Evaluation of Labor Support

Name: Infant & Child CPR Group Class
Start: 2022-06-05T09:30:00+00:00
End: 2022-06-05T12:00:00+00:00
Location: Upper Marlboro, MD

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
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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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