Hypnobirthing Enquiry and Requirements Form

Hypnobirthing Enquiry and Requirements Form

Please complete all required fields *
Your Information

Please complete all required fields
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is this your first baby?*
Yes or No
When is your baby due? *

DayMonthYear
Please tell me a little about yourself and this pregnancy
Are there any medical or psychological factors I should be aware of?*
Please tell me about any medical conditions you may have and any medication or treatments you currently take.
Your Requirements

Please complete each section
In order for us to tailor-make a programme that provides the knowledge and skills you need to empower you for your labour and birth, there are a few topics you should consider within the sections below.

Please complete each section and indicate one answer per row.

Labour and Birth*

	No knowledge	Some knowledge	Good knowledge	Not rrquired
Fear-Tension-Pain cycle
Energy and Muscles
Chemical Messengers
The Uterus during Labour
The Cervix during Labour
The Vagina and Perineum during Labour
Birth Processes
The Role of Support
Onset of Labour
Early Labour
Established Labour
Second stage/The Birth
Third stage of Labour
Applying hypnobirthing tools for Labour and Birth
Preparing for 'Labour' day
Personalising Birth and Meeting your Baby

	No knowledge	Some knowledge	Good knowledge	Not required
What is hypnobirthing?
Evidence from Research
Fears and Expectations
Making Choices
Making A Birth Plan
Basic Anatomy and Physiology
The Uterus
The Cervix
The Vagina and Perineum
Hypnobirthing skills to practice during pregnancy

	No knowledge	Some knowledge	Good knowledge	Not required
Affirmations
Breathwork
Knowledge about Childbirth
Mindfullness
Positive Mindset
Relaxation
Deep Relaxation and Self-Hypnosis
Visualisation and Imagery

	No knowledge	Some knowledge	Good knowledge	Not required
Skin-to-Skin and First Feed
Vitamin K
Care and ongoing initial support (hospital)
Adjusting to motherhood and being at home

	No knowledge	Some knowledge	Good knowledge	Not required
Baby's Position
Making Decisions - using BRAIN
Pain Relief - all options
Being over your due date
Induction
Accelerating Labour
Assisted Birth
Caesarean - planned and emergency
Mum issues and baby issues (acute and emergency)

Your Information