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.

Name (optional)

Email (optional)

SECTION A – PRENATAL CARE:

Rate the following aspects of your prenatal, labour and birth, and postpartum care. Check one rating choice for each sub-category.

number of my prenatal visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

length of my prenatal visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

scheduling of my prenatal visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Usefulness of information provided to me for making decisions(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

how easy it was to reach my midwife or midwives(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

my confidence in the midwives' skills and abilities(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

how comfortable i felt asking questions(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Comments or suggestions for improvement to prenatal care:

LABOUR AND BIRTH CARE:

how easy it was to reach my midwife or midwives during labour(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

How easy it was to reach my midwife or midwives during labour(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

My confidence in the midwives' skills and abilities(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Usefulness of information provided to me for making decisions(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Comments or suggestions for improvement to labour and birth care:

POSTPARTUM CARE:

Number of my postpartum visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Length of my postpartum visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

scheduling of my postpartum visits(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

how easy it was to reach my midwife or midwives(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

usefulness of information about caring for myself(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

usefulness of information about caring for my baby(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

my comfort calling my midwife or midwives with questions or problems(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

my confidence in the midwives' skills and abilities(required) 1 – Poor

2 – Good

3 – Fair

4 – Excellent

Comments or suggestions for improvement to postpartum care:

SECTION B –

The questions in this section cover your midwifery care from pregnancy, through labour and birth and after your baby’s birth until six weeks postpartum. Please check one answer for each question.

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.

did you know which midwife or midwives were primarily responsible for your care?(required) Yes

Were there adequate opportunities for you to meet the midwives involved in your care?(required) Yes

Did you understand how to reach your midwife 24 hours a day?(required) Yes

Comments or suggestions for improvement to continuity of care:

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.

In general, were your choices and decisions respected by your midwife or midwives?(required) Yes

Did you receive enough information to make informed decisions about your care?(required) Yes

Were you given enough information to decided where to have your baby's birth?(required) Yes

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.

Did you understand the reasons why a doctor might become involved in your care?(required) Yes

Did your midwife need to consult with a doctor during your care? if so, did you understand why and what would happen?(required) Yes

If you answered yes to the above question, please expand:

Was your care trasferred to a doctor? If so, did you understand why and what would happen?(required) Yes

If you answered yes to the above question, please expand:

Comments or suggestions for improving consultation and transfer of care:

College of Midwives of Ontario – Quality of Care Evaluation Form

Midwife alliance

A client based midwifery practice serving the west end of Toronto

Quality of Care Evaluation Form

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