Post Pregnancy Client Information

Year and Month of Final Visit:

Please take some time to provide us with your evaluation of the midwifery care that you received during your recent pregnacy, birth and postpartum period. Your comments will be reviewed by the midwifery practice and can help us improve the quality of care we provide to our clients.

Your age:

Was this your first birth?

YesNo

Was this your first birth with a midwife?

YesNo

Section A: Rate the following aspects of your prenatal, labour and birth, and postpartum care. Check rating choice for each sub-category.

1. Prenatal Care

	Excellent	Good	Fair	Poor
Number of my prenatal visits
Length of my prenatal visits
Scheduling of my prenatal visits
Usefulness of information provided to me for making decisions
How easy it was to reach my midwife or midwives
My confidence in the midwives' skills and abilities
How comfortable I felt asking questions

Comments or suggestions for improvement to prenatal care:

2. Labour and Birth Care

	Excellent	Good	Fair	Poor
How easy it was to reach my midwife or midwives during labour
My confidence in the midwives' skill and abilities
Usefulness of information provided to me for making decisions

Comments or suggestions for improvement to labour and birth care:

3. Postpartum Care

	Excellent	Good	Fair	Poor
Number of my postpartum visits
Length of my postpartum visits
Scheduling of my postpartum visits
How easy it was to reach my midwife or midwives
Usefulness of information about caring for myself
Usefulness of information about caring for my baby
My comfort calling my midwife or midwives with questions or problems
My confidence in midwives' skills and abilities

Comments or suggestions for improvement to postpartum care:

Section B: The questions in this section cover your midwifery care from pregnancy, through labour and birth and after your baby's birth until six weeks postpartum. Please check one answer for each question. (Midwives must ensure that clients have no more than four midwives involved in their care and that there is 24-hour on-call access through pregnancy, labour and postpartum)

4. Continuity of care

	Yes	No
Do you know which team of midwives were responsible for your care?
Were there adequate opportunities for you to meet the midwives involved in your case?
Did you understand how to reach a midwife 24 hours a day?

Comments or suggestions for improvement to continuity of care:

5. Informed choice (Midwives must provide clients with information about their education and experience, how they practice in Ontario and what standards and protocols they must follow. Throughout care midwives must provide clients with enough information to make informed decisions regarding their care).

	Yes	No
In general, were your choices and decisions respected by your midwife or midwives?
Did you receive enough information to make informed decisions about your care?
Were you given enough information to decide where to have your baby's birth?

Comments or suggestions for improvement to informed choice:

6. Consultations and transfer of care (Midwives are requires to consult with physicians for conditions that may arise during pregnancy, labour and postpartum. Some certain conditions require that a physician take over care).

	Yes	No
Did your midwife need to consult with a doctor during your care?
If so, did you understand why and what would happen?
Was your care transferred to a doctor?
If so, did you understand why and what would happen?
Did you understand the reasons why a doctor might become involved in your care?

Comments or suggestions for improvement to consultations and transfer of care:

7. Student involvement (Community Midwives Halton is a practice committed to being involved with student midwives).

	Yes	No
Were you approached to have a student midwife involved in your care?
If yes, were you comfortable with her involvement?
Was a student involved in your labour and birth?
If yes, were you comfortable with her involvement?
Was a student involved in your care following the birth?
If yes, were you comfortable with her involvement?

Comments or suggestions for improvement to student involvement:

8. Office: Staff and location (Please rate on a scale 1 to 5, 1 being very poor and 5 being excellent).

	1	2	3	4	5
How were you treated by our office staff when you: Contacted the clinic?
Needed to contact your midwife?
Requested literature or information?
Booked your appointments?
How would you rate the characteristics of the staff: Polite?
Pleasant and courteous?
Helpful?
Professional?
How would you rate the Practice office: Comfort of the office?
Location of the office?
Access to the office?

Comments or suggestions regarding the office staff and location:

9. Additional information:

Name of midwife/midwives involved in your case? *

Name of student(s) involved in your care?

Personal comments for your midwives:

If you would like to discuss any concerns regarding your care. Please provide your information below and a senior midwife will contact you.

Name

First NameLast Name

Phone Number

Area CodePhone Number

Thank you for taking the time to complete this survey.

Client Evaluation of Midwifery Care