Student Midwife-Client Feedback - Birthingway College of Midwifery
Student Midwife-Client Feedback - Birthingway College of Midwifery
Student Midwife-Client Feedback - Birthingway College of Midwifery
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<strong>Student</strong> <strong>Midwife</strong> – <strong>Client</strong> <strong>Feedback</strong><strong>Student</strong> <strong>Midwife</strong> Name: _____________________________________Approximately how many prenatals did the student midwife attend with you? ______How many postpartum visits? _____________________Did you meet the student midwife when you interviewed your midwife? Yes NoPlease use the scale below to rate the student midwife on the following aspects:Excellent Very Good Satisfactory Needs Work Problem Area5 4 3 2 1student midwife dressed appropriately 5 4 3 2 1was respectful toward me and my partner 5 4 3 2 1made meaningful contributions to prenatals 5 4 3 2 1was an asset to me in labor 5 4 3 2 1was available to answer questions/concerns 5 4 3 2 1was not afraid to admit when she didn’t know an answer 5 4 3 2 1was neat and clean in appearance 5 4 3 2 1seemed prepared and knowledgeable at meetings, prenatals, 5 4 3 2 1and at my birtharrived on time to appointments 5 4 3 2 1was a good listener 5 4 3 2 1complimented the senior midwife’s working style 5 4 3 2 1was open to constructive criticism 5 4 3 2 1seemed confident and knowledgeable when using skills5 4 3 2 1(i.e. during dilation checks etc.)explained necessity <strong>of</strong> and importance <strong>of</strong> procedures 5 4 3 2 1helpful during labor 5 4 3 2 1sensitive to me and my family’s feelings and needs 5 4 3 2 1reassuring during labor 5 4 3 2 1projected feeling <strong>of</strong> calmness and warmth 5 4 3 2 1arrived at labor prepared and with equipment in good order 5 4 3 2 1able to think and act in an emergency 5 4 3 2 1I would rate the <strong>Student</strong> <strong>Midwife</strong>’s overall performance as 5 4 3 2 1I would choose this student midwife as a birth attendant again. True FalsePlease add any comments or constructive criticisms you may have to the back <strong>of</strong> this form.May we call you to clarify any comments? Yes NoPhone:____________________________ Best time to call:___________________Your name:_______________________________Baby’s name and date <strong>of</strong> birth:_____________________________<strong>Birthingway</strong> <strong>College</strong> <strong>of</strong> <strong>Midwife</strong>ry
Dear New Mom,As midwives, we are continually trying to honeour craft and better serve growing families. Never isthis process more important than during our studentmidwife years. Your feedback would be most helpfulto the student midwife that attended you during yourpregnancy and birth. Please take a few moments t<strong>of</strong>ill out the enclosed form. If you wish, you may file itanonymously.Thank you for your help,enjoy your baby!
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