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FEEDBACK FORM
Name
Email
Student No
PRE-LABOUR
Did you do the Pre-Natal Exercises regularly?
Yes
No
Not at all
Did you use Hot Towels on Breasts 15 days before the Estimated Date of Delivery?
Yes
No
Not at all
Have you used any of the following for well being in pregnancy or labour,if yes please give details of what you used and what was your experience?
*
Homoeopathy
*
Accupressure
*
Ayurveda
*
Home Remedies
*
Faith Healings (Reiki, EFT, Pranic healing etc)
Comments:
LABOUR & DELIVERY
Contractions began at
Time:
Date
You checked into hospital at
Time:
Date
Did your Water Bag burst?
*
On its own
*
Was made to burst
*
Did it leak
At :
Time:
Date
If given the Drip, please state:
Time:
Date
If given Epidural/Spinal Anesthetic, please state
Time:
Date
The experience was :
*
Positive
*
Negative
Your Baby Boy/Girl was born at
Time:
Date
Your Delivery was
*
Normal
*
Ceasarean
*
Vaccum
*
Forceps
Did you do Breathing Exercises?
Yes
No
If Yes, Which Did You Use?
DEEP CLEANSING
NOT PUSHING (PANT/PANT BLOW)
WAIST LEVEL
PUSHING
CHEST LEVEL
ALL OF THEM
"OUT"
NONE OF THE ABOVE
CONCENTRATION
Could You relax between contractions?
(I) INITIALLY
(ii) LATER STAGES
Definitely Yes
1
1
Yes Somewhat
2
2
Not Really
3
3
Definitely No
4
4
Which Massage Did You Use?
HAND SQUEEZE
LEG MASSAGE
BACK MASSAGE
LIGHT ABDOMINAL STROKES
PALMS ON LOWER BACK AND LOWER ABDOMEN
Did you manage to use the Upright Positions in Labour?
YES, RIGHT THROUGHOUT
Comment:
ONLY IN THE BEGINNING
Comment:
ONLY IN THE LATER STAGE
Comment:
NOT AT ALL
Comment:
What was the
best
thing about your Experience of Birth?
Comments:
What was the
worst
thing about your Experience of Birth?
Comments:
Did you breastfeed successfully?
Yes
No
When did you first breastfeed?
AT BIRTH
6 HOURS LATER
12 HOURS LATER
LATER THAN THAT
COMMENTS/SUGGESTIONS:
Latest News
New Teachers Training Nutan pandit has now invited applications by like minded women to carry this message forward through a Teachers Training Programme slated for August 2009; details of which can be requested on email (nutanpandit@yahoo.com).
© 2003-2008,
The Nutan Pandit Lamaze Program® for Childbirth
.