(Pre-Survey) SANKOFA BIRTH AMBASSADORS
Please complete this form and submit before the Week 1 Session.

PLEASE ANSWER THE BEST YOU CAN. THIS SURVEY WILL ONLY BE USED TO GUIDE OUR SESSIONS. IF YOU DO NOT KNOW AN ANSWER IT IS OKAY TO SAY THAT YOU DO NOT KNOW. YOU SHOUD NOT RESEARCH ANYTHING TO COMPLETE THIS SURVEY. ALL TOPICS WILL BE COVERED DURING THE WORKSHOP SESSIONS.

Please complete this survey before the first session.
Email address *
First and Last Name *
Which Sankofa Birth Ambassadors Workshop would you like to register for?
Phone Number
Age *
What is motivating you to work in birth? *
What is a DOULA? What does the word DOULA mean? *
Have you ever observed or been a part of a birth other than your own? Have you ever been with someone in the delivery room during a vaginal birth? *
Briefly describe your own birth experience(s). Have you had positive and/or negative experiences? *
Describe some things that are unique about how the pregnant and birthing body works? *
How do you think childbirth scenes on television differ from how childbirth happens in real life? *
What are some important things for pregnant mothers to consider about the primary care provider or medical professional they choose? *
What are some important things for pregnant mothers to consider about the hospital or birth facility they choose? *
What are some important things for pregnant mothers to consider about the support people they choose to have with them in the birth room? *
Before they grab their C.O.A.T., what are some things that pregnant mothers should consider IF their bag of waters breaks? *
How can a mother (and partner) use her B.R.A.I.N. when making decisions about her and her newborn's medical care? *
What are some medical interventions that may be used during labor and delivery in a hospital? *
If a birthing mother is told that she needs to be induced, what type of questions can she ask to get an idea about how "ready" her body is for labor? *
How is P.A.I.N. experienced in labor different than other pain we may feel in our daily lives? *
What is one thing that can improve the way people birth? *
Name something that happens in the woman's body that can hinder the birthing process? *
What is the name of the first test newborns are given after they are born in hospitals? What does it check for? *
Have you ever been around a breastfeeding woman or breastfed a child? *
What has your personal experience been with breastfeeding? *
How can a person encourage mothers' breastfeeding relationship with their babies? *
How can family, friends and/or community support mommies and babies during the postpartum period, the first 6 weeks after birth? *
Please share any questions you have that you would like addressed during the workshop.
A copy of your responses will be emailed to the address you provided.
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