Type of birth |
a. Vaginal b. Cesarean |
Did you have a single birth or multiples? |
a. Single birth b. Twins c. Triplets |
Baby’s gestational age in weeks: _____ |
Have you given birth to any other children? |
Did you breastfeed your other children? |
Are you still breastfeeding the child you just gave birth to? |
If you are still breastfeeding, are you breastfeeding exclusively or offering supplements? |
a. Breastfeeding exclusively with no supplements |
b. Breastfeeding with one supplement per 24 hours |
c. Breastfeeding with 2–3 supplements per 24 hours |
d. Breastfeeding with 4 or more supplements per 24 hours |
If you are supplementing, are you supplementing with (check all that apply): |
a. Expressed breastmilk |
b. Formula |
c. Other |
While you were in the hospital, can you remember when the first time you breastfed your baby? |
a. Within the first hour of birth |
b. Within 2–3 hours of birth |
c. Within 4–6 hours of birth |
d. Within 7–24 hours of birth |
e. After 24 hours of birth |