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Step 1 of 42

2%
  • Thank you for taking the time to complete The Lifestyle Assessment. As you reflect on your life, you become more self aware and stronger as a woman. The goal is to provide a place for you to reflect on your current habits. You will receive your results in an email to further assist in taking One Simple Step towards greater health.

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Step 1 of 23

4%
  • Thank you for taking the time to complete The Birth Preparation Guide. As you anticipate your upcoming birth, you become stronger as you prepare yourself. The goal is to provide a place for you to reflect on your feelings and a space to write down your concerns. You will receive your results in an email to further assist in your preparation of your Birth Day and meeting your baby! Congratulations Mom!

  • To understand your desires, Reflect on the following statements:
    Scale: 1 = Very uncomfortable
    2 = Somewhat uncomfortable
    3 = Neutral, flexible, okay
    4 = Somewhat comfortable
    5 = Very comfortable
    ? = Unsure right now, need to think about it more
    N/A = Not applicable

  • 12345?N/A
    Vaginal delivery
    Cesarian delivery
    Induction
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    Continuous- limits mom’s movement
    Intermittent-periodic monitoring
    Telemetry-remote monitoring
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    My Doctor
    Midwife
    Doula
    Hospital
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    Lights dimmed
    Flameless candles
    Music
    Aromatherapy (essential oils)
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    Pictures during delivery
    Video during delivery
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    Laying on back
    Shower
    Birthing ball/Peanut ball
    Sidelying
    Water birth
    Squatting stool
    On hands/knees
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?N/A
    Spinal
    Epidural
    Breathing
    Massage
    Shower
    TENs unit
    Essential Oils
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?NA
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?NA
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?NA
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?NA
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 12345?NA
    1 = Very uncomfortable; 2 = Somewhat uncomfortable; 3 = Neutral, flexible, okay; 4 = Somewhat comfortable; 5 = Very comfortable
  • 1 = Not important at all
    3 = Neutral
    5 = Very important
    ? = Questions
    N/A = Not applicable

  • 12345?N/A
    Skin on skin immediately
    Breastfeeding
    Bottlefeeding
    Pacifier
    Use of bottle in hospital
    Baby rooming In
    Nursery care
    1 = Not important at all; 3 = Neutral; 5 = Very important
  • 12345?NA
    1 = Not important at all; 3 = Neutral; 5 = Very important
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.
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