself to be about labour?*
1 - No knowledge, 4 - Very knowledgeable
1 2 3 4
Mum
Birth Partner
How knowledgeable do you consider yourself to be about newborn babies?*
1 - No knowledge, 4 - Very knowledgeable
1 2 3 4
Mum
Birth partner
How knowledgeable do you consider yourself to be about breastfeeding?*
1 - No knowledge, 4 - Very knowledgeable
1 2 3 4
Mum
Birth partner
How much hands on experience have you had with babies?*
1 - No experience, 4 - Extensive experience
1 2 3 4
Mum
Birth partner
Do either of you have any special dietary restrictions?*
Mum: How active are you on the following social media platforms?*
1 - I don't have an account, 4 - I use it daily
1 2 3 4
Facebook
Twitter
Instagram
Google+
Pinterest
Partner: How active are you on the following social media platforms?*
1 - I don't have an account, 4 - I use it daily
1 2 3 4
Facebook
Twitter
Instagram
Google+
Pinterest

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Testimonial

“A wonderfully engaging and informative course delivered with care, sensitivity and the right amount of fun by a midwife with an obvious passion and bags of real-life NHS experience.” Read More

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New Life Classes
Trinity Quay
Avon Street
Bristol
BS2 0PT

0117 214 0349

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