Pre-Course Questionnaire - Mum

Please complete your answers with as much detail as possible so that your course material can be tailored to suit your needs. All information given is completely confidential.

Pre-course questionnaire - Mum

Name:*
D.O.B:
Due Date:*
Course Date & Location:*
Where are you planning on giving birth?:
What other antenatal courses are you planning to attend?:
How did you find out about this course?:
What was your initial response when you found out you were pregnant?:
How has this pregnancy effected your relationships with your partner/other members of your family?:
How will the baby fit into your current lifestyle? Will a baby alter your lifestyle significantly or change longterm plans? If so how?:
Describe how you envisage the birth of this baby. What is important to you? Who will be present?:
How do you think you will cope with pain during labour? How do you want to prepare for it?:
How did you feel about your body before you were pregnant?:
How do you feel about your body now?:
Describe any particular fears you have at the moment regarding the birth, your baby, or the post natal period.:
How do you like to relax?:
Describe somewhere you could have as a 'special place' either real or imaginary, somewhere which only has positive associations for you.:
Do you have any fears, phobias or allergies?:*
Do you have any medical conditions?:*
Is this your first pregnancy?:*
Describe any previous pregnancy or birth as fully as possible.:

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