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OB/Midwife Interview Checklist

(page 4 of 4)


For Midwives

How many babies do you deliver on a average month?

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Who is your back-up obstetrician?

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Can you give me some examples of when you might manage my care jointly with the backup obstetrician or transfer me to one full time?

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

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If I need a cesarean, will you stay with me during the procedure?

_____________________________________


References:

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_____________________________________

_____________________________________

_____________________________________

_____________________________________

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Overall

Did you feel comfortable with doctor or midwife?

yesno

Do you feel you can ask a question without feeling embarrassed?

yesno

Do you think you would feel comfortable calling the doctor or midwife in the middle of the night?

yesno

Did they take the time to talk to you?

yesno

Did you feel like they were rushing you through the appointment?

yesno

Did they answer your questions completely?

yesno


Final Comments:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

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Rating

(Scale from 1-10:10 being the highest and 1 being the lowest)

_____________________________________


Decision
yesno



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