Name

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First Name

Last Name

Were you already a birth center patient?

Yes, I had prenatal care and gave birth at the birth center or transferred out during labor.

Yes, I had prenatal care there but did not give birth there

Yes, I have had well-person care there

Yes, I have had lactation services at the birth center before

No, I had not received care here prior to lactation services

What is your age?

Under 20

20-29

30-39

40-49

50 and above

How many children do you have?

1

2

3

4 or more

How long have you been breastfeeding?

Less than 1 month

1-3 months

4-6 months

7-12 months

More than 12 months

How easy was it for you to find information on lactation services at the birth center?

Very difficult

Difficult

Neutral

Easy

Very Easy

Were you able to schedule an appointment(s) in a timely manner to address your needs?

Always

Most of the time

Sometimes

Rarely

Never

How knowledgeable and supportive was the lactation consultant?

Very knowledgeable and supportive

Knowledgeable and supportive

Neutral

Somewhat knowledgeable and supportive

Not knowledgeable or supportive

Did you feel respected and understood by the lactation consultant?

Always

Most of the time

Sometimes

Rarely

Never

How effective was the advice and support you received in helping you breastfeed?

Extremely effective

Very effective

Moderately effective

Slightly effective

Not effective

Did the support you received help you feel more confident in breastfeeding?

Yes, a lot

Yes, somewhat

Neutral

No, not much

No, not at all

Would you recommend the lactation support services you received to other parents?

Definitely

Probably

Not sure

Probably not

Definitely not