Evaluation Form - Whole Spirit Riverdale

Client's Name

Partner's Name

Baby's Birth Date

My Doula provided helpful and informative prenatal appointments.

My Doula suggested useful pain management techniques during the birth.

My Doula suggested useful emotional coping techniques for labor and birth.

My Doula provided support to my birth partner that enabled them to participate in the birth.

My Doula worked well with my Midwife, Doctors, Nurses, etc.

The prenatal education provided was current and evidence-based as it pertains to labor and birth.

My Doula was able to provide me with the information and tools I needed for decision making at every stage of my pregnancy and birth.

During the birth, the suggestions my doula made were helpful for my partner and/or support persons.

My Doula was a helpful addition to my care team.

Overall, my Doula contributed to my having a positive birth experience.

I would recommend my Doula to others.

Did your Doula do anything specific during pregnancy, birth, and immediately postpartum that was particularly helpful or outstanding?

Thinking back on your experience with your Doula, what would you have changed? Is there anything you would have wanted more/less of?

Is there anything you feel your Doula could improve on in the services that she provided?

Is there anything else you would like to add?

Whole Spirit Riverdale