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To start, we would like to ask you a few questions about yourself to ensure we gain the views from across all our communities.
 
These questions are optional, and you can tick the ‘Prefer not to say’ option if you do not want to disclose this information. The details you provide are strictly confidential and will only be used to inform this maternity services improvement project.

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* 1. How old are you?

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* 2. What is your ethnic group? Please select one option that best describes your ethnic group or background?

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* 3. Do you consider yourself to have a disability/impairment?

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* 4. Please select which applies:

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* 5. Have you had a baby before?

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* 6. When will you give birth (month and year), or when did you give birth?

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* 7. If you are currently pregnant, are you planning a vaginal birth?

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* 8. In which hospital did you have your baby or are you booked to have your baby?

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* 9. Please tell us the type of birth you had?

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* 10. How many vaginal births have you had in total?

Problems with your bladder and bowel are common during pregnancy and after giving birth. In the next section please tell us about any existing problems that you may have experienced in the past or currently. We would like to know if you were able to get the help you needed. 

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* 11. How often do you leak urine?

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* 12. How often do you have problems holding wind?

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* 13. How often are you unable to control the loss of stool (poo)

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* 14. Do you have a Prolapse (bulging/feeling of pressure or heaviness in vagina)

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* 15. Do you experience pain or bleeding during or after sex (intercourse)?

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* 16. Pain or bleeding from the perineum (area between vagina and anus/back passage)

Regards to tear and cutting etc.

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* 17. Overall, how much of the problems above interfere with your everyday life? Please select a number between 0 (not at all) and 10 (a great deal)

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* 18. Did you speak to a healthcare professional regarding those issues?

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* 19. We would like to know if you were able to get the help you needed with any problems you experienced with your pelvic floor, bladder or bowels during or after pregnancy.

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* 20. If so, who did you receive the help from?

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* 21. If you did not receive any help, what would you have liked to know or what support would you have liked to have?

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* 22. Have you or did you receive any information during pregnancy about pelvic floor exercises?

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* 23. Have you or did you receive any information about pelvic healing after birth?

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* 24. Have you or did you receive any information about preventing tears at vaginal birth?

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* 25. What information would you have liked to receive?

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* 26. Who would you have liked to receive information from?

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* 27. Do you know how to access specialist advice if you suffer or are suffering with problems related to your pelvic floor or genital area after birth?

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* 28. Was there anything that stopped you accessing help?

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* 29. Please let us know if you have any comments about the future of this service so it can be developed in accordance to your needs?

If you would like to become a service user representative for this pelvic health project, please express your interest in an email to SWLMaternity@swlondon.nhs.uk
Thank you for taking the time to complete this survey. If you are experiencing difficulties with your own pelvic health and you have not sought medical help. Please do contact your GP or local midwifery team.
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