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

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