’s Questionnaire (version 11) (For more Questionnaires please click here)
* Please note this needs to be copy and pasted inot eg word ... answered and then e-mailed to us. There are plans for you to be able to fill it in on line, however this is not possible at this time. Thank you *

*this questionaire is constantly evolving and so some people may not have been asked or had chance to update their informaion to the new version, that is why some questions will have not asked next to them

**please compete this questionnaire as much as possible, if you are not comfortable answering certain questions please just place 'not answered' next to it so that we know it has not been missed .... thank you

Background

((Name
Our admin ….. X
Name for web page if you would like a little anonymity? ….. X
How arrived with us ….. X
Address full ….. X
Telephone number ….. X
e-mail address ….. X
Date of birth? ….. X ))

Age at hysterectomy? …..
Questionnaire completed .....
How arrived with us .....
Address ....
Children …..
Religion .....
Marital status before …..
Relationship changed? …..
Ethnic group …..
What academic level did you hold prior to hysterectomy .....
Did you / do you smoke …..
Mother survived …..
Baby survived …..
Job or career before / after …..

Pregnancy

Was it 'normal' …..
Whist expecting did you develop any conditions? .....
Where was the birth wanted/planned home or hospital …..
If a planned home birth why a change of plan …..
If c/s, planned or elective, why …..
Hospital ……
Doctor/s …..
Previous 'childbirth' vaginal, c/s etc …..
Did you want to / plan to breast feed …..
Have you breast fed before, if so for how long …..

Labour and birth

Date that labour began? …..
Were you induced? .....
Date of delivery? .....
Problems during delivery? .....
If emergency caesarian why? were you happy with this? .....
Problems after delivery? .....

****
1. Where you induced and if so what reason was given?
2. Did you have an epidural? Did you have any problems with your epidural?
Any other pain relief
3. How long was the first / second / third stage? ( My second stage was quite short and as it turned out it was a blessing as that could have lead to further complications)
4. Were you aware of any precautions made for the delivery eg saving blood units / not allowing a birth in the 'home suite', being given 'senior' midwives for the delivery?
Did you have any other intervention?
5. Were you allowed to eat / drink and if not what reasons were given?
6. What procedures were followed immediatley after delivery?
7. When did you realise that there was a problem?
8. Was your husband allowed to stay in the delivery suite whilst they attempted to stem the bleeding?
9. What was done to stem the bleeding?
10. Did you have any bi-manual compresions and if so did you have any pain relief?
11. Were you conscious whlist they attempted to solve the problems?
12. Did you ever feel as though you were not going to survive?
13. Did you feel as though everything (ie the staff) were completely in control of the situation?
14. Were you fully informed at all times about what was happening and why?
*****

Before operation

If planned c/s how long was the consultation? (should be no less than an hour) .….
Were any risks including hysterectomy given to you? …..
Was sterilisation talked about / planned / agreed to? …..
Were you asked if you would consent to a blood transfusion? …..
If after arrival of baby were you given any transfusion? …..
What were the circumstances for you to be taken (back) in? …..
If taken (back) in were you told it was for a hysterectomy or warned it may result in hysterectomy? …..
Were you asked if you suffered from depression? …..
Were you asked if you had ever been abused? …..
If you were abused in the past has this come to mind more than before the operation .....

During operation

Hysterectomy date …..
Were you conscious or under general anaesthetic? .....
What did they try before undertaking the hysterectomy …..
How much blood transfused before / during hysterectomy …..
Consent specifically given for hysterectomy? …..
How many minutes from death, if applicable …..
Did you go into cardiac arrest …..
Was your partner/husband told they were going to do it before they did it? …..

