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First, We Would Like to Ask a Few Questions About You and the Time

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First, We Would Like to Ask a Few Questions About You and the Time 1 First, we would like to ask a few questions 6. How tall are you without shoes? about you and the time before you became pregnant with your new baby. Please Feet Inches check the box next to your answer. OR Centimeters 1. Just before you got pregnant, did you have health insurance? (Do not count Medicaid.) 7. Before your new baby, did you ever have ‘ No any other babies who were born alive? ‘ Yes ‘ No º Go to Question 10 ‘ Yes 2. Just before you got pregnant, were you on Medicaid? 8. Did the baby born just before your new one ‘ No weigh 5 pounds, 8 ounces (2.5 kilos) or less ‘ Yes at birth? ‘ No 3. In the month before you got pregnant with ‘ Yes your new baby, how many times a week did you take a multivitamin (a pill that contains many different vitamins and minerals)? 9. Was the baby just before your new one born more than 3 weeks before its due date? ‘ I didn’t take a multivitamin at all ‘ 1 to 3 times a week ‘ No ‘ 4 to 6 times a week ‘ Yes ‘ Every day of the week 10. Thinking back to just before you got 4. What is your date of birth? pregnant, how did you feel about becoming pregnant? Check one answer Month Day Year ‘ I wanted to be pregnant sooner ‘ I wanted to be pregnant later 5. Just before you got pregnant, how much did ‘ I wanted to be pregnant then you weigh? ‘ I didn’t want to be pregnant then or at any time in the future Pounds OR Kilos 2 15 11. When you got pregnant with your new The next questions are about the prenatal Please use this space for any additional comments you would like to make about the health of baby, were you trying to become care you received during your most recent mothers and babies in Ohio. pregnant? pregnancy. Prenatal care includes visits to a doctor, nurse, or other health care ‘ No ‘ Yes º Go to Question 14 worker before your baby was born to get checkups and advice about pregnancy. (It 12. When you got pregnant with your new may help to look at a calendar when you baby, were you or your husband or answer these questions.) partner doing anything to keep from getting pregnant? (Some things people do 14. How many weeks or months pregnant to keep from getting pregnant include not were you when you were sure you were having sex at certain times [rhythm], and pregnant? (For example, you had a using birth control methods such as the pill, pregnancy test or a doctor or nurse said you Norplant®, shots [Depo-Provera®], were pregnant.) condoms, diaphragm, foam, IUD, having their tubes tied, or their partner having a vasectomy.) Weeks OR Months ‘ No ‘ I don’t remember ‘ Yes º Go to Question 14 13. What were your or your husband’s or 15. How many weeks or months pregnant partner’s reasons for not doing anything were you when you had your first visit for to keep from getting pregnant? prenatal care? (Don’t count a visit that was only for a pregnancy test or only for WIC Check all that apply [the Special Supplemental Nutrition Program for Women, Infants, and Children].) ‘ I didn’t mind if I got pregnant ‘ I thought I could not get pregnant at that time Weeks OR Months ‘ I had side effects from the birth control method I was using ‘ I didn’t go for prenatal care ‘ I had problems getting birth control when I needed it ‘ I thought my husband or partner or I was sterile (could not get pregnant at all) ‘ My husband or partner didn’t want to use anything ‘ Other º Please tell us: Thanks for answering our questions! Your answers will help us work to make Ohio mothers and babies healthier. 14 3 77. During your most recent pregnancy, what 78. Listed below are some things about safety. 16. Did you get prenatal care as early in your If you did not go for prenatal care, go to did you think about breastfeeding your For each thing, circle Y (Yes) if it applies to pregnancy as you wanted? Page 4, Question 23. new baby? you or circle N (No) if it does not. No Yes ‘ No Check one answer a. My infant was brought home ‘ Yes 18. Where did you go most of the time for your Go to from the hospital in an infant ‘ I didn’t want prenatal visits? (Do not include visits for Question 18 ‘ I knew I would breastfeed car seat......................N Y prenatal care WIC.) ‘ I thought I might breastfeed b. My baby always or almost always Check one answer ‘ I knew I would not breastfeed