Medical Provider Survey on Breastfeeding
Instructions: Hello. The South MS Breastfeeding Coalition and the Mississippi Public Health Institute are gathering information that will help to better promote the practice of breastfeeding. We are contacting you because you provide medical services to women of childbearing age or patients who are pregnant. This survey should take 3 minutes to complete, and we are grateful for your consideration. Even if you are in a group practice, we’d like to hear from each of you and your colleagues.

Questions? Contact Tennille Collins, Mississippi Public Health Institute: (601) 398-4406;
Sign in to Google to save your progress. Learn more
Your Name
Your Practice Name
Which of the following best describes your role at your health center or medical practice?
How many years have you been practicing medicine or working as a healthcare provider?
Clear selection
How would you rate the importance of breastfeeding for the health the baby?
Clear selection
Does your practice educate expectant and new mothers on breastfeeding practices?
Clear selection
Does your practice offer trainings for staff to help them provide lactation counseling?
Clear selection
Do you or your staff ask about the cultural beliefs and practices of a patient before counseling about breastfeeding?
Clear selection
How often is prenatal care provided to expectant mothers in your practice?
Clear selection
How often are prenatal visits in your practice used to discuss delivery room considerations such as skin-to-skin care and rooming of the mother and newborn?
Clear selection
How often do you encounter patient enthusiasm for breastfeeding among expectant or new mothers?
Clear selection
How often is an expectant or new mother referred to breastfeeding support groups through your practice?
Clear selection
When discussing feeding options with parents of a healthy full-term infant in your practice, which one of the following do you usually recommend for the first month of life?
Clear selection
For approximately what length of time do you recommend exclusive breastfeeding?
Clear selection
How often, if at all, is your office able to provide a quiet and comfortable private space, with appropriate resources (seating, an electric outlet, refrigeration), set aside for mothers to breastfeed or express breast milk?
Clear selection
Which of the following describe the availability of brochures, pamphlets, and other resources about breastfeeding in your practice? (Please select all that apply.)
Does your practice ever provide information about any of the following to expectant/new mothers or other parents?
Only upon request
Lactation specialists
Community-based breastfeeding support groups
Breastfeeding peer counselors
How familiar are you with recommendations from Optimizing Support for Breastfeeding as Part of Obstetric Practice issued by the American College of Obstetricians and Gynecologists (ACOG) or the American Academy of Pediatrics’ (AAP) policy statement on breastfeeding? (Please answer concerning familiarity with either one of these.)
Clear selection
What barriers to breastfeeding are commonly faced by your patients? (Please select up to five top barriers.)
What factors might most encourage mothers to breastfeed? (Please select up to five top factors.)
What might assist your practice in its effort to offer breastfeeding support? (Please select all that apply.)
Your email address (will not be shared)
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy