appleyoga Postnatal Health Form

Registration form for postnatal yoga students (and their babies) All information will be treated in the strictest confidence = Required Name of mother Sex of your baby Boy Girl Name of baby Address   Postcode Phone Email Mother's date of Birth Baby's date of Birth Date of first yoga class How did you hear about our classes Have you had any previous births Yes No Please give ages of your older children. Birthing Experiences Please give brief details, of this most recent birth,  ticking options as they apply to you: Midwifery practice team Length of labour Was the labour? self-starting induced accelerated                       The nature of the labour? vaginal ventouse forceps caesarean                   Delivery Environment? hospital home waterbirth other                   Any drugs administered during labour? gas and air pethidine epidural other Any stitches required following tearing / episiotomy ?   Was your baby? full-term premature overdue     At what stage was the umbilical cord cut State of health of baby at and immediately after birth Since the birth of this baby have you experienced any of the following? Please tick as necessary:   sacro iliac pain back pains sciatica   high blood pressure anaemia prolonged bleeding   depression anxiety exhaustion Since birth, has your baby experienced any of the following? Please tick as necessary:   colic jaundice irritability   hip dislocation cranial compression fevers Have you practiced yoga before? Please give details of how long, what style of yoga etc. Prior to this birth, have you suffered any injury or undergone any surgery that may have some bearing on your yoga practice? Yes No If so, please state details. Are you taking any form of medication that may have some bearing on your yoga practice? Yes No If so, please state details.