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Maternal Pain Relief in Child Birth Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What type of pain relief did you use during child birth?
Select all that apply.
Epidural
Gas and air
TENS machine
Water birth
Other
2
Rate your overall satisfaction with the pain relief methods used (1-10)
Rate with 1 being very dissatisfied and 10 being very satisfied.
3
Please describe your experience with the pain relief methods used.
Please provide a detailed response.
4
Did you receive information about pain relief options during prenatal care?
Yes or No
Yes
No
5
What was the most effective pain relief method for you? Why?
Please provide detailed reasons.
6
Were you satisfied with the support provided by the healthcare team during labor?
Yes or No
Yes
No
7
How did you prepare for pain relief options before the birth?
Select all that apply.
Attended prenatal classes
Read books/articles
Consulted with healthcare provider
Other
8
On a scale of 1 to 5, how would you rate the information provided about pain relief options?
Rate with 1 being very poor and 5 being excellent.
9
What changes or improvements would you suggest for pain relief options in the future?
Please provide detailed suggestions.
10
Did you feel empowered to make decisions about pain relief during labor?
Yes or No
Yes
No
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