Perinatal Partner Absence Form
Please answer the following questions about your experience with partner absence during the perinatal period. Your responses are anonymous and will help us understand this topic better.
During which phase did your partner experience absence?
*
Pregnancy
Labor and birth
Postpartum
Multiple phases
Other
How frequently was your partner absent during the perinatal period?
*
Never
Rarely
Sometimes
Often
Always
What were the main reasons for your partner's absence?
Work commitments
Travel or distance
Family obligations
Personal choice
Health reasons
Other
How did your partner's absence affect your perinatal experience?
*
No impact
1
2
3
4
5
6
Significant impact
7
1 is No impact, 7 is Significant impact
How supported did you feel from other sources during your partner's absence?
Not supported
1
2
3
4
5
6
Very supported
7
1 is Not supported, 7 is Very supported
Please rate your overall emotional response to your partner's absence.
1
2
3
4
5
Did you seek additional help or support due to your partner's absence?
Yes
No
If yes, what type of support did you seek?
Family
Friends
Healthcare provider
Community group
Online resources
Other
What would have helped improve your experience during your partner's absence?
Any additional comments or feedback?
Submit Survey
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