Birth Arts International Parental Birth Evaluation Form
Client's Name
Doula's Name
Name of Infant
Type of Delivery
Vaginal
VBAC
C-section
Place of Delivery
Hospital
Home
Birth Center
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
1
Date of Evaluation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
2
Did you feel that your doula performed well for you during your birth?
Yes
No
Somewhat
Do you feel that your birth experience was enhanced by the presence of a doula?
Yes
No
Somewhat
What are some suggestions for your doula?
Would you have a doula again?
Yes
No
Maybe
Would you have YOUR doula again?
Yes
No
Maybe
How do you feel your birth experience was overall?
Do you feel that having a doula was an asset to the birth process?
Yes
No
Somewhat
Were the suggestions of the doula of benefit to yourself, family, and friends?
Yes
No
Somewhat
What labor support techniques did you find the most useful?
May Birth Arts International contact you about your experience? If so, please include your contact information.
By submitting your evaluation, we are better able to train future doulas.
If you have any questions, please contact Birth Arts International at 866-303-4372 or www.birtharts.com
Submit
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