Survey for Past and Present Nursing Mothers by NFP International
Breastfeeding Survey
Name_______________________________
Email _______________________________
Mother’s age _________
This survey covers baby # ______
How many months did you exclusively breastfeed? (This means no water, liquids or solids; only mother’s milk) _____ months
How many months did you nurse your baby? _____ months
Did your baby use a pacifier? _____ If so, when? _____________________________________
Did your baby use a bottle? _______ If so, when? _____________________________________
Did you co-sleep with your nursing baby during the night? _______ If so, for how long? ______
Did you nurse lying down for your daily nap? _______
Did you nurse lying down during the night? ________
When did you finally leave your baby home with others? ______________________________
Did you stay close to your baby in the home? ________________________________________
Did you nurse your baby frequently? ___________
Did your baby like to be nursed to sleep? ______
Were there other times when the baby liked to be pacified at the breast? ____________________
Did you feed your baby by a schedule? ______
How old was your baby when he or she began to take solid food? ______
How old was your baby when he or she began to take liquids? _______
How many months did you rely on ecological breastfeeding for postpartum infertility? ________
Did you rely only on breastfeeding amenorrhea before your periods returned? _______________
If you relied on breastfeeding for birth spacing, when did you conceive again or have you? ____
Did you encourage or hasten weaning? _____
Did you let the baby wean on its own? _________
How old was your baby when your first postpartum period returned? ______________________
Explain if possible the return of your periods (e.g. weaning, sickness, etc.)
Was there any other possible reason for decreased nursings 2-4 weeks before the return of your periods? __________
Comments are welcome.
Please send this to nfpandmore@nfpandmore.org or to NFPI, P. O. Box 861, Steubenville OH 43952.
If you prefer an online submission form, go to: https://docs.google.com/forms/d/e/1FAIpQLSdgzHcGwTY8lwoSWe_sESvCdxoc-q6WHPmOMtdMmRiT2WYaaA/viewform
Name_______________________________
Email _______________________________
Mother’s age _________
This survey covers baby # ______
How many months did you exclusively breastfeed? (This means no water, liquids or solids; only mother’s milk) _____ months
How many months did you nurse your baby? _____ months
Did your baby use a pacifier? _____ If so, when? _____________________________________
Did your baby use a bottle? _______ If so, when? _____________________________________
Did you co-sleep with your nursing baby during the night? _______ If so, for how long? ______
Did you nurse lying down for your daily nap? _______
Did you nurse lying down during the night? ________
When did you finally leave your baby home with others? ______________________________
Did you stay close to your baby in the home? ________________________________________
Did you nurse your baby frequently? ___________
Did your baby like to be nursed to sleep? ______
Were there other times when the baby liked to be pacified at the breast? ____________________
Did you feed your baby by a schedule? ______
How old was your baby when he or she began to take solid food? ______
How old was your baby when he or she began to take liquids? _______
How many months did you rely on ecological breastfeeding for postpartum infertility? ________
Did you rely only on breastfeeding amenorrhea before your periods returned? _______________
If you relied on breastfeeding for birth spacing, when did you conceive again or have you? ____
Did you encourage or hasten weaning? _____
Did you let the baby wean on its own? _________
How old was your baby when your first postpartum period returned? ______________________
Explain if possible the return of your periods (e.g. weaning, sickness, etc.)
Was there any other possible reason for decreased nursings 2-4 weeks before the return of your periods? __________
Comments are welcome.
Please send this to nfpandmore@nfpandmore.org or to NFPI, P. O. Box 861, Steubenville OH 43952.
If you prefer an online submission form, go to: https://docs.google.com/forms/d/e/1FAIpQLSdgzHcGwTY8lwoSWe_sESvCdxoc-q6WHPmOMtdMmRiT2WYaaA/viewform
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