Liliana Williams-Cantor BA, IBCLC International Board Certified Lactation Consultant
BREASTFEEDING QUESTIONNAIRE TODAY’S DATE_________________________________________________________ MOTHER’S NAME_____________________________DOB________ INFANT’S NAME__________________________________DOB__________________ IN YOUR OWN WORDS DESCRIBE ANY FEEDING PROBLEMS THAT CONCERN YOU: ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ FAMILY HISTORY DOES ANYONE ON EITHER SIDE OF THE BABY’S FAMILY HAVE ANY OF THE FOLLOWING? (CIRCLE) allergies to foods environmental allergies asthma eczema hay fever breast cancer diabetes genetic disease thyroid disease other___________________________________________________________________________________________ WHAT AGE WERE YOU WHEN YOU HAD YOUR FIRST MENSTRUAL PERIOD? ________________________ REGULAR OR IRREGULAR WAS THIS YOUR FIRST PREGNANCY? (CIRCLE) yes no if no, how many pregnancies?_________how many children?_____________did you breastfeed your other children?__________________________ WHICH OF THE FOLLOWING FAMILY PLANNING METHODS ARE YOU USING OR DO YOU PLAN TO USE? (CIRCLE) Norplant birth control shot barriers birth control pills vasectomy natural family planning/rhythm tubes tied none WILL YOU BE RETURNING TO WORK? (CIRCLE) yes no WHEN?________________________________________________FULL TIME?___________________PART TIME______________________ PREGNANCY AND BIRTH HISTORY DOES YOUR BABY HAVE ANY KNOWN HEALTH PROBLEMS? _______________________________________________________________________________________________________________________ IS THE BABY CURRENTLY ON ANY MEDICATIONS?_________________________________________________________________________________________________________________________________ ARE YOU TAKING ANY OF THE FOLLOWING? (CIRCLE) prenatal vitamin-mineral iron antihistamines cold remedies antibiotics aspirin laxatives diuretics/water pills antacids birth control pills pain pills diet pills herbs other_______________________________________________________________________ HAVE YOU EVER HAD ANY OF THE FOLLOWING PROCEDURES RELATED TO YOUR BREAST? (CIRCLE) biopsy lumps implants breast reduction surgery nipple problems other_______________________________________________________________________________________________________________________________________________________________________________ DO YOU PRESENTLY HAVE OR HAVE YOU EVER HAD ANY OF THE FOLLOWING? (CIRCLE) anemia allergy/asthma diarrhea (chronic) heart disease diabetes hepatitis venereal disease high blood pressure liver disease thyroid disorders miscarriages hemorrhoids cancer infertility abortions depression sexual abuse abnormal pap smear constipation eating disorder kidney/bladder disease or infection yeast infections tuberculosis polycystic ovarian syndrome other______________________________________________________________________________________________ DID YOU HAVE ANY OF THE FOLLOWING DURING THIS PREGNANCY? (CIRCLE) premature labor gestational diabetes high blood pressure nausea/vomiting-severe anemia fever urinary tract infection medications other___________________________________________________________________________________________________________ DID YOU HAVE ANY OF THE FOLLOWING DURING THIS LABOR AND DELIVERY? (CIRCLE) premature rupture of membranes drugs to control pain drugs to control high blood pressure epidural fever antibiotics drugs to induce or speed labor-if so how long during labor was this drug administered?________________________________________hours hemorrhage-if so how much blood was lost_____________________pints, other_______________________________________________________________________________________________________________ WHAT TYPE OF DELIVERY DID YOU HAVE WITH THIS BIRTH? (CIRCLE) vaginal emergency c-section planned c-section GESTATIONAL AGE OF BABY AT BIRTH?