I had a community birth transfer survey draft Thank you for taking the time to give feedback here about your community labor/birth transfer setting. The informatin provided will be used to inform providers about how to make improvements. California Community Birth Transfer Survey CALM Transitions Transfer Survey - Client - OR How old are you? 15-19 20-24 25-29 30-34 35-39 40-44 How do you describe your race/ethnicity? Check all that applyAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic or Latino or ChicanoIndigenousMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderWhite or EuropeanAre you insursed by Medi-Cal (Medicaid)? Yes No Do you have a disability? Yes No What was the year of your hospital transfer? What was the location (city/town) of the receiving hospital? What is the name of the receiving hospital? You do not have to provide the name of the hospital if you do not wish to for any reason. Did your midwife discuss the possibility of transfer with you? Yes No During your pregnancy and planning for your community birth did you fee prepared for the possibility of transfer? Yes No If you you like to describe your experience use the "other" field.Before your transfer, how likely did you think it was that you or your baby would need to transfer to the hospital during labor, birth, or postpartum?* Very unlikely Unlikely Undecided Likely Very likely Please describe the reason you and/or your baby transferred to a hospital:*Did you and/or your baby transfer to the hospital by private car or ambulance?* Private car Ambulance Did you transfer during labor?* Yes No What type(s) of providers did you and/or your baby receive care from after your transfer? Check all that apply.ObstetricianNurse MidwifeMaternal-Fetal Medicine PhyscianNursePediatricianNeonatologistSocial WorkerLactation ConsultantI don't knowDid your homebirth/birth center midwives give you clear information during and after your transfer about the risks, benefits, and alternate options related to your care?* Yes No Did the hospital doctor give you clear information during and after your transfer about the risks, benefits, and alternate options related to your care?* Yes No Did the hospital nurse give you clear information during and after your transfer about the risks, benefits, and alternate options related to your care?* Yes No Did you feel your homebirth/birth center midwives respected your choices during and after your transfer?* Yes No Did you feel your hospital physician respected your choices during and after your transfer?* Yes No Did you feel your hospital nurse respected your choices during and after your transfer?* Yes No Did you experience any of the following types of mistreatment during or after your transfer?*Shouting, scolding and/or verbal abuseThreats, intimidation, and/or coercion about accepting treatments(s) you did not want or were not medically indicatedRefusal of requests for help and/or threats to withhold treatmentViolation of your privacyTouch, examinations, or procedures without your consentNone of the aboveDid you feel you experienced any poor treatment based on your appearance, identity, race or another factor?* Yes No Please choose "other" if you'd like to explain your experience.Please select all procedures, treatments and/or outcomes that you experienced.*Intravenous Fluids (I.V.)Labor inductionPitocin to increase strength and/or frequency of contractionsEpiduralIV Fentyal or other narcotic during laborIV antibiotics (for mother)Infection (for mother)Vacuum extraction of babyForceps delivery of babyEpisiotomyCaesarean SectionShoulder dystocia (baby got stuck and required help being delivered)Postpartum Hemorrhage (mother bled too much after the birth)Manual removal of placenta or clotsResuscitation of babyInfection (baby)IV antibiotics (baby)Baby admitted to NICUDeath of babyWere you offered follow-up with your homebirth or birth center midwives after you left the hospital?* Yes No Please choose "other" if you'd like to explain your experience.Did you chose to have follow-up care with your homebirth or birth center midwives after you left the hospital?* Yes No Please choose "other" if you'd like to explain your experience.How would you describe the interactions and communication between your community midwife and the hospital staff? Select all that apply.*FriendlyCollaborativeMixed interationsNo direct communicationsRespectfulDisrespectfulTolerantHostileOtherIf you chose "other" in the above questions about interactions between your midwife and hospital staff please describe here.What went well in your transfer experience?What could have been better in your transfer experience?What else would you like us to know about your transfer experience and the care you received?What else do you want us to know about this survey or our work to improve community birth to hospital transfers?If you would like to participate in a focus group to help us improve the transfer process for birthing families in California, please provide your email address for follow up. Each focus group will meet for 1-2 hours online to talk about your experiences and let us know what midwives and hospital can do better. Your email address will only be used for focus group purposes and will not be linked to your survey responses. 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