Epidural patient experience survey
Date of epidural: Today’s date:Name of anaesthetist:
Your age: o under 20 o 20-24 o 25-29 o 30-34 o 35-39 o 40 or older
Please tick the correct answer
- What did you have an epidural for? (tick as many as apply)
o elective Caesarian o stitching of tears
o unplanned Caesarian o removal of retained placenta
2. How did you discover the positive and negative aspects of having an epidural? (tick as many as apply)
o reading o internet o midwife o anaesthetist o previous experience o other
3. Were you given enough information to decide whether or not to have an epidural?
Yes / No (please circlethe correct answer)
Please comment if you didn’t have enough information.
4. How long did it take the anaesthetist to come once s/he was called? (please tick the correct answer)
o 15 mins o 30 mins o 45 mins o more than 45 mins o don’t know
Do you have any comment to make about the waiting time?
5. The anaesthetist explained the epidural procedure
opoorly o well o very well
Do you have any comment?
6. I found the anaesthetist answered my questions about the epidural
o poorly o well o very well
Would you like to comment on this?
7. I found the anaesthetist approachable/easy to talk to.(please circlethe correct answer) Yes / No
Please comment if the anaesthetist was not easy to talk to.
8. Did you have any discomfort during the placement of the epidural? Yes / No
Please comment if you had discomfort.
9. How long after you had the epidural before it worked well for you?
o 10 mins o 20 mins o 30 mins o never o don’t know
10. Was the performance of the epidural satisfactory? (please circlethe correct answer) Yes / No
Please comment if the answer was no.
11. After the anaesthetist put in your epidural it was managed by the midwife.
Were you happy with it? Yes / No
If the answer is no please comment.
12. How long after you had your baby did it take for the epidural to completely wear off?
o 1 hour o 2 hours o 3 hours o more than 3 hours o don’t know
13. Were there any bad after-effects you’d like to comment on e.g. headache, ongoing back pain, ongoing abnormal sensation, discomfort at the epidural site?
14. If you were to have another baby would you have another epidural? (please tick one)
o yes o no, not for relief of labour pain
o yes, but I’d ask for it sooner o no, not for any reason at all
o yes but only if I really needed it
o yes, but only for a Caesarian
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