______________WEEKS DID YOU HAVE ANY OF THE FOLLOWING WITH THIS BIRTH? (CIRCLE) total labor longer than 30 hours episiotomy or tear pushing stage longer than 2 hours breech presentation tear that involved the rectum (3rd or 4th degree laceration) forceps delivery vacuum extraction other______________________________________________________________________ DID YOU EXPERIENCE ANY POSTPARTUM COMPLICATIONS? (CIRCLE) urinary/other infections low blood pressure high blood pressure excessive bleeding or hemorrhaging other_______________________________________________________________________________________________________________________________________________________________________________ DID THE BABY HAVE ANY OF THE FOLLOWING AFTER BIRTH? (CIRCLE) breathing difficulties high hematocrit low blood sugar meconium aspiration jaundice (highest bili level____________) other_____________________________________________________________________________________________________________________________________ WHAT WAS YOUR BRA SIZE: BEFORE PREGNANCY_________ NOW________ CHANGES SINCE THE BIRTH? hard/engorged heavy warm leaking no changes BREASTFEEDING HISTORY HOW OLD WAS YOUR BABY WHEN YOU FIRST REALIZED THAT YOU WERE HAVING BREASTFEEDING DIFFICULTIES?_______________________________________________________________ HAVE YOU USED ANY BREASTFEEDING SUPPLIES OR PUMPS?____________________________________________________________Type of PUMP_____________________________________________ HAS YOUR BABY BEEN SUPPLEMENTED WITH ANY OF THE FOLLOWING? NONE water formula expressed breastmilk TYPE OF FORMULA_________________________________ IF SO, HOW WAS THE BABY SUPPLEMENTED? feeding tube finger feeding cup feeding bottle TYPE of BOTTLE_____________________________________________________________ IF SUPPLEMENTS HAVE BEEN USED, HOW OFTEN IN PAST 24 HOURS? __________________________________HOW MUCH PER FEEDING?__________________________________________________ HOW MANY TIMES IN THE PAST 24 HOURS HAVE YOU BREASTFED YOUR BABY? (CIRCLE) less than 6 times less than 8 times 8-10 times more than 12 times ARE YOU EXPERIENCING ANY OF THE FOLLOWING? (CIRCLE) latch-on difficulties engorgement sleepy baby sore nipples preference for one breast baby not interested cracked/bleeding nipples breast pain feeling that there is not enough milk baby crying excessively baby always seems hungry other______________________________________________________________________________________________________________________________________________________________________________ IS THE BABY CONTENT OR SLEEPING BETWEEN FEEDINGS? (CIRCLE) never occasionally often WHAT IS THE LONGEST TIME YOUR BABY HAS GONE BETWEEN FEEDINGS? DAY:_____________________________________ NIGHT:__________________________________ WHO DECIDES WHEN THE FEEDING IS OVER? (CIRCLE) Mother or Baby HOW LONG DOES BABY NURSE AT BREAST?_______________________ ONE BREAST OR BOTH BREAST HOW MANY MONTHS DO YOU WISH TO BREASTFEED YOUR BABY? 1 MONTH 2-3 MONTHS 3-6 MONTHS 6-9 MONTHS 12 MONTHS LONGER THAN 12 MONTHS ARE YOU PRESENTLY USING A PACIFIER? yes or no HOW OFTEN? _________________________________________________________________________________________________________________ IN THE PAST 24 HOURS, HOW MANY? WET DIAPERS_________________ STOOLS_______________________ WERE THE STOOLS BIGGER THAN A TABLESPOON? yes no
Preferences in Game Logics Abstract even excluding the possibility that an agent might value op-tions equally. Models of social procedures that do not re- We introduce a Game Logic with Preferences ( GLP ), quire one to completely specify the preferences of agents which makes it possible to reason about how information are thus highly desirable. Gal and Pfeffer [9, 10] have also or as
Alberto Pera Changing Views of Competition, Economic Analysis and EC Antitrust Law* INTRODUCTION During the last decades the criteria governing the application of EC Antitrust Law have been subjected to substantial changes. These have concerned a number of aspects: procedure, through the enactment of Regulation 1/2003, the “Modernization Regulation”; and substance, through