After hysterectomy

How did you learn of your hysterectomy …..
Reason for hysterectomy …..
How much blood were you transfused after hysterectomy? …..
Type of hysterectomy, sub/total? If total were you told straight away that it had been done and were you given a reason for this? …..
Do you still have both ovaries? If not were you told straight away that it had been done and were you given a reason for this? …..
Was your vagina pleated? If so were you told straight away that it had been done and were you given a reason for this? …..
What incision scars have you? .....
If more than one do you know what was for caesarian and what was for hysterectomy? .....
Intensive care/ how long? …..
On recovery/ward care? …..
Infections post hysterectomy, either in hospital or shortly after …..
How was pain managed eg good bad with what? …..
When expected to fend for self and baby? …..
How were you treated by the staff? …..
Did they care for you well? …..
Did they care for your child/ren well? …..
If you were crying were you given compassion? …..
Were you told that you should be grateful you had a partner/husband (many women in here do not)? …..
If you had your ovaries were you told you could still have children with surrogacy? …..
Were you told to adopt ? …..
If you were very unhappy were you told to change your attitude or you may well loose your partner / husband? …..
Did a counsellor see you? …..
Did the physiotherapist see you/ Were you given exercises to make your uterus contract? …..
How long was your hospital stay? …..
Were you encouraged to stay as long as you needed or not? …..
Were you told how often this happened? …..
Were you given any information about how long your ovaries would 'last'? …..

(After) Leaving hospital

Were you given information on family planning? …..
How much help did you at home and for how long? …..
How were you treated by your GP? …..
How were you treated by your midwife? …..
How were you treated by your Health Visitor? …..
If you wanted to go though a process of more children were you helped? …..
Did you breast feed for as long as you wished. If so for how long? …..

Consequences

Your well being ...

Did you bond with your baby or do you feel the operation caused problems? .....
Do you feel like a survivor or victim?…..
Do you feel as though you have been raped? .....
Do you still feel like a woman? …..
Do you feel there is anyone to blame or fate? …..
Are you grateful to be alive? …..
If only caesarian (s) do you feel robbed of giving birth? ...
Do you tell others what has happened? If not do you have a reason? …..
Any legal action taken? Sucessful? .....
If applicable were the police contacted? Successful? …..
Have you suffered post traumatic stress disorder? .....
Have you suffered a change in depression? .....
Do you now suffer from anxiety? .....
Do you suffer from sleeplessness? .....
Do you have nightmares or have you had, that you feel are associated with this? .....

Physical ...

Has / did your menopause start early? …..
Do you now have or a change in IBS? …..
Do you now have incontinence, if so when did it start? …..
Do you have movement in your abdomen like a baby moving? (a couple of us guess it is just the bowel doing its job)? …..
Do you now suffer from a shortness of breath? …..
Can you still stretch properly? …..
Has you libido changed (as it altered your sex life)? ….
- if yes is this positive or negative? .....
- is penetration possible, if so is it painful? .....
- if applicable are you still able to achieve orgasm, is it the same quality? .....
- do your erogenous zones still as sensitive? .....
Do you now have problems (pain / incontinence) coughing and sneezing? …..
Do you have regular abdominal pain, either internal or scar related? .....
Do you now have a problem with weight gain? …..
Do you now have a different figure? …..
Do you suffer more headaches? …..
Do you now suffer from rashes? .....
Do you now suffermore from pains like trapped nurves or something twisted inside if you turn the wrong way? .....
If you sffer from cold sores do they now scar? .....
Have you had any tidy up operation/s? comments? …..

Hospitals reaction ...

Do you know, have you met the doctor that did the operation? Was the doctor a consultant? .....
Was an internal review undertaken to see hat happened and if mistakes coul be learnt from? (Anna was told this was standard practice with such an outcome) .....
Did you think about having your organ (s) returned to you? Any results? …..
Have you obtained your notes? Were there any problems? .....
Do you beleive they are an accutate portrayal of what happened? .....
Has the doctor gone over your notes with you? .....
Did you have all your questions answered? If so was this straight away or did you have to go though some form of complaints procedure? Sucessful? .....
If you wish to meet or speak to the pepole involved in your 'care' are you able to? .....
Have you gone back to the hospital if so was this helpful for you? .....

Miscellaneous

When did it HIT you? .....
Did you plan to be an organ donor before the hysterectomy? Are you still? Or vice versa. …..
Has it effected family life, if so how? .....
How has your husband / partner dealth with this? .....
How has this changed the quality of your life? .....
What are your overall views? .....
With hindsight would you have done anything differently? .....
Advice for others …..
Any other thoughts or comments? …..

If IVF before hysterectomy…

Cycle number …..
Eggs retrieved - embryos …..
Embryos implanted …..
Result …..

More children wanted/hoped for ? If so how many? …..

Surrogacy …..
Eggs retrieved - embryos …..
Embryos implanted …..
Result …..

Adoption …..

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