Maternity Service Users Survey

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* 1. Please tell is about yourself

Please enter the first half of your postcode (e.g. TN14)

Please describe your ethnicity (or leave blank if you prefer not to answer)

Please tell us the date of your most recent birth in the format DD/MM/YYYY

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* 2. Please tell us what kind of labour and birth you had most recently. Please tick all those from the list below which you experienced in your most recent birth.

You went into labour naturally

You had your labour induced

You had a planned caesarean

You had a straightforward vaginal birth

A doctor assisted the birth with forceps or ventouse

You had an unplanned caesarean

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* 3. Where was this baby/these babies born? Please select 1 answer from the list below.

At home

Maidstone Birth Centre

Crowborough Birthing Centre

Maidstone & Tunbridge Wells Hospital (Pembury)

Other (please write in)

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* 4. How would you rate the care that you received from your Community Midwives during your pregnancy? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

My care was awful

My care was OK

My care was excellent

Does not apply

My care was awful

My care was OK

My care was excellent

Does not apply

Please comment briefly on why you have chosen this score

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* 5. How would you rate the care that you received from your birth centre or hospital during your pregnancy? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent..

My care was awful

My care was OK

My care was excellent

Does not apply

My care was awful

My care was OK

My care was excellent

Does not apply

Please comment briefly on why you have chosen this score

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* 6. How would you rate the care you received during your labour/birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

My care was awful

My care was OK

My care was excellent

Does not apply

My care was awful

My care was OK

My care was excellent

Does not apply

Please comment briefly on why you have chosen this score

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* 7. How would you rate the care you received while you were in your birth centre/hospital after giving birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

My care was awful

My care was OK

My care was excellent

Does not apply

My care was awful

My care was OK

My care was excellent

Does not apply

Please comment briefly on why you have chosen this score.

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* 8. How would you rate the care you received from the Community Midwives at home after your baby's/babies' birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

My care was awful

My care was OK

My care was excellent

Does not apply

My care was awful

My care was OK

My care was excellent

Does not apply

Please comment briefly on why you have chosen this score.

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* 9. How would you rate the breastfeeding support you received ? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

I received no support

The support was OK

The support was excellent

Does not apply

I received no support

The support was OK

The support was excellent

Does not apply

Please explain briefly why you have chosen this score, and who you received the support (if any) from.

Maternity Service Users Survey

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* 1. Please tell is about yourself

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* 2. Please tell us what kind of labour and birth you had most recently. Please tick all those from the list below which you experienced in your most recent birth.

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* 3. Where was this baby/these babies born? Please select 1 answer from the list below.

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* 4. How would you rate the care that you received from your Community Midwives during your pregnancy? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

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* 5. How would you rate the care that you received from your birth centre or hospital during your pregnancy? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent..

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* 6. How would you rate the care you received during your labour/birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

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* 7. How would you rate the care you received while you were in your birth centre/hospital after giving birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

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* 8. How would you rate the care you received from the Community Midwives at home after your baby's/babies' birth? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

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* 9. How would you rate the breastfeeding support you received ? Please tick a number from 1 to 5 where 1 = awful and 5 = excellent.

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* 10. Please use this box to comment briefly on how your experience of the maternity services could have been improved.