Pregnancy or baby loss care form

We are very sorry that you have experienced a pregnancy or baby loss. We are grateful for your time to answer these questions. The information you provide will help to improve existing services, and develop new ones, to meet the needs of families affected by the death of a baby or pregnancy loss in the future. Your views are, therefore, important to us.

This questionnaire is specifically focused around receiving difficult news, planning for your birth/loss, and the care you received after your loss. If you have thoughts about other aspects of your care in maternity services, you can contact the Somerset Maternity Voices Partnership.

We realise this questionnaire may bring back strong memories. It is also possible that it will highlight things that you may not have been offered. If you feel upset or distressed, you do not have to continue with the questionnaire and can stop at any time. There is an option to save and continue later by providing an email address at any point (your name and email address will not be saved, and the survey will remain anonymous).

If you would like support during or after completing the questionnaire, please get in touch with Towards Tomorrow Together. We are working with them throughout this process. You can reach them at

All questions can be left unanswered, apart from one which determines the questions you will be asked. Throughout please choose the responses that best apply, leaving comments if you wish to explain further.

Any extracts from what you say that are quoted in written work will be anonymous.

You can find further information about the Evolving Communities Privacy Statement, by going to All electronic and paper copies will be stored safely and securely by Evolving Communities CIC.

Thank you for your time and consideration.