JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lactation Spectrum Survey
2021 Copyright Genny Stiller C-PNP, IBCLC
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Thank you for your participation in the Lactation Spectrum Survey (LSS). No part of this survey may be copied or reproduced. Responses will be recorded confidentially and used for current and future research by Genny Stiller IBCLC. Do you understand these conditions and consent to the terms of use of your responses by Genny Stiller IBCLC?
*
Yes
No
Are you 18 years or older?
*
You must be 18 years or older to participate in this survey.
Yes
No
What is your current age?
Your answer
Have you been formally diagnosed Autistic (ASD), Autism Spectrum Condition (ASC), Asperger's Syndrome (AS), or Sensory Processing Condition (SPC) by a medical professional?
Yes
No
Clear selection
At what age were you diagnosed?
Between ages 0-20 years
Between ages 21-40 years
Between ages 41-60 years
Between ages 61-80 years
I have not been formally diagnosed.
Clear selection
Do you self identify as ASD, ASC, AS, SPC, or as neurodiverse without a formal diagnosis?
Yes
No
Clear selection
At what age did you self identify?
Your answer
Did you share the ASD, ASC, AS, SPC, or neurodiverse identity with any of your medical providers during pregnancy, birth, or lactation?
Yes
No
Clear selection
What is the best way for a health care provider to inquire about your neurodiversity?
Directly asking the question during a face to face interaction.
On a health history form using a check box.
Other:
Clear selection
Are you aware of any personal sensory preferences and/or aversions (things you avoid)?
Yes
No
Maybe
Clear selection
What are your sensory preferences and/or aversions?
Your answer
Did you share your sensory preferences and/or aversions with your partner?
Yes
No
Clear selection
Did you consider your sensory preferences and/or aversions when preparing for birth or lactation?
Yes
No
Clear selection
Did you take any steps to manage your sensory preferences and/or aversions?
Yes
No
Clear selection
If you answered yes to the above question, what did you do?
Your answer
Did you experience an increased intensity in your preferences and/or aversions during your lactation experience(s)?
Yes
No
Clear selection
Can you identify a specific sensory experience(s) during lactation that felt extremely intense, overwhelming, or intolerable? Such as the sound of infant crying, infant suckling sensation, or the let down.
Your answer
What sensory details made breast-feeding difficult or challenging in your experience?
Nipple stimulation
Infant crying
Leaking from breasts
Infant pulling or tugging on chest
Restricted movement
All of the above
I had no sensory issues during lactation
Other:
Would you say that you notice small sounds when others do not?
Yes
No
Maybe
Clear selection
Would you say that you often heard your baby when others did not?
Yes
No
Maybe
Clear selection
When feeding your infant at the breast, did you experience a delay in your let down as a result of sensory overstimulation?
Yes
No
Maybe
Clear selection
When feeding your infant at the breast, did you experience a delay in your let down as a result of sensory aversion(s)?
Yes
No
Maybe
Clear selection
When expressing milk with your hands or a pump did you experience a delay in your let down as a result of sensory overstimulation?
Yes
No
N/A
Clear selection
When expressing milk with your hands or a pump did you experience a delay in your let down as a result of sensory aversion(s)?
Yes
No
N/A
Clear selection
Do you think any of the following would have decreased your overstimulation while breastfeeding?
Headphones
Closing eyes
Quiet room
Breathing exercises
Grounding exercise
Fidgeting
Stimming
Do you think any of the following would have decreased your aversions while breastfeeding?
Headphones
Closing eyes
Quiet room
Breathing exercises
Grounding exercises
Fidgeting
Stimming
Next
Page 1 of 6
Clear form
Never submit passwords through Google Forms.
This form was created inside of Genny Stiller IBCLC.
Report Abuse
Forms
