Birth Class Evaluation Form

Class Evaluation
Full Name
First NameLast Name
This class was taught by:*
Date of Classes:*
I am (related to the birth)
MotherFatherPartnerFriendRelativeDoula
What number baby is this?
Rate on the following scale:
My Mentor:
was engaging and approachable*

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
gave clear answers and explanations*

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
inspired self-confidence*

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
facilitated lively discussions with parents*

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
asked thought-provoking questions that made the process of making birth art meaningful*

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
My comprehension of each of these pain-coping practices, based on my Mentor's instruction: ***If your mentor did not teach the pain-coping practice, leave blank.
Breath Awareness

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
Non-Focused Awareness

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
Edges, Spiraling, or Finding the Center

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
Circular Breathing

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
Drugs and Epidurlas

1 2 3 4 5 6 7
1 is Terrible, 7 is Excellent
I rate my Mentor's capacity to build a pain coping mindset by completing these statements, giving a number from 1-7, where 1=no confidence, 3-4= somewhat confident, 7= very confident
(If a birth companion, rate your confidence in your ability to cope with and help the birthing woman in labor.)
When I started the class, my confidence in coping with pain was:
Today, at the end of my classes, I rate my confidence in coping with pain as:
I rate how much I learned from and valued the following:
Practical Information

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
Birth Art (Labyrinth, Labor as a Landscape, etc.)

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
Role Play- Contraction

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
Cesarean Awareness

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
Inanna Story

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
Father's Class

1 2 3 4 5 6 7
1 is Totally Useless, 7 is Extremely Valuable
What I liked and/or valued most in the classes and why:
What I had the most trouble relating to during these classes was:
How these classes influenced my partner's attitude towards labor, birth, and parenting:
How these classes influenced our relationship:
Anything else I want to share about the class, my Mentor, and/or my learning process:
Optional testimony about class/Shalene for Rhythm of Birth website and/or Face Book page:
I wish to remain anonymous
YesNo
You may use my name and comments publicly.
YesNo
Thanks for filling out the evaluation!
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