Inova BabyNET 2010 Monthly Survey

Page 1 of 1     Baby Steps to a Healthier Baby   Pregnancy is a great time to focus on good habits. Use the following questions to guide you along the path of a healthy pregnancy and healthy baby. You can complete this survey every month.   1. What is your name? Please use first and last name, so we can be sure to give the right person points and prizes.*         2. Some great habits: Let's see how many steps toward a healthy pregnancy you are taking weekly.* Please check off how many times per week you do the following:       Almost every day   Most days   Some days   Occasional days   Almost never or never Have small, frequent meals and healthy snacks           Get 7-8 hours sleep           Get 30 min of physical activity           Practice relaxation or meditation of some kind                 3. How has your last month been? Please let us know how you've been feeling, any new developments in your pregnancy or any questions you have for your Care Manager.         4. How often do you take a vitamin with at least 400 mcg of folic acid?* This question is worth up to 2 points   Almost every day   Most days   Some days   Occasional days   Almost never or never       5. How often do you drink 6-8 glasses of water?* This question is worth up to 2 points   Almost every day   Most days   Some days   Occasional days   Almost never or never       6. Getting good prenatal care is essential to a healthy pregnancy. Did you attend all scheduled health care provider visits in the last 30 days?* This question is worth 2 points.   Yes, I attended all scheduled visits   No, I missed a visit   I didn't have any visits scheduled in the last 30 days       7. Some not so great habits. The following habits should be limited or eliminated. How often do you do the following?*       Almost every day   Most days   Some days   Occasional days   Almost never or never Staying on my feet all day           Smoking one or more cigarettes           Drinking one or more alcoholic beverages           Ignoring what my body is telling me           Having more than one caffeinated beverage                 8. Have you attended a childbirth, infant skills or breastfeeding class this month?* This question is worth one point.   Yes, within the last 30 days   Done already   No, but I signed up for one in the future   Not yet   I don't plan on taking any classes (if this is your second baby, for example)       9. Have you chosen a pediatrician?* This question is worth one point. If this is the first time you're taking this survey and you've already chosen a pediatrician, please choose "Yes: this month". After that use "Done already"   Yes: this month   Done already   Not yet or N/A       10. Have you gotten a professional car-seat check (fire department, baby store etc)?* This question is worth one point. If this is the first time you're taking this survey and you've already gotten a car seat check, please choose "Yes: this month". After that use "Done already"   Yes: this month   Done already   Not yet or N/A