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Evaluation of Labor Support
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Home
About Momease
Contact Momease
Momease Products
Gift Cards
History
Policies
Press Room
Partners
Classes & Tours
Class Schedule
Child Birth Classes
Baby Care for the 1st Month Classes
DC Area Hospitals Prenatal Tours
Parenting Classes
Newborn to 1-year old Classes
Touch and Tone Classes
Payment Plans for Government Shutdown
Meet the Doulas
Client Intake Form
Labor Doula Packages
Postpartum Packages
Breastfeeding
Lactation Services
Breastfeeding Products and Pumps
Class Modifications
Instructors
Instructors
Labor Doula Instructors
Postpartum Doula
Resources
Blog and Birth Stories
Parent Resources
Instructor Resources
Evaluations
Class Evaluation
Evaluation of Labor Support
Evaluation of Postpartum Support
Reviews
Evaluation of Labor Support
Evaluation of Labor Support
Mother’s Name
*
Father/Partner’s Name
Email
*
Baby’s Date of Birth
OB/Midwifery Practice
Did you have one or more doulas?
*
Yes
No
Doula’s Name
*
Momease would appreciate you taking a moment to evaluate your perception of the doula’s role. Please circle the number that most closely reflects your opinion of her contribution.
Were the techniques suggested by the doula helpful to the mother in handling the physical aspects?
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Were the techniques used by the doula helpful to the mother in handling emotional aspects ?
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Were the suggestions of the doula helpful for the father/partner and/or family members or friends present for the labor?
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Overall, how would you evaluate the usefulness of having the doula present?
*
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
What was your role in the labor and birth?
*
Doctor
Midwife
Nurse
Baby’s mother
Father/Partner
Friend
Other Family
Other staff
Your Name (optional)
Feedback
Feedback Options
Feel free to use these comments on the Momease websites and promotional materials. If we use your comments on our website, we will attribute it to you with your first name and last initial.
Please don't share these comments on Momease websites or promotional materials.
Thank you very much for taking the time to complete this evaluation. If you have further comments or questions, feel free to contact us at the address printed on the letterhead.
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