What is your gender? Female Male
What city do you live in?
If you do not live in Utah, what state do you live in? -outside US- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Are you (or your partner) planning to give birth within the next two years? Yes No
Have you (or your partner) given birth before? Yes No
If yes, how many children did you (or your partner) deliver

in a hospital
in a birthing center
at home
in another location

Do you have maternity insurance? Yes No

If yes, what is your maternity deductible? If unsure, give your best guess or put “unknown.”
If yes, what percentage does your insurance cover? (For example, it may cover 80% of expenses and you pay 20%).

For the delivery of any FUTURE children, please rank the importance of each of the following to your decision of where to deliver your baby,
where 1=I definitely don’t want that, 3= it doesn’t matter to me, and 5=I must have it:

Can be delivered by a midwife (rather than a doctor) -- 1 2 3 4 5
Can be delivered by a doctor (rather than a midwife) -- 1 2 3 4 5
My favorite provider delivers there -- 1 2 3 4 5
Continuous presence of my care provider throughout labor -- 1 2 3 4 5
Facility is close to my home -- 1 2 3 4 5
Atmosphere and comfort of the facility -- 1 2 3 4 5
Availability of epidural or other pain relief medication -- 1 2 3 4 5
Support for natural birth -- 1 2 3 4 5
Availability of waterbirth or ability to labor in water -- 1 2 3 4 5
Availability of/support for VBAC (vaginal birth after cesarean) -- 1 2 3 4 5
Ability to eat and drink as desired in labor -- 1 2 3 4 5
Amenities for the comfort of the father of the baby (shower, bed, food) -- 1 2 3 4 5
Low cost -- 1 2 3 4 5
Insurance coverage -- 1 2 3 4 5

Are there other factors important to you in deciding where to have your baby? Please describe:

Assuming there are no complications, how long would you like to stay at a facility after giving birth?

BellaNatal Birthing Suites is a birthing facility designed to help normal, healthy pregnant women experience beautiful, natural births. Care providers delivering at BellaNatal are nationally certified and state licensed midwives who meet their laboring clients at the door and remain with them until after delivery. Prenatal appointments are held at the facility or at the provider’s office. The facility is beautiful and serene, designed with your every comfort in mind including a queen-sized bed for you and your partner. Waterbirth and vaginal birth after cesarean are available. The kitchen is fully stocked for you, your partner, your guests, and your birth team. Although safety medications and equipment are available, epidural anesthesia is not. The facility is not covered by any insurance, but is priced less than what most people with insurance coverage would end up paying out-of-pocket for a hospital birth. For those without maternity insurance or with a high deductible, BellaNatal Birthing Suites is substantially less expensive than a hospital delivery.

How appealing is having your next baby at such a facility? (1=not appealing at all, 5=sign me up!) -- 1 2 3 4 5

If there were a BellaNatal Birthing Suites in Saratoga Springs, how likely would you be to have your next baby there?  -- 1 2 3 4 5

Please leave any comments or questions you may have about BellaNatal Birthing Suites here:

May we contact you to discuss your responses to this survey? Yes No
Would you like more information about BellaNatal Birthing Suites or a tour of our Orem facility? Yes No
Would you like us to keep you updated on our plans for opening a BellaNatal Birthing Suites in Saratoga Springs? Yes No