EmailMe Form - Quality of Care Evaluation Form

Prenatal Care

	Excellent	Good	Fair	Poor
Number of prenatal visits
Length of prenatal visits
Scheduling of prenatal visits
Usefulness of information provided for making decisions
How easy it was to reach my midwives
My confidence in the midwives skills & abilities
How comfortable I felt asking questions

Comments or Suggestions for improvement to prenatal care:

Labour & Birth Care

	Excellent	Good	Fair	Poor
How easy it was to reach my midwives during labour
My confidence in the midwives skills and abilities
Usefulness of information provided to me for making decisions

Comments and suggestions for improvements to labour and birth care:

Postpartum Care

	Excellent	Good	Fair	Poor
Number of postpartum visits
Length of postpartum visits
Scheduling of Postpartum visits
How easy it was to reach my midwives
Usefulness of information about caring for myself
Usefulness of information about caring for my baby
My comfort calling my midwives with questions or problems
My confidence in the midwives skills and abilities

Comments and suggestions for improvement to postpartum care:

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

	Yes	No
Did you know which midwife or midwives were primarily responsible for your care?
Were there adequate opportunities for you to meet the midwives involved in your care?
Did you understand how to reach a midwife 24 hours a day?

Comments and 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

	Yes	No
In general, were your choices and decisions respected by your midwives?
Did you receive enough information to make informed decisions about your care?
Were you given enough information to decide where to have your baby's birth?

Comments and 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

	Yes	No	N/A
Did you understand the reasons why a doctor might become involved in your care?
Did your midwife need to consult during your care?
If so, did you understand why and what would happen?
Was your care transferred to a doctor?
If so, did you understand why and what would happen?

Comments and suggestions for improving consultation and transfer of care:

Thank you for helping us with this quality improvement initiative. Please add any final comments or suggestions below.