Pregnancy Mood Experience - Demographic Sheet (It is completely subjective with the participant as the expert to their experience.) I haven't look at this in a long time. I am sure I'd make changes but not many. This is ONLY the Demographis Sheet and the number that would come off this alone would be stangering because we hoped to hit every aspect of 'womanhood' conceivable. Not meant as a pun.

In filling in this question sheet consider pregnancy the state of carrying an unborn child. Consider birth of a child whether living, premature or 'still born' at birth.

Please write any and all comments to the extent you would like to share. Answer any or all questions you feel comfortable answering. Please number the comments on the back or on a separate piece of paper and include in your return envelope.

l. Age

2. Gender

3. Partner and/or Natural Parent

4. Race/Ethnicity

5. State of Health (excellent, good, fair, poor)

6. Income

7. Profession/Work

8. Did pregnancy or having a pregnant partner affect your relationship?

9. Was sex good before pregnancy?

10. Was sex good during pregnancy?

11. Was sex good the six months following pregnancy?

12. Did pregnancy or having a pregnant partner affect your job/profession performance?

13. Did you take a leave of absence during your pregnancy?

14. How long was your leave of absence?

15. Did you return to work after your leave of absence?

16. Did you regret returning to your job/profession when you did?

17. What symptoms of pregnancy did you experience (nausea, vomiting, discomfort, urinary frequency, empathetic symptoms, etc,)? (please describe)

18. Did you use contraceptives before getting pregnant?

19. Did you stop using contraceptives before getting pregnant?

20. What gender was your baby?

21. Were you happy about the gender of your baby?

22. Did you have an ultrasound/or participate with the ultrasound before giving birth?

23. Who was present at the birth?

24. Was the birth in a hospital?

25. If yes, how long was your hospital stay?

26. If yes, did you receive education/support in the hospital?

27. If yes, describe:

28. Did you consider the birth natural?

29. If no, why?

30. Did you consider pregnancy and child birth traumatic?

31. If yes, describe:

32. Did you ever experience the Baby Blues?

33. If yes, how long did it last?

34. If yes, what were your symptoms?

35. If yes, did anyone explain to you what the ‘Baby Blues’ were?

36. If yes, who explained the “Baby Blues” to you?

37. Have you ever experienced depression?

38. If yes, was it before pregnancy?

39. If yes, was it during pregnancy?

40. If yes, was it after the birth/termination of the pregnancy?

41. If yes, were you ever treated for depression?

42. If yes, did you feel you received adequate treatment?

43. Have you ever experienced anxiety?

44. If yes, were you ever treated for anxiety?

45. If yes, did you feel you received adequate treatment?

46. Do you feel you ever experienced Postpartum Psychosis?

47. If yes, who did you speak to about your experience?

48. If yes, were you treated for it?

49. If yes, did you feel you received adequate treatment?

50. If yes, do you experience residual effects until today?

51. Have you ever received supplemental estrogen?

52. Did you return to normal menstrual functioning?

53. Did you breast feed or have a partner that breast feed the infant?

54. If yes, for how long?

55. If yes, was it a satisfying aspect of life?

56. Were you married?

57. If no, did you want to marry?

58. Was this your first marriage?

59. Did you have a miscarriage with this pregnancy?

60. Have you ever terminated a pregnancy voluntarily?

61. If yes, how many times?

62. Did you have assistance getting pregnant or have exceptional circumstances surrounding your pregnancy (in vitro fertilization, surrogate parent, etc)?

63. Was this your first pregnancy?

64. How many children have you given birth to?

65. How many children do you have in your family?

66. Did you have a ‘weight problem’?

67. If yes, how many pounds were you overweight before your pregnancy?

68. How much weight did you gain/loss during your pregnancy?

69. Did you sustain a prolonged weight problem after your pregnancy?

70. Do you consider a state of being over weight a significant problem in your life?

71. Do you exercise regularly?

72. If yes, describe:

73. Did you take medications?

74. If yes, which ones?

75. Have you ever had cholesterol level problems?

76. Did you sleep well?

77. Describe:

78. How many brothers and sisters do you have?

79. What was your birth order (first born, second sister, youngest brother)?

80. Did either of your parents have depression?

81. Sexual identity, are you heterosexual/bisexual/homosexual, uncertain?

82. Drug Addition Amount Length

83. Cigarette Smoking Amount Length

84. Alcohol Consumption Amount Length

85. Did you stop or decrease any of these habits during your pregnancy?

86. Did you restart or resume pre-pregnancy levels when the baby was born?

87. Were you ever part of a support group at any stage of your pregnancy including pre-pregnancy?

88. Are you happy with your life today?

89. Comments:

If you would like to share information regarding any of the issues above, please include your name, address and/or phone number. All information is treated with strict confidentiality. If you rather contact the authors of this study anonymously please call 910-297-1292 (or a designated voice mail for the study) and leave a voice mail. Thank you for you cooperation, it is sincerely appreciated.