Midwifery Care Evaluation Form

Thank you for taking a moment to complete this satisfaction survey regarding your experience with midwifery care. Your feedback is important to us - it helps us learn how to better support women.

* Required

Who was your midwife or your midwife team? *

What month and year was your due date? *

Please select your age group *

less than 20
20-24
25-29
30-34
35-39
40-44
45 or older

Midwifery Care

The questions below are regarding the care you received from your midwife/midwives during your pregnancy, your birth and after the birth.

* Required

Prenatal Care*
Please rate the following aspects of the prenatal care you received

	Poor	Fair	Good	Excellent	Not Applicable
Number and length of my prenatal visits
Scheduling of my prenatal visits
Support given to help me make decisions
Clinical care I received overall
Access to routine prenatal tests and investigations
Access to specialists as needed
Ease of reaching my midwife/midwives
My comfort in asking questions

Please add any comments regarding the question above on Prenatal Care

Labour and Birth Care*
Please rate the following aspects of the care you received during your labour and birth

	Poor	Fair	Good	Excellent	Not Applicable
Ease of reaching my midwife/midwives during labour
The care and support provided by my midwife/midwives in labour
Access to routine monitoring during labour and birth
Access to specialists as needed
Choice of birthplace
Support given to help me make decisions
Support and information about the labour and birth process

Please add any comments regarding the question above on Labour and Birth Care

Postpartum Care *
Please rate the following aspects of the care you received during your postpartum time

	Poor	Fair	Good	Excellent	Not applicable
Number and length of my postpartum visits
Scheduling of my postpartum visits
Usefulness of information about caring for myself
Usefulness of information about caring for my baby
Ease of reaching my midwife/midwives
Support for breastfeeding and/or choice of infant feeding
Access to my midwife/midwives for support during the postpartum period for myself or my baby

Please add any comments regarding the question above on Postpartum Care

Philosophy and Standards of Midwifery Care

Information about our regulations and standards as Registered Midwives in BC can be found on the College of Midwives of BC website: www.cmbc.bc.ca

We also have much of this information on our website. The following questions are about specific pieces about midwifery care that we feel are especially important.

* Required

Continuity of Care

Continuity of Care is an important part of midwifery care in British Columbia. Continuity of Care in midwifery refers to developing a relationship over time between you and your midwife/midwives. This means that the midwife/midwives you get to know during your prenatal care, are the ones who are on-call for you when you give birth to your baby and the ones who see you after your baby is born for your postpartum care.

Continuity of Care*

	Yes	No	Not Applicable
Did you know which midwife/midwives were responsible for your care?
Were there adequate opportunities for you to meet and get to know the midwife/midwives involved in your care?
Did you understand how to reach a midwife 24/7?
Did you have access to your midwife/midwives during your prenatal care as needed?
Did you have access to your midwife/midwives during your labour and birth as needed?
Did you have access to your midwife/midwives during your postpartum time as needed?

Informed Choice

Informed choice is an important principle of midwifery care in British Columbia. Informed choice means being aware of your options, having time to discuss them with your midwife and making decisions about your care. Because midwives provide woman-centred care, we strive to support the decisions you make that are based on your own values and that feel right to you. Your personal and family values are an important part of making decisions that suit you.

Informed Choice*

	Yes	No	Not Applicable
Did you receive enough information to make informed decisions about your care?
Did you have sufficient time to discuss your options for care?
Were you given other resources, such as written materials or website links, to support your decision-making?
Were you given enough information about your options to decide where to give birth?
In general, were your choices and decisions respected by your midwife/midwives?

Consultations and Transfer of Care

As a primary caregiver, your midwife is responsible for providing the best care to you in accordance with the Midwifery Standards of Care. There may be times when your midwife/midwives will consult with a specialist. This may mean that we are writing letters on your behalf about your care or that you may have a visit with a specialist about a certain aspect of your care. In some circumstances, it may be necessary to transfer you to a specialist who will then take over as your primary caregiver.

Was there a time in your pregnancy, birth or postpartum time that your midwife consulted with a physician? *
If your answer is "no", please skip to the end of the page.

Yes
No
Not sure

Consultations and Transfer of Care*

	Poor	Fair	Good	Excellent	Not Applicable
Information I received regarding the need for consulting with a physician or specialist
Choice I was given about the need to consult a physician/specialist
Opportunities for discussion with my midwife regarding the need for a consultation or transfer of care
Quality of care I received from the consulting physician/specialist
Communication between my midwife and consulting physician/specialist

Philosphy and Standards of Midwifery Care

Please include any comments you have regarding the survey questions below.

Your Pomegranate Experience

At Pomegranate, we strive to meet excellent clinical care with a meaningful experience at our clinic and through the other services we provide. Thank you for taking a moment to tell us how your time at Pomegranate Community Midwives was.

Your time in our clinic

	Totally	Usually	Only sometimes	Never	Not Applicable
I felt welcomed at Pomegranate during my visits
The office staff was helpful to me/my family during my visits
My calls/emails were returned in a reasonable amount of time by the office staff
I was able to make appointments that usually fit my schedule

Pomegranate Resources

	Often	Usually	Only sometimes	Never	Not Applicable	Often
I visited your website to find out what was happening at the clinic
I read the handouts on your RESOURCES page
I consulted the services listed on your LINKS page
I took books out from your library

Other Pomegranate Experiences

I attended a class/workshop at Pomegranate
I attended an Info Night on Homebirth or Waterbirth
I attended BirthFest
I attended another community event where Pomegranate was present

Are you connected with us?

Let us know how you stay informed about things going on at Pomegranate.

I have joined you on facebook
I follow your posts on twitter
I read your blog on your NEWS page
I have attended/plan to attend your Pomegranate Postpartum Drop-In on Fridays

Let us know more!

Please feel free to add any information below that we have not addressed in this survey. Your feedback is important to us!

Midwifery Student Evaluation

Thank you for involving midwifery students in your care. Pomegranate Community Midwives is dedicated to supporting students and we consider our clinic a teaching clinic for midwives-to-be. We also often have students from other disciplines, such as medicine, nursing, physiotherapy etc, who are keen to broaden their awareness of maternal-newborn health. We are committed to providing students with positive learning experiences so that they can join our community as competent and well-rounded practitioners. Please note that students may be at various stages of learning - from an observational status to a highly involved, clerkship status. Please take a moment to let us know how we are doing in terms of integrating students in your care with us.

What was the name of the student involved in your care?

Who were your midwives?

How many times did you meet this student?

please check all that apply

I had 1 or 2 visits with the student present
I had half of my visits with the student present
I had nearly all of my visits with the student present
The student was present at my birth
The student attended at least one of my postpartum visits

Please choose the description that best suits the role of the student involved in your care

The student observed the midwife only
The student observed the midwife mostly, but was involved in some of our discussions
The student observed the midwife mostly, but was involved in some of our discussions and even conducted some physical assessments of me and/or my baby
The student was highly involved in my care, conducting some of the visits and assessments on her own

What aspects of the student’s care did you find most helpful? What did you enjoy about having a student involved in your care?

Are there ways the student could improve her care?

Do you think the preceptor and practice could have improved your experience working with students? How?

Do you have any other comments?

Survey Completed!

Thank you for taking time to complete this survey - we know that free moments are precious and sometimes hard to come by! Please feel free to contact us in any way that suits you if you have any other feedback that wasn't captured in this survey.

You can phone us. Email us or send us a letter.
www.pomegranate-midwives.com

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