ChildbirthJoy Prenatal Series Follow Up Form


ChildbirthJoy Follow-up Form Birth Experience

Please note that all fields followed by an asterisk must be filled in.
None
GBS+
Prolonged rupture of membranes
Postdates
Posterior Presentation
Other
None
Pitocin
Demerol
Nubain
Epidural
Nitrous
Oxide
Local freezing for sutures postpartum
Other
None
Induction
Augmentation (meds to incourage contractions once in labour)
Vacuum Extraction
Forceps
Caesarian
Other
None
Fetal distress - mild
Fetal distress - severe
Excess bleeding postpartum
Newborn resuscitation
Other

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