rides in an infant car seat........N Y ‘ I didn’t know what to do about c. My home has a working 17. Did any of these things keep you from breastfeeding smoke alarm .................N Y getting prenatal care as early as you ‘ Hospital clinic d. There are loaded guns, rifles, or wanted? ‘ Health department clinic other firearms in my home.......N Y ‘ Private doctor’s office or HMO clinic Check all that apply ‘ Community health center or clinic ‘ Military facility ‘ I couldn’t get an appointment earlier in ‘ Other º Please tell us: my pregnancy ‘ I didn’t have enough money or insurance to pay for my visits ‘ I didn’t know that I was pregnant ‘ I had no way to get to the clinic or 19. How was your prenatal care paid for? doctor’s office Check all that apply ‘ The doctor or my health plan would not start care earlier ‘ I didn’t have my Medicaid card ‘ Medicaid ‘ I had no one to take care of my children ‘ Personal income (cash, check, or credit ‘ I had too many other things going on card) ‘ Other º Please tell us: ‘ Health insurance or HMO ‘ Military coverage (including TRICARE Prime) ‘ Other º Please tell us: 4 13 20. During any of your prenatal care visits, 21. At any time during your prenatal care, did 75. Since you delivered your new baby, would 76. This question asks about things that may did a doctor, nurse, or other health care a doctor, nurse, or other health care you have the kinds of help listed below if have happened at the hospital where your worker talk with you about any of the worker ask if you were smoking you needed them? For each thing, circle new baby was born. For each item, circle things listed below? (Please count only cigarettes? Y (Yes) if you would have it or circle N (No) Y (Yes) if it happened or circle N (No) if it discussions, not reading materials or videos.) if not. did not happen. For each item, circle Y (Yes) if someone ‘ No No Yes No Yes talked with you about it or circle N (No) if ‘ Yes a. Hospital staff gave me no one talked with you about it. a. Someone to loan me $50........N Y information about No Yes 22. At any time during your prenatal care, did b. Someone to help me if I were breastfeeding.................N Y a. How smoking during pregnancy a doctor, nurse, or other health care sick and needed to be in bed.....N Y b. My baby stayed in the same could affect your baby..........N Y worker ask if you were drinking alcoholic c. Someone to talk with about room with me at the hospital.....N Y b. Breastfeeding your baby........N Y beverages (beer, wine, wine cooler, or my problems .................N Y c. I breastfed my baby in the c. How drinking alcohol during liquor)? d. Someone to take care of hospital .....................N Y pregnancy could affect your my baby.....................N Y d. I breastfed my baby in the first baby........................N Y ‘ No e. Someone to help me if I were hour after my baby was born.....N Y d. Using a seat belt during ‘ Yes tired and feeling frustrated with e. Hospital staff helped me learn your pregnancy ...............N Y my new baby.................N Y how to breastfeed .............N Y e. Birth control methods to use 23. Have you ever heard or read that taking f. My baby was fed only breast after your pregnancy...........N Y the vitamin folic acid can help prevent milk at the hospital ............N Y f. Medicines that are safe to take some birth defects? g. Hospital staff told me to If your baby was not born in a hospital, go to during your pregnancy..........N Y breastfeed whenever my Page 14, Question 77. g. How using illegal drugs could ‘ No baby wanted..................N Y affect your baby...............N Y ‘ Yes h. The hospital gave me a gift h. Doing tests to screen for birth pack with formula.............N Y defects or diseases that run in 24. At any time during your most recent i. The hospital gave me a your family ..................N Y pregnancy or delivery, did you have a telephone number to call for i. What to do if your labor blood test for HIV (the virus that causes help with breastfeeding.........N Y starts early...................N Y AIDS)? j. My baby used a pacifier j. Getting your blood tested for HIV in the hospital ................N Y (the virus that causes AIDS) .....N Y ‘ No k. Physical abuse to women by ‘ Yes their husbands or partners.......N Y ‘ I don’t know The next questions are about your most recent pregnancy and things that might have happened during your pregnancy.
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