The Nutan Pandit Lamaze Program® for Childbirth 

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Feedback Form (For Ex Students)

Please take a printout of this form and mail to Nutan Pandit on the mailing address. You may also email the form directly.
 
 
Name
Batch of Month Year , at
Email
Tick as Applies

PRE-LABOUR
 
A. Did you do the Pre-Natal Exercises regularly?
Yes No Not at all
B. Did you use Hot Towels on Breasts for 15 days before the Estimated Date of Delivery?
Yes No Not at all
C. Have you used any of the following for the well being in pregnancy or labour, if yes please give details of what used and what was your experience.
Homeopathy Acupressure Ayurveda
Home Remedies Faith Healings (Reiki, EFT, Pranic etc.)
Comments:


 
LABOUR & DELIVERY
 
A Contractions began at:
Time:
Date:
 
B You checked in the hospital at:
Time:
Date:
 
C Did your Water Bag burst?
On its own Was made to burst Did it leak
D At:
Time:
Date:
E If given the Drip, please state
Time:
Date:
F If given the Epidural/Spinal Anesthetic, please state
Time:
Date:
The Experience was Positive Negative
G Your Baby Boy/Girl was born at:
Time:
Date:
H Your Delivery was
Normal Vacuum Forceps
* Caesarean, because:

I Did you do Breathing Exercises? If yes then which of the following:
Deep Cleansing Waist Level Chest Level
"OUT" Concentration Pushing
Not Pushing (PANT/ PANT BLOW) All of them None of them
Comments:
J Could you Relax Between contractions?
  INITIALLY LATER STAGES
Definitely Yes 1 1
Yes Somewhat 2 2
Not Really 3 3
Definitely No 4 4
K Which Massage did you use?
Hand Squeeze Leg Massage Back Massage
Light Abdominal Strokes Palms on Lower Back and Lower Abdomen
L Did you manage to use Upright Positions in Labour?
Yes, Right Throughout Only in the Beginning
Only in Later Stage Not at all
Comment
M Did you Breastfeed successfully?
Yes No
N When did you first breastfeed?
At Birth 6 Hours Later
12 Hours Later Later than that
O What was the best thing about your Experience of Birth?
P What was the worst thing about your Experience of Birth?
Q Comments/ Suggestions
   
To Know the well being of the baby which of the test were done ?
Month Week Name of test & No. of times repeated Reason
1 1-4

2 4-8
3 8-12
4 12-16
5 16-20
6 20-24
7 24-28
8 28-32
9 32-36
10 36-40
   
  Were you put on the fetal heart monitor in labor: If Yes.
 
From Date Time
To Date Time

Up to Delivery
   

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