Quality of Care Evaluation Form

Please take some time to provide us with your evaluation of the midwifery care that you received during your recent pregnancy, birth and postpartum period. You do not need to identify yourself, unless you would prefer to do so. Your comments will be reviewed by the midwifery practice and can help us improve the quality of care we provide to our clients. Please check one rating choice for each category.

SECTION A - Prenatal, Labour and Birth, and Postpartum Care

Please rate the following aspects of your pregnancy, labour and birth, and postpartum care.

1. Prenatal Care

Team or pod letter(Required)

1. Number of my prenatal visits(Required)

2. Length of my prenatal visits(Required)

3. Scheduling of my prenatal visits(Required)

4. Usefulness of information provided to me for making decisions(Required)

5. How easy it was to reach my midwife or midwives(Required)

6. My confidence in the midwives' skills and abilities(Required)

7. How comfortable I felt asking questions(Required)

Comments or suggestions for improvement to prenatal care:

2. Labour and birth care

1. How easy it was to reach my midwife or midwives during labour(Required)

2. My confidence in the midwives' skills and abilities(Required)

3. Usefulness of information provided to me for making decisions(Required)

Comments or suggestions for improvement to labour and birth care:

3. Postpartum Care

1. Number of my postpartum visits(Required)

2. Length of my postpartum visits(Required)

3. Scheduling of my postpartum visits(Required)

4. How easy it was to reach my midwife or midwives(Required)

5. Usefulness of information about caring for myself(Required)

6. Usefulness of information about caring for my baby(Required)

7. My comfort in calling my midwife or midwives with questions or problems(Required)

8. My confidence in the midwives' skills and abilities(Required)

Comments or suggestions for improvement to postpartum care:

SECTION B - Continuity of Care, Informed Choice, Consultation

4. CONTINUITY OF CARE - Midwives must ensure that clients have no more than four midwives involved in their care and that there is 24-hour on-call access through pregnancy, labour and postpartum.

1. Did you know which midwife or midwives were primarily responsible for your care?(Required)

Yes

Not applicable

2. Were there adequate opportunities for you to meet the midwives involved in your care?(Required)

Yes

Not applicable

3. Did you understand how to reach a midwife 24 hours a day?(Required)

Yes

Not applicable

Comments or suggestions for improvement to continuity of care:

5. INFORMED CHOICE - Midwives must provide clients with information about their education and experience, how midwives practice in Ontario and what standards and protocols they must follow. Throughout care, midwives must provide clients with enough information to make informed decisions regarding their care.

1. In general, were your choices and decisions respected by your midwife or midwives?(Required)

Yes

Not applicable

2. Did you receive enough information to make informed decisions about your care?(Required)

Yes

Not applicable

3. Were you given enough information to decide where to have your baby's birth?(Required)

Yes

Not applicable

Comments or suggestions for improvement to informed choice:

CONSULTATION AND TRANSFER OF CARE - Midwives are required to consult with physicians for certain conditions that may arise during pregnancy, labour and postpartum. Some conditions require that a physician take over care.

1. Did you understand the reasons why a doctor might become involved in your care?(Required)

Yes

Not applicable

2 a. Did your midwife need to consult with a doctor during your care?(Required)

Yes

Not applicable

2 b. If so, did you understand why and what would happen?(Required)

Yes

Not applicable

Comments or suggestions for improvement to consultation and transfer of care:

SECTION C - STUDENT INVOLVEMENT

Please rate your level of satisfaction with student involvement in prenatal care, labour and birth, and postpartum care.

7. STUDENT INVOLVEMENT

1. Prenatal Care(Required)

2. Labour and Birth(Required)

3. Postpartum Care(Required)

What you liked / most valued about student involvement in overall care:

What you disliked / least valued about student involvement in overall care, and would like to see changed:

SECTION D - ADMINISTRATIVE SERVICES

Please rate your level of satisfaction with our Administrative Services during your care.

8. SCHEDULING APPOINTMENTS

The way in which our Administrator scheduled your appointments, informed you of cancellations and made changes to appointment dates/times.(Required)

9. TELEPHONE MANNER

The way in which our Administrator returned your phone calls, left messages for you, provided information over the telephone, etc.(Required)

10. PERSONAL ATTENTION

The way in which our Administrator provided you with information and treated you whenever you were in our office.(Required)

What you liked / most valued about our Administrative Services and would like to see remain the same:

What you disliked / least valued about our Administrative Services and would like to see changed:

QUALITY OF CARE EVALUATION FORM

SECTION A - Prenatal, Labour and Birth, and Postpartum Care

1. Prenatal Care

2. Labour and birth care

3. Postpartum Care

SECTION B - Continuity of Care, Informed Choice, Consultation

4. CONTINUITY OF CARE - Midwives must ensure that clients have no more than four midwives involved in their care and that there is 24-hour on-call access through pregnancy, labour and postpartum.

CONSULTATION AND TRANSFER OF CARE - Midwives are required to consult with physicians for certain conditions that may arise during pregnancy, labour and postpartum. Some conditions require that a physician take over care.

SECTION C - STUDENT INVOLVEMENT

7. STUDENT INVOLVEMENT

SECTION D - ADMINISTRATIVE SERVICES

8. SCHEDULING APPOINTMENTS

9. TELEPHONE MANNER

10. PERSONAL ATTENTION

Thank you for completing this survey

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