HCV Maternal Mental Health Service Questionnaire

***Trigger warning – baby loss and mental health***

A new Maternal Mental Health service is starting to support women who are struggling with their mental health following baby loss.

The service will be available across Humber, Coast and Vale which includes Hull, East Riding, North Lincolnshire, North East Lincolnshire, York and North Yorkshire.

We would like to hear from women who live in these areas and have experienced baby loss (miscarriage, recurrent miscarriage, stillbirth, neonatal death, unsuccessful IVF, termination due to medical reasons) to help us shape this new service.

We know this is an incredibly difficult and personal experience and appreciate anything you can share with us.

If you have any questions, please do not hesitate to contact us via e-mail on hnf-tr.hcvmhpmo@nhs.net

In the meantime, if you feel you need support relating to these areas you may find these national charities useful or please speak to a healthcare professional such as your GP.

www.sands.org.uk

www.miscarriageassociation.org.uk

www.tommys.org

The Humber, Coast and Vale Health and Care Partnership are setting up this service. You can find out more about this work and the Partnership at www.humbercoastandvale.org.uk

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* 1. What is your age?

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* 2. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 3. What is your location

Hull

East Riding

North Lincolnshire

North East Lincolnshire

North Yorkshire

York

Other (please specify)

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* 4. Where did you receive your maternity care?

Hull

Grimsby

Scunthorpe

Scarborough

York

Other (please specify)

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* 5. Are you the patient or partner/family member or other?

Patient

Partner

Family member

Other (please specify)

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* 6. Have you experienced any of the following?

Miscarriage

Still birth

Neonatal death

Termination due to medical reasons

Birth trauma

Unsuccessful IVF

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* 7. Please can you tell us about your experience?

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* 8. Where did you get support from?

Maternity services

Health visitor

Open Minds

Let's Talk

Talking Shop

Mind

SANDS

Specialist mental health services

Private therapy

Family

Friends

Religious community

Other (please specify)

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* 9. Please can you tell us about the support you received?

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* 10. Did anything else help you through your experience?

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* 11. What else do you think would have been helpful?

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* 12. If you were to be seen by the Maternal Mental Health service, where would you like the appointments to be held? (e.g. hospital, GP surgery, community centre, virtual/online etc.)

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* 13. By sharing your experiences you are helping us to shape our new Maternal Mental Health service – what do you think this service should be called?

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* 14. Any other comments

Thank you for taking the time to fill out this questionnaire.