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Back Water Labor
BB © 2018
Zip Code:

Date of Birth:
Child's Name:
What Number Child is this:
Place of Birth:
(City, State, Country)

Home Hospital Birth Center

Did you hire a professional Doula?
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How may we contact
your Doula?
Medical Caregiver:
Midwife Obstetrition None

1. What prompted you to choose water as a labor/birth tool?

2. Who initiated the interest to investigate this procedure?

3. Did you have any fears in working with water as a labor/birth tool?

4. Is this your first child? If not, did you have a water labor/birth before?

5. What were the differences between the labors/births? (For mom & dad, child 1, 2 or 3)

6. What sort of birth experience was this for both of you using water?

7. What advantages did you find with utilizing water as a tool?

8. Would you recommend this to others? Would you do it again?

9. What sort of preparation steps did you both do to get ready for this?

10. What was the most memorable aspect of your birth?

11. Dad: How was supporting your wife with this labor and birth different from your first child?

12. Dad: If this was your first birth, did you find the water helpful or not? How?

13. When you brought the idea to your medical caregivers, what was their response to your requests?

14. If anything, what would you do differently for the next labor and birth?

15. Why did you choose to have the baby in a hospital as opposed to your home or birth center?

16. If you were to have another child, would you choose water as a labor or birth tool again? Why?

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