PHINMA University of IloiloCollege of Allied Health SciencesRizal Street, Iloilo City

Questionnaire

Name (Optional):___________________________________ Date:_______________________Ngalan (indi ubligado)Petsa

Part I. Demographic Profile(Una nga Parte: Demographic Profile)

Direction: Please answer the data that is being asked honestly. Write your answer on the space provided for each information or check the box of the desired answer.(Pagpanudlo: Palihog sabat sang tampad ang mga palamangkuton. Ibutang ang imo sabat sa lang-at pagkatapos sang kada pamankot ukon nutangan sang marka ang kahon sang imo sabat.)

Age: ___________________________(Edad)

Monthly Income:(Bulanan nga Sweldo)

0 4,500 pesos a month (0 4,500 pesos taga bulan)

4,500 10,000 pesos a month (4,500 10,000 pesos taga bulan)

More than 10,000 pesos a month (masobra 10,000 pesos taga bulan)

Educational Attainment()

Elementary graduate (Naka gradwar sa elementarya)High-school graduate (Naka gradwar sa high-school)College level (Naka eskwela sa colehiyo pero wala ka gradwar)

College graduate (Naka gradwar sa colehiyo)

Part II. Level of Awareness on Risks of Home Delivery(Ikaduwa nga Parte: Lebel sang Pagkabalo Gikan sa Risgo sang Pagbata sa Balay)

Statements(Mga pagpangasoy)KnowNot sureDont know

Maternal Risks

1. Mothers who give birth at home are at a higher risk for suffering post-partum hemorrhage.

2. Maternal deaths are higher in home deliveries.

3. Prior C-section is a contraindication for a home delivery due to possible uterine rupture.

4. Placenta may not be fully delivered at home deliveries.

5. Complications of home deliveries are not limited to newborns but also include mothers.

6.

Neonatal Risks

1. Births at home are ten (10) times more likely to be stillborn.

2. Babies born at home are two to three times more likely to die shortly after birth.

3. There is a high risk for neonatal seizures in home deliveries.

4. Babies born at home are more likely to have neurological defects.

5. Neonatal deaths are higher in home deliveries.

6. Babies delivered at home are mostly born preterm and with low birth weights

7.

Legality of home deliveries in Estancia, Iloilo

1. Home deliveries are prohibited in Estancia, Iloilo.

2. Penalties are given to those who give birth at home in Estancia, Iloilo according to Ordinance 2011-001.

3. There are penalties for those who assist in home deliveries in Estancia, Iloilo according to Ordinance 2011-001.

4.