The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss
Perceived Traumatic Birth Screening Tool
No responses
Loading...
Chart Information
Name:
No responses yet for this question.
Age:
No responses yet for this question.
Gender:
No responses yet for this question.
Room number:
No responses yet for this question.
Reason for hospital admit:
No responses yet for this question.
BMI:
No responses yet for this question.
Gravida/parity:
No responses yet for this question.
Contact Information
Address:
No responses yet for this question.
Phone number:
No responses yet for this question.
Email address:
No responses yet for this question.
Patient Demographics
Race:
No responses yet for this question.
Ethnicity:
No responses yet for this question.
Marital status:
No responses yet for this question.
Birth Information
Date of delivery:
No responses yet for this question.
Time of delivery:
No responses yet for this question.
Time of delivery baby B:
No responses yet for this question.
Time of delivery baby C:
No responses yet for this question.
Attending:
No responses yet for this question.
L&D nurse:
No responses yet for this question.
Delivery type:
No responses yet for this question.
Damage to perineal area:
No responses yet for this question.
Estimated gestational age:
No responses yet for this question.
Neonatal outcome:
No responses yet for this question.
Neonate weight:
No responses yet for this question.
Neonate weight baby B:
No responses yet for this question.
Neonate weight baby C:
No responses yet for this question.
APGAR score:
No responses yet for this question.
APGAR score baby B:
No responses yet for this question.
APGAR score baby C:
No responses yet for this question.
Feeding plan:
No responses yet for this question.
Length of labor:
No responses yet for this question.
Written birth plan:
No responses yet for this question.
Baby for adoption:
No responses yet for this question.
Surrogate pregnancy:
No responses yet for this question.
Complications (select all that apply):
No responses yet for this question.
NICU stay:
No responses yet for this question.
NICU stay baby B:
No responses yet for this question.
NICU stay baby C:
No responses yet for this question.
Interview Date and Time
Date:
No responses yet for this question.
Time:
No responses yet for this question.
Numeric pain scale
No responses yet for this question.
Perceived Traumatic Birth Screening Tool
Did you worry that you or your baby were at risk of death during the birthing process?
No responses yet for this question.
Did you worry that you or your baby were at risk of serious injury during the birthing process?
No responses yet for this question.
Do you feel like your labor was hard and upsetting?
No responses yet for this question.
Did you feel frightened or helpless during your labor?
No responses yet for this question.
Interventions and Resources Provided
Skin-to-skin contact in the first two hours after giving birth:
No responses yet for this question.
VIsuospatial cognitive intervention for 15 min within 6 hours of giving birth (sound turned off):
No responses yet for this question.
Access to www.happybirthdayprogram.com was given:
No responses yet for this question.
Transition planning was provided:
No responses yet for this question.
Ergonomics training was provided:
No responses yet for this question.
Safe infant handling training was provided:
No responses yet for this question.
Educated on breathing techniques for stress reduction:
No responses yet for this question.
Notes
No responses yet for this question.
Waiting for responses
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
