Cervical ripening Balloon (CRB) Induction Feedback
1. Was this your first birth?
Yes
No
2. Have you had a Caesarean section in a previous pregnancy?
Yes
No
3. Have you had an induction of labour in a previous pregnancy?
Yes
No
4. If yes, What method of induction was used in your previous pregnancy? (Please select all that apply)
Propess/Pessary
Prostin gel
Dilapan
Balloon
Artificial Rupture of Membranes
Hormone drip
Other
5. How did this balloon induction compare to your previous experience/s with other induction methods?
6. Thinking about your recent balloon induction, What was your pain score when the balloon was inserted? (1 being very little pain and 5 being the worst pain ever)
Very little pain
1
2
3
4
Very painful
5
1 is Very little pain, 5 is Very painful
7. What was your pain score once the balloon was in place? (1 being very little pain and 5 being the worst pain ever)
Very little pain
1
2
3
4
Very painful
5
1 is Very little pain, 5 is Very painful
8. Did you require any pain relief while the balloon was in place?
Yes
No
9. Those at low risk may be offered to go home once the balloon is in place (Outpatient Induction). If you had an outpatient induction, please describe your experience:
10. How much for you agree with this statement? "When the balloon was in place I was able to sleep and relax as normal" (1 being I strongly disagree and 5 being I strongly agree)
Strongly disagree
1
2
3
4
Strongly agree
5
1 is Strongly disagree, 5 is Strongly agree
11. How much do you agree with this statement? "When the balloon was in place I was able to walk around and eat as normal" ( 1 being I strongly disagree and 5 being I strongly agree)
Strongly Disagree
1
2
3
4
Strongly agree
5
1 is Strongly Disagree, 5 is Strongly agree
12. How much do you agree with this statement? "I felt fully informed about how the balloon worked and how it would be inserted" (1 being I strongly disagree and 5 being I strongly agree)
Strongly disgaree
1
2
3
4
Strongly agree
5
1 is Strongly disgaree, 5 is Strongly agree
13. Would you be happy to choose a balloon induction again in future pregnancies?
Yes
No
Maybe
14. Please tell us any other feedback about your recent balloon induction that you would like to share with us.
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