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Question #1
There are conditions that can help a new baby grow healthy and there are other conditions that can harm a newborn baby. Please check whether the following conditions can: harm the baby, help the baby grow healthy, or neither (has no effect on the baby).

   Pregnant woman has high blood pressure     
Can Hurt
Can Help
Has no effect

   Pregnant woman eats fruits vegetables and dairy products     
Can Hurt
Can Help
Has no effect

   Pregnant woman has diabetes    
Can Hurt
Can Help
Has no effect

   Pregnant woman takes naps during the day     
Can Hurt
Can Help
Has no effect

   Pregnant woman delivers her baby two months early     
Can Hurt
Can Help
Has no effect

   Pregnant woman eats three meals a day   
Can Hurt
Can Help
Has no effect

   Pregnant woman smokes cigarettes   
Can Hurt
Can Help
Has no effect

   Pregnant woman starts to "bleed"      
Can Hurt
Can Help
Has no effect

   Pregnant woman eats hamburgers, snack foods, and soda     
Can Hurt
Can Help
Has no effect

   Pregnant woman drinks wine or beer    
Can Hurt
Can Help
Has no effect

   Pregnant woman works as a bank teller all week     
Can Hurt
Can Help
Has no effect

   Pregnant woman baby-sits for her older sister's children     
Can Hurt
Can Help
Has no effect

   Pregnant woman has sexual intercourse with her partner     
Can Hurt
Can Help
Has no effect

   Pregnant woman stops using illegal drugs     
Can Hurt
Can Help
Has no effect

Question #2
A woman is thinking about having a baby.
 When is the best time for her to make her first visit to the doctor or nurse midwife?
before getting pregnant
beginning of the pregnancy (first three months)
middle of the pregnancy (fourth to sixth month)
near the end of the pregnancy (seventh to ninth month)

Question #3
What is the best amount of weight gain during pregnancy for most women?
under 10 pounds
around 20 pounds
as many pounds as possible

Question #4
What is an "OK" amount of alcohol for a woman early in her pregnancy?
3 or more drinks a day
1 or 2 drinks a day
none

Question #5
If a woman continues doing her usual activities during pregnancy (for example: walking, preparing meals, doing chores):
Check all that apply:
does not harm the baby
may lead to a low birth weight baby
may lead to a baby who is born too early
may lead to a baby with birth defects
may lead to bleeding during the pregnancy

Question #6
Infection during pregnancy including sexually transmitted diseases (STD's):
Check all that apply:
does not harm the baby
may lead to a low birth weight baby
may lead to a baby who is born too early
may lead to a baby with birth defects
may lead to bleeding during the pregnancy

Question #7
Smoking cigarettes during pregnancy:
Check all that apply:
does not harm the baby
may lead to a low birth weight baby
may lead to a baby who is born too early
may lead to a baby with birth defects
may lead to bleeding during the pregnancy

Question #8
Using drugs or alcohol during pregnancy:
Check all that apply:
does not harm the baby
may lead to a low birth weight baby
may lead to a baby who is born too early
may lead to a baby with birth defects
may lead to bleeding during the pregnancy

Question #9
Use of prescription and over-the-counter medications during pregnancy are:
always safe
usually safe but should be checked by a doctor or pharmacist
always dangerous

Question #10
Sometimes a baby is born too soon and is premature. What do you think is the likelihood of survival for a premature baby born after only 24 weeks of pregnancy (the earliest time a baby can survive outside the womb with a modern intensive care unit in the hospital)?
20% likelihood
40% likelihood
60% likelihood
80% likelihood
100% likelihood

Question #11
Often there are problems for premature babies after birth and after they leave the hospital. What do you think are some of the problems?

Question #12
Suppose a pregnant woman from your block tells you she really wants to stop smoking cigarettes. She asks for your help. What would you do or suggest?

Question #13
A woman from your block tells you that she is concerned about starting a good diet during her pregnancy. What would you do or suggest?

Question #14
If a woman from your block who is pregnant tells you that she has not seen a doctor for prenatal care. What would you do or suggest?

Question #15
One day as you meet one of your neighbors on your block and both of you stop to talk for a while. She tells you that her boyfriend it hitting her and the children. She says she would like to know where she could go for help. What would you suggest or do?

Thank you for completing this questionnaire!