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Birth Class with Naomi
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* Indicates required question
Email
*
Your email
What class series are you registering for?
*
Breastfeeding Webinar (1.5 hours)
Breastfeeding Mini Class (5 hours)
Birth and Baby Foundations (7 class series, 14 hours)
Homebirth Mini Class (5 hours)
Individual class
Other:
How did you hear about this class?
*
Your answer
First and last name (pregnant person)
*
Your answer
Name of support person attending the class with you
Your answer
Email address of the person attending the class with you (if they wish to receive copies of our recap and resources)
Your answer
Phone number (pregnant person)
*
Your answer
Anticipated “due date” (40 weeks)
MM
/
DD
/
YYYY
What city & state, or country (if not the U.S.) are you in?
*
Your answer
What are you hoping to gain from this class?
*
Your answer
What topics from our syllabus are you most interested in?
Your answer
Are there topics you don’t see on the syllabus that are important to you?
Your answer
Where are you hoping to birth your baby?
*
In a public hospital
In a military hospital
In a birth center
At home
Not sure, yet!
Other:
What are your breastfeeding goals?
*
Exclusively breastfeeding (nursing, pumping)
Exclusively donor milk
Exclusively formula
A combination of the above
I haven’t thought about it 🤷♀️
Whatever works!
Required
What support will you have postpartum?
*
Spouse or partner
Older children
Other family
Friends
A postpartum Doula
No one
Not sure 🤔
Required
What is an ideal birth for you? (Select all that apply.)
*
Vaginal birth
Cesarean birth
Coping with pain medication
Coping with non-medicated relief strategies
Laboring alone
Laboring privately, with my partner and maybe a Doula
Laboring with a small team of trusted people
Laboring in a medical environment with multiple nurses or doctors
Other:
Required
How much knowledge do you have about labor?
*
Pretty minimal
1
2
3
4
5
I know a fair bit!
How much knowledge do you have about birth?
*
Pretty minimal
1
2
3
4
5
I know a fair bit!
How much knowledge do you have about postpartum?
*
Pretty minimal
1
2
3
4
5
I know a fair bit!
How much knowledge do you have about breastfeeding?
*
Pretty minimal
1
2
3
4
5
I know a fair bit!
How much knowledge do you have about caring for a newborn?
*
Pretty minimal
1
2
3
4
5
I know a fair bit!
Optional: Feel free to share fears you're battling regarding your pregnancy, labor, or birth. This can include past experience with birth, trauma, or loss, if you wish. These responses will remain anonymous.
Your answer
Send me a copy of my responses.
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