Please fill out this survey regarding breastfeeding and health practices. 
All identifying information provided will be kept private. 
Responses will be used to gain greater understanding of current viewpoints and practices around birth, breastfeeding and health matters.
This survey may take 10 minutes or more to complete.

 

1. Please provide a valid email address (and phone number if desired), so we can follow up if we need clarification or more information. Only those fields marked with an asterisk are required. All identifying information provided will be kept private. email address (required): *
 phone number:
     
2. Age   * required  
3. Race    
4. Number of children and their ages and genders   * required  
5. Income    
6. Where do you live (City, State, Country)?   * required  
7. Are you a stay-at-home mom? yes no

Birth Questions:
8. Have you ever had an unmedicated childbirth? (i.e., no pain killers, epidural or otherwise) yes no
9. Have you ever had a c-section? yes no
10. Did you deliver any of your children in a hospital? (If no, please skip to question 16) yes no
11. If you delivered any child in a hospital, did you receive any labor medications, IVs, or undergo any medical procedures (e.g. episiotomy)? yes no
12. If you answered yes, please tell us the types of interventions that took place and medications that were given.  
13. Did any of your children spend any time in the NICU? yes no
14. Did any of your children use a pacifier at the hospital? yes no
15. Did  any of your children cosleep with you while in the hospital? yes no

Breastfeeding Questions:
16. Are you currently breastfeeding one or more children? yes no
17. How long has each child been nursed? (Please provide weeks, months, or years and months.)  
18. Do you or did you find breastfeeding to be difficult?    
19. If you answered that you had difficulties with breastfeeding, please tell us what types of difficulties you had.  

 
20. Have any of your children ever been fed infant formula? yes no
21. If you answered yes, how much infant formula did each child receive? (e.g., 25% of feedings for first 6 weeks, 50% of feedings thereafter, or 25% of feedings first 6 weeks, and then none, etc.)  
22. Have any of your children ever choked on formula?  
23. How often would you say you slept in the same bed with any of your children as infants? If you feel you need to provide an explanation please add any details here:
24. Have you ever suffered from low milk supply? yes no
25. How comfortable are you, yourself, nursing in public?  
26. How many times, if any, have you been harassed or made uncomfortable by someone else who was not happy that you were nursing in public, or around them?
27. If you said you experienced discrimination for breastfeeding in public, please describe any incidents that have occurred.  
28. If you are not comfortable nursing in public, please describe the reasons for the discomfort.  
29. Have you ever had breast implants, breast reduction surgery, or any other breast surgery? yes no
30. Have you ever continued a breastfeeding relationship while working full time outside of the home? yes ( If so, how long did you continue breastfeeding?) no
31. If you have any children who are weaned, what factors led to their weaning?  

Postpartum Issues:
32. Did you have any emotional difficulties (for example, depression, anxiety, PTSD, psychosis) following the birth of any of your children? yes no
33. If you answered yes, please briefly describe the difficulties. If you are aware of anything that may have caused the difficulties or made them worse, please include an explanation.  
34. If you had emotional difficulties, what strategies or treatments, if any, did you use to try and feel better?  
35. If you used medications for emotional problems, please list the names of the medications, dosages, and amount of time you took the medications, and whether the medications seemed effective to you.  
36. If you have ever used psychoactive medications, did you use them while breastfeeding a child or during a pregnancy?  
37. If you answered that you used psychoactive medications while breastfeeding, how old was your child when you started taking the medications and breastfeeding, and how long did the breastfeeding on medication last?  
38. If you used the medications during a pregnancy, please explain how long they were used, at what point you began using them, and at what point you stopped.  
39. If you used medications for emotional problems, please describe any adverse events or side effects you experienced (in either you or your child).  

Health Questions About Your Children:
40. Did any of your children receive any vaccines? yes no
41. If you answered yes, are there any vaccines that any of your children skipped? If so, please list the ones that were skipped and reason for skipping, if desired.

 
42. If any of your children received any vaccines, did you notice any side effects or adverse reactions from the vaccines? yes no
43. If you answered yes, please describe the adverse events.
44. Have any of your children been circumcised? (If not applicable, please select N/A and skip to question 47)  
45. If you answered yes, did all of the children who were circumcised heal as expected? yes no
46. If any of your children had a circumcision that did not heal properly, please describe any medical or cosmetic difficulties that occurred.  
47. Did circumcision seem to cause pain or discomfort for any of your babies?  
48. Have your children ever been given Vitamin D supplement drops (with Iron and fluoride)?  
49. Have your children ever been fed nursery water (bottled water with extra fluoride added)?  
50. How often do your children eat foods with artificial sweeteners, such as Splenda, aspartame, or saccharin?  
51. How often do your children eat organic food?  
52. How often do your children eat foods with artificial flavors, colors, and/or preservatives?  
53. Do you think your children are in good health?  
54. Please describe how often, if at all, your children have used "alternative" health treatments, and for what health conditions (example: chiropractic, accupuncture, iridology, homeopathic, herbal et cetera). Also list whether the cost of these treatments was completely out of pocket or partially covered by insurance.  

Health Questions About You:
55. Do you consider yourself in good health?  
56. How severe would you consider any dental problems you may have had? (i.e. - cavities, gum problems, bone loss)
57. If you have had any back pain, neck pain, or other spinal or muscle problems, how severe were they?
58. Do you suffer from fibromyalgia? yes no
59.  Please describe any significant long-lasting changes to your health that occurred  in conjunction with pregnancy, childbirth or breastfeeding.  
60. Please describe how often, if at all, you have used "alternative" health treatments for yourself and for what health conditions (example: chiropractic, accupuncture, iridology, homeopathic, herbal supplements, et cetera). Also list whether the cost of these treatments was completely out of pocket or partially covered by insurance.  

Child Temperament and Soothing Questions:
61. How many minutes or hours per day does your child cry? (estimate - if more than one child, please answer for each child)  
62. What do you think are the reasons for the crying?  
63. How do you prefer to soothe your children when they cry?  
64. Have you routinely used a baby wrap or sling or other baby carrier to keep your children close? yes no
65. If you answered no, how much time per day would you say your children routinely spend or spent in arms, as an infant?  
66. Do you consider crying-it-out as a valid or effective method for parents to use to get their babies or children to sleep? yes no
67. If so, do you, or have you used this method?  
Questions Relating to Prenatal Health and Prescription or Non-Prescription Drugs
68. Have you or your partner ever used prescription or non-prescription drugs prior to or during any of your pregnancies? If so, please list any medications, drugs or herbal supplements that were used, when they were used (in relation to the pregnancy) and which parent or partner used them.  
69. Have you ever suffered a miscarriage, preterm birth, stillbirth, birth defect, or neonatal death of your child? If so, please describe.  
70. Have you ever experienced pain following unprotected intercourse? If so, was the pain from anything specific? Please describe.  
Breastfeeding & Upbringing, Family & Social Support
71. Were you breastfed as a baby? If so, how long were you nursed?  
72. How supportive are your family members of breastfeeding?  
73. Do you find the support of friends, family, community, or society to play a role in how your children are fed or nurtured?  
Thank you very much for your thoughtful responses!
Do you have any suggestions or feedback for this survey or our website, babywhys.org? If so, please describe: