Pregnancy Risk Assessment Monitoring System (PRAMS)

Massachusetts PRAMS Phase 5 – 2007-2008 Survey

First, we would like to ask a few questions about you and the time before you got pregnant with your new baby. Please check the box next to your answer.

1.	Just before you got pregnant, did you have health insurance? Do not count Medicaid (MassHealth).

No
Yes

2.	Just before you got pregnant, were you on Medicaid (MassHealth)?

No
Yes

3.	During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin or a prenatal vitamin? These are pills that contain many different vitamins and minerals.

I didn’t take a multivitamin or a prenatal vitamin at all
1 to 3 times a week
4 to 6 times a week
Every day of the week

4.	What is your date of birth?

[BOX]	[BOX]	19[BOX]	
Month	Day	Year	

5.	Just before you got pregnant with your new baby, how much did you weigh?

[BOX]  Pounds  OR  [BOX]  Kilos

6.	How tall are you without shoes?

[BOX]  Feet  [BOX]  Inches
OR  [BOX]  Centimeters

7.	Would you say that, in general, your health is—

Excellent
Very good
Good
Fair
Poor

8.	Before you got pregnant with your new baby, did you ever have any other babies who were born alive?

No  º  Go to Question 11
Yes

9.	Did the baby born just before your new one weigh 5 pounds, 8 ounces (2.5 kilos) or less at birth?

No
Yes

10.	Was the baby just before your new one born more than 3 weeks before its due date?

No
Yes

The next questions are about the time when you got pregnant with your new baby. 

11.	Thinking back to just before you got pregnant with your new baby, how did you feel about becoming pregnant? Check one answer

I wanted to be pregnant sooner
I wanted to be pregnant later
I wanted to be pregnant then
I didn’t want to be pregnant then or at any time in the future

12.	When you got pregnant with your new baby, were you trying to get pregnant?

No
Yes  º  Go to Question 15

13.	When you got pregnant with your new baby, were you or your husband or partner doing anything to keep from getting pregnant? (Some things people do to keep from getting pregnant include not having sex at certain times [rhythm] or withdrawal, and using birth control methods such as the pill, condoms, cervical ring, IUD, having their tubes tied, or their partner having a vasectomy.)

No
Yes  º  Go to Question 17

14.	What were your or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant? Check all that apply

I didn’t mind if I got pregnant
I thought I could not get pregnant at that time
I had side effects from the birth control method I was using
I had problems getting birth control when I needed it
I thought my husband or partner or I was sterile (could not get pregnant at all)
My husband or partner didn’t want to use anything
Other  º  Please tell us:
[BOX]

If you were not trying to get pregnant when you got pregnant with your new baby, go to Question 17.

15.	Did you receive treatment from a doctor, nurse, or other health care worker to help you get pregnant with your new baby? (This may include infertility treatments such as fertility-enhancing drugs or assisted reproductive technology.)

No  º  Go to Question 17
Yes

16.	Did you use any of the following treatments during the month you got pregnant with your new baby? Check all that apply

Fertility-enhancing drugs prescribed by a doctor (fertility drugs include Clomid®, Serophene®, Pergonal®, or other drugs that stimulate ovulation) 
Artificial insemination or intrauterine insemination (treatments in which sperm, but NOT eggs, were collected and medically placed into a woman’s body)
Assisted reproductive technology (treatments in which BOTH a woman’s eggs and a man’s sperm were handled in the laboratory, such as in vitro fertilization [IVF], gamete intrafallopian transfer [GIFT], zygote intrafallopian transfer [ZIFT], intracytoplasmic sperm injection [ICSI], frozen embryo transfer, or donor embryo transfer)
Other medical treatment  º  Please tell us:
[BOX]

The next questions are about the prenatal care you received during your most recent pregnancy. Prenatal care includes visits to a doctor, nurse, or other health care worker before your baby was born to get checkups and advice about pregnancy. (It may help to look at the calendar when you answer these questions.)

17.	How many weeks or months pregnant were you when you were sure you were pregnant? (For example, you had a pregnancy test or a doctor or nurse said you were pregnant.)

[BOX]  Weeks  OR  [BOX]  Months

I don’t remember

18.	How many weeks or months pregnant were you when you had your first visit for prenatal care? Do not count a visit that was only for a pregnancy test or only for WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children).

[BOX]  Weeks  OR  [BOX]  Months

I didn’t go for prenatal care

19.	Did you get prenatal care as early in your pregnancy as you wanted?

No
Yes 
I didn’t want prenatal care  º  Go to Question 21 

20. 	Here is a list of problems some women can have getting prenatal care. For each item, circle Y (Yes) if it was a problem for you during your most recent pregnancy or circle N (No) if it was not a problem or did not apply to you.

	No	Yes
a.	I couldn’t get an appointment when I wanted one	N	Y
b.	I didn’t have enough money or insurance to pay for my visits	N	Y
c.	I had no way to get to the clinic or doctor’s office	N	Y
d.	I couldn’t take time off from work	N	Y
e.	The doctor or my health plan would not start care as early as I wanted	N	Y
f.	I didn’t have my Medicaid (MassHealth) card	N	Y
g.	I had no one to take care of my children	N	Y
h.	I had too many other things going on	N	Y
i.	I didn’t want anyone to know I was pregnant	N	Y
j.	Other	N	Y

	Please tell us:
[BOX]

If you did not go for prenatal care, go to Question 23.

21.	How was your prenatal care paid for? Check all that apply

Medicaid (MassHealth)
Personal income (cash, check, or credit card)
Health insurance or HMO (including insurance from your work or your husband’s/partner’s work)
Free Care
Other  º  Please tell us:
[BOX]

22.	During any of your prenatal care visits, did a doctor, nurse, or other health care worker talk with you about any of the things listed below? Please count only discussions, not reading materials or videos. For each item, circle Y (Yes) if someone talked with you about it or circle N (No) if no one talked with you about it.

											No	Yes
a.	How smoking during pregnancy could affect my baby	N	Y
b.	Breastfeeding my baby	N	Y
c.	How drinking alcohol during pregnancy could affect my baby	N	Y
d.	Using a seat belt during my pregnancy	N	Y
e.	Birth control methods to use after my pregnancy	N	Y
f.	Medicines that are safe to take during my pregnancy	N	Y
g.	How using illegal drugs could affect my baby	N	Y
h.	Doing tests to screen for birth defects or diseases that run in my family	N	Y
i.	What to do if my labor starts early	N	Y
j.	Getting tested for HIV (the virus that causes AIDS)	N	Y
k.	Physical abuse to women by their husbands or partners	N	Y

23.	At any time during your most recent pregnancy or delivery, did you have a test for HIV (the virus that causes AIDS)?

No
Yes   º Go to Question 27
I don’t know

24.	Were you offered an HIV test during your most recent pregnancy or delivery?

No  º  Go to Question 27
Yes

25.	Did you turn down the HIV test?

No  º    Go to Question 27

Yes

26.	Why did you turn down the HIV test? Check all that apply

I did not think I was at risk for HIV
I did not want people to think I was at risk for HIV 
I was afraid of getting the result
I was tested before this pregnancy, and did not think I needed to be tested again  
Other  º  Please tell us:
[BOX]

The next questions are about your most recent pregnancy and things that might have happened during your pregnancy.

27.	During your most recent pregnancy, were you on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children)?

No
Yes

28.	Did you have any of these problems during your most recent pregnancy? For each item, circle Y (Yes) if you had the problem or circle N (No) if you did not.

		No	Yes
a.	High blood sugar (diabetes) that started before this pregnancy	N	Y
b.	High blood sugar (diabetes) that started during this pregnancy	N	Y
c.	Vaginal bleeding	N	Y
d.	Kidney or bladder (urinary tract) infection	N	Y
e.	Severe nausea, vomiting, or dehydration	N	Y
f.	Cervix had to be sewn shut (incompetent cervix)	N 	Y
g.	High blood pressure, hypertension (including pregnancy-induced hypertension 
[PIH], preeclampsia, or toxemia)	N	Y
h.	Problems with the placenta (such as abruptio placentae or placenta previa) 	N	Y
i.	Labor pains more than 3 weeks before my baby was due (preterm or early labor)	N	Y
j.	Water broke more than 3 weeks before my baby was due 
(premature rupture of membranes [PROM])	N	Y
k.	I had to have a blood transfusion	N	Y
l.	I was hurt in a car accident	N	Y

If you did not have any of these problems, go to Question 30.

29.	Did you do any of the following things because of these problems? For each item, circle Y (Yes) if you did that thing or circle N (No) if you did not.

	No	Yes
a.	I went to the hospital or emergency room and stayed less than 1 day	N	Y
b.	I went to the hospital and stayed 1 to 7 days	N	Y
c.	I went to the hospital and stayed more than 7 days 	N	Y
d.	I stayed in bed at home more than 2 days because of my doctor’s or nurse’s advice	N	Y

The next questions are about smoking cigarettes and drinking alcohol.

30.	Have you smoked at least 100 cigarettes in the past 2 years? (A pack has 20 cigarettes.)

No  º  Go to Question 34
Yes

31. 	In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

41 cigarettes or more
21 to 40 cigarettes
11 to 20 cigarettes
6 to 10 cigarettes
1 to 5 cigarettes
Less than 1 cigarette
None (0 cigarettes)

32. 	In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

41 cigarettes or more
21 to 40 cigarettes
11 to 20 cigarettes
6 to 10 cigarettes
1 to 5 cigarettes
Less than 1 cigarette
None (0 cigarettes)

33.	How many cigarettes do you smoke on an average day now? (A pack has 20 cigarettes.)

41 cigarettes or more
21 to 40 cigarettes
11 to 20 cigarettes
6 to 10 cigarettes
1 to 5 cigarettes
Less than 1 cigarette
None (0 cigarettes)

34.	Have you had any alcoholic drinks in the past 2 years? (A drink is 1 glass of wine, wine cooler, can or bottle of beer, shot of liquor, or mixed drink.)

No  º  Go to Question 37
Yes

35a.	During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week?

14 drinks or more a week
7 to 13 drinks a week
4 to 6 drinks a week
1 to 3 drinks a week
Less than 1 drink a week
I didn’t drink then

35b.	During the 3 months before you got pregnant, how many times did you drink 5 alcoholic drinks or more in one sitting?

6 or more times 
4 to 5 times 
2 to 3 times 
1 time 
I didn’t have 5 drinks or more in 1 sitting
I didn’t drink then

36a.	During the last 3 months of your pregnancy, how many alcoholic drinks did you have in an average week?

14 drinks or more a week
7 to 13 drinks a week
4 to 6 drinks a week
1 to 3 drinks a week
Less than 1 drink a week
I didn’t drink then

36b.	During the last 3 months of your pregnancy, how many times did you drink 5 alcoholic drinks or more in one sitting?

6 or more times 
4 to 5 times 
2 to 3 times 
1 time 
I didn’t have 5 drinks or more in 1 sitting
I didn't drink then

Pregnancy can be a difficult time for some women. The next question is about things that may have happened before and during your most recent pregnancy.

37.	This question is about things that may have happened during the 12 months before your new baby was born. For each item, circle Y (Yes) if it happened to you or circle N (No) if it did not. (It may help to use the calendar.)

											No	Yes
a.	A close family member was very sick and had to go into the hospital	N	Y
b.	I got separated or divorced from my husband or partner	N	Y
c.	I moved to a new address	N	Y
d.	I was homeless	N	Y
e.	My husband or partner lost his job	N	Y
f.	I lost my job even though I wanted to go on working	N	Y
g.	I argued with my husband or partner more than usual	N	Y
h.	My husband or partner said he didn’t want me to be pregnant	N	Y
i.	I had a lot of bills I couldn’t pay	N	Y
j.	I was in a physical fight	N	Y
k.	I or my husband or partner went to jail	N	Y
l.	Someone very close to me had a bad problem with drinking or drugs	N	Y
m.	Someone very close to me died	N	Y

The next questions are about the time during the 12 months before you got pregnant with your new baby.

38a.	During the 12 months before you got pregnant, did an ex-husband or ex-partner push, hit, slap, kick, choke, or physically hurt you in any other way?

No
Yes

38b.	During the 12 months before you got pregnant, were you physically hurt in any way by your husband or partner?
		
No
Yes

The next questions are about the time during your most recent pregnancy.

39a.	During your most recent pregnancy, did an ex-husband or ex-partner push, hit, slap, kick, choke, or physically hurt you in any other way?

No
Yes

39b.	During your most recent pregnancy, were you physically hurt in any way by your husband or partner?

No
Yes

The next questions are about your labor and delivery. (It may help to look at the calendar when you answer these questions.)

40.	When was your baby due?

[BOX]	[BOX]	[BOX]	
Month	Day	Year	

41.	When did you go into the hospital to have your baby?

[BOX]	[BOX]	[BOX]	
Month	Day	Year	

I didn’t have my baby in a hospital

42.	When was your baby born?

[BOX]	[BOX]	[BOX]	
Month	Day	Year	

43.	When were you discharged from the hospital after your baby was born? (It may help to use the calendar.)

[BOX]	[BOX]	[BOX]	
Month	Day	Year	

I didn’t have my baby in a hospital

44.	How was your delivery paid for? Check all that apply

Medicaid (MassHealth)
Personal income (cash, check, or credit card)
Health insurance or HMO (including insurance from your work or your husband’s/partner’s work)
Free Care
Other  º  Please tell us:
[BOX]

The next questions are about the time since your new baby was born.

45.	After your baby was born, was he or she put in an intensive care unit?

No
Yes
I don’t know

46.	After your baby was born, how long did he or she stay in the hospital?

Less than 24 hours (less than 1 day)
24 to 48 hours (1 to 2 days)
3 days
4 days
5 days
6 days or more
My baby was not born in a hospital
My baby is still in the hospital  º  Go to Question 49

47.	Is your baby alive now?

No  º  Go to Question 58
Yes

48.	Is your baby living with you now?

No  º  Go to Question 58
Yes

49.	Did you ever breastfeed or pump breast milk to feed your new baby after delivery?

No  º  Go to Question 53
Yes

50.	Are you still breastfeeding or feeding pumped milk to your new baby?

No
Yes  º  Go to Question 52

51.	How many weeks or months did you breastfeed or pump milk to feed your baby?

[BOX]  Weeks  OR  [BOX]  Months

Less than 1 week

52.	How old was your baby the first time you fed him or her anything besides breast milk? Include formula, baby food, juice, cow’s milk, water, sugar water, or anything else you fed your baby.

[BOX]  Weeks  OR  [BOX]  Months

My baby was less than 1 week old
I have not fed my baby anything besides breast milk

If your baby is still in the hospital, go to Question 57.

53.	About how many hours a day, on average, is your new baby in the same room with someone who is smoking?

[BOX]  Hours

Less than 1 hour a day
My baby is never in the same room with someone who is smoking

54.	How do you most often lay your baby down to sleep now? Check one answer

On his or her side
On his or her back
On his or her stomach

55.	Was your new baby seen by a doctor, nurse, or other health care worker during the first week after he or she left the hospital?

No
Yes

56.	Has your new baby had a well-baby checkup? (A well-baby checkup is a regular health visit for your baby, usually at 2, 4, or 6 months of age.)

No
Yes

57.	What type of health insurance is your new baby covered by right now? Check all that apply

My new baby does not have health insurance
Medicaid (MassHealth)
Private insurance or HMO (including insurance from your work or your husband’s/partner’s work)
Other    Please tell us: [BOX]

The next few questions are about the time since your new baby was born and things that may have happened after delivery.

58.	Are you or your husband or partner doing anything now to keep from getting pregnant? (Some things people do to keep from getting pregnant include not having sex at certain times [rhythm] or withdrawal, and using birth control methods such as the pill, condoms, cervical ring, IUD, having their tubes tied, or their partner having a vasectomy.)

No
Yes  º  Go to Question 60

59.	What are your or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant now? Check all that apply

I am not having sex
I want to get pregnant
I don’t want to use birth control
My husband or partner doesn’t want to use anything
I don’t think I can get pregnant (sterile)
I can’t pay for birth control
I am pregnant now
Other  º  Please tell us:
[BOX]

60.	Since your new baby was born, have you had a postpartum checkup for yourself? (A postpartum checkup is the regular checkup a woman has after she gives birth.)

No 
Yes

61. 	During the 12 months before your new baby was born, what were the sources of your household’s income? Check all that apply

Paycheck or money from a job
Money from family or friends
Money from a business, fees, dividends, or rental income
Aid such as Temporary Assistance for Needy Families (TANF), welfare, WIC, public assistance, general assistance, food stamps, or   Supplemental Security Income
Unemployment benefits
Child support or alimony
Social security, workers’ compensation, disability, veteran benefits, or pensions
Other  º  Please tell us:
[BOX]

62.	During the 12 months before your new baby was born, what was your total household income before taxes? Include your income, your husband’s or partner’s income, and any other income you may have used. (All information will be kept private and will not affect any services you are now getting.) Check one answer

Less than $10,000
$10,000 to $14,999
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $34,999
$35,000 to $49,999
$50,000 or more

63.	How many people, including yourself, depended on this income?

[BOX]  People

The next questions are on a variety of topics before, during, and after your pregnancy.

64.	Before you got pregnant with your new baby, had you ever heard or read about emergency birth control (the “morning-after pill”)? This combination of pills is used to prevent pregnancy up to 3 days after unprotected sex.

No
Yes

65.	During the last 3 months of your most recent pregnancy, about how many servings of fruits or vegetables did you have in a day? Check one answer

Less than 1 serving per day
1 or 2 servings per day
3 or 4 servings per day
5 or more servings per day

66.	During the 3 months before you got pregnant with your new baby, how often did you participate in any physical activities or exercise for 30 minutes or more? (For example, walking for exercise, swimming, cycling, dancing, or gardening.) Do not count exercise you may have done as part of your regular job.

Less than 1 day per week
1 to 4 days per week
5 or more days per week

67.	During the last 3 months of your most recent pregnancy, how often did you participate in any physical activities or exercise for 30 minutes or more? Do not count exercise you may have done as part of your regular job.

Less than 1 day per week
1 to 4 days per week
5 or more days per week
I was told by a doctor, nurse, or other health care worker not to exercise 

68.	During your most recent pregnancy, did a doctor, nurse, or other health care worker talk with you about the signs and symptoms of preterm labor? (Preterm labor is defined as early labor more than 3 weeks before the baby is due.) 
No
Yes, before I went into labor
Yes, because I was in preterm labor

69.	Before you had your new baby, did you ever have a baby by cesarean delivery (when a doctor cuts through the mother’s belly to bring out the baby)?

No  
Yes

70.	How was your new baby delivered?

Vaginally  º  Go to Question 72
I went into labor but had to have a cesarean delivery
I didn’t go into labor and had to have a cesarean delivery

71.	Whose idea was it for you to have a cesarean delivery?  Please select the choice that best describes whose idea it was.  

My health care provider recommended a cesarean delivery before I went into labor.	
My health care provider recommended a cesarean delivery while I was in labor.
Mine, I wanted the cesarean delivery before I went into labor.	
Mine, I asked for the cesarean delivery while I was in labor.

If your baby is not currently living with you, go to Question 74a.

72.	In the last month, where did your new baby usually sleep? Check one answer
           
In a crib, cradle, or bassinet
On an adult bed or mattress with you or another person(s)
On an adult bed or mattress alone
On a sofa or couch
In a car seat or infant seat
Someplace else?    Please tell us: [BOX]

73.	Listed below are some statements about safety. For each one, circle Y (Yes) if it applies to you or circle N (No) if it does not.

		No	Yes
a.	My infant was brought home from the hospital in an infant car seat	N	Y
b.	My baby always or almost always rides in an infant car seat	N	Y
c.	My home has a working smoke alarm	N	Y
d.	There are loaded guns, rifles, or other firearms in my home	N	Y

	
74a.	Since your new baby was born, how often have you felt down, depressed, or hopeless? 

Always
Often
Sometimes
Rarely 
Never

74b.	Since your new baby was born, how often have you had little interest or little pleasure in doing things?

Always
Often
Sometimes
Rarely
Never

75.	Since your new baby was born, did you seek help for depression from a doctor, nurse, or other health care worker?

No
Yes

76.	What type of health insurance are you covered by right now? Check all that apply

I do not have health insurance
Medicaid (MassHealth)
Private insurance or HMO (including insurance from your work or your husband’s/partner’s work)
Other    Please tell us: [BOX]

77.	Are you limited in any way in any activities because of physical, mental, or emotional problems?

No º  Go to Question 79
Yes

78.	For how long have your activities been limited because of physical, mental, or emotional problems?

[BOX]  Number of Days  OR   [BOX]  Number of Weeks  OR  [BOX]  Number of Months  OR  [BOX]  Number of Years

	
79.	Have you ever had your teeth cleaned by a dentist or dental hygienist?

No  º  Go to Question 81
Yes 

80.	When did you have your teeth cleaned by a dentist or dental hygienist? For each of the three time periods, circle Y (Yes) if you had your teeth cleaned then or circle N (No) if you did not have your teeth cleaned then. 

		No	Yes
a.	Within a year before I became pregnant	N	Y
b.	During my most recent pregnancy	N	Y
c.	After my most recent pregnancy	N	Y

81.	What is today’s date?

[BOX]	[BOX]	[BOX]	
Month	Day	Year	

Please use this space for any additional comments you would like to make about the health of mothers and babies in Massachusetts.

Thanks for answering our questions!

Your answers will help us work to make Massachusetts mothers and babies healthier.