JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Is Home Birth Right for You?
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
How has this pregnancy been for you?
*
Nothing too exciting! I felt some nausea and fatigue at first, but things seem to be getting better.
This pregnancy is kicking my butt! I am eager to feel more like myself and learn how to tackle these challenges and any that come my way.
I have some health concerns that may not make me a good home birth candidate, but I’d like to learn more about natural childbirth and decide what may be best.
My doctor told me that I am “high risk” and that it’s necessary for me to have some interventions for my birth, but I know thoat midwifery care can help!
What pregnancy is this for you?
*
We aren’t pregnant, but just excited to learn more about home labor and/or birth!
This has been a long road to meeting our baby. We have had a history of losses and/or used fertility treatments to help us conceive this pregnancy.
This is our first baby!! We like what you are putting down here, and are excited to learn more about this process.
This isn’t our first, but we’ve gone the hospital road before and want to be more prepared this time or look into other options.
I have more than enough babies to count on one hand - I just don’t know if I have time to make it to the hospital anymore!
Why are you interested in staying home for labor and/or birth?
*
My friend/family member told me about their awesome experience with the Bradley Method or having a home birth and I’m sold that it's right for me too.
I think that birth is a normal process. If it didn’t work, we wouldn’t be here!
I really don’t like hospitals that much and I’m concerned about some of their protocols impacting me and my baby negatively.
I had a bad experience with a past birth and I really want something different for us this time around.
My husband and I really want him to be involved in our care. It’s important to me that we are both prepared and that we go about this process together.
We know we want a hospital birth, but we want to make sure that we have the tools to navigate our options well and to labor at home before going in.
How do you feel about being actively involved in your care?
*
I trust my provider easily and feel that she knows best for me and my baby.
I have to research everything before I feel like it’s the right choice for me or not. I see myself as a consumer in my healthcare.
I know there’s no perfect way to go about parenting, but I really desire to be involved and work together with my provider to have the best possible pregnancy, birth and postpartum possible.
This sounds great and all, but I really don’t have the bandwidth to think about every little decision right now.
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report