Items:

Subscale: Dignity and Respect
1. Did the doctors, nurses, or other staff at the facility treat you with respect?
2. Did the doctors, nurses, and other staff at the facility treat you in a friendly manner?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3

3. Did you feel the doctors, nurses, or other health providers shouted at you, scolded, insulted, threatened, or talked to you rudely?
4. Did you feel like you were treated roughly like pushed, beaten, slapped, pinched, physically restrained, or gagged?

Response Options:
No, never - 0
Yes, once - 1
Yes, a few times - 2
Yes, many times - 3

5. During examinations in the labor room, were you covered up with a cloth or blanket or screened with a curtain so that you did not feel exposed?
6. Do you feel like your health information was or will be kept confidential at this facility?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3

Subscale: Communication and Autonomy
7. During your time in the health facility did the doctors, nurses, or other health care providers introduce themselves to you when they first came to see you?

Response Options:
No, none of them - 0
Yes, a few of them - 1
Yes, most of them - 2
Yes, all of them - 3

8. Did the doctors, nurses, or other health care providers call you by your name?
9. Did you feel like the doctors, nurses or other staff at the facility involved you in decisions about your care?
10. Did the doctors, nurses or other staff at the facility ask your permissionconsent before doing procedures and examinations on you?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3

11. During the delivery, do you feel like you were able to be in the position of your choice?

Response Options:
No, never - 0
Yes, for a short time - 1
Yes, most of the time - 2
Yes, all the time - 3

12. Did the doctors, nurses or other staff at the facility speak to you in a language you could understand?
13. Did the doctors and nurses explain to you why they were doing examinations or procedures on you?
14. Did the doctors and nurses explain to you why they were giving you any medicine?
15. Did you feel you could ask the doctors, nurses or other staff at the facility any questions you had?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3

Subscale: Supportive Care
16. How did you feel about the amount of time you waited? Would you say it was very short, just a little long, somewhat long, or very long?

Response Options:
Very short - 0
Somewhat short - 1
Somewhat long - 2
Very long - 3

17. Were you allowed to have someone you wanted (outside of staff at the facility, such as family or friends) to stay with you during labor?
18. Were you allowed to have someone you wanted to stay with you during delivery?
19. Did the doctors and nurses at the facility talk to you about how you were feeling?
20. When you needed help, did you feel the doctors, nurses or other staff at the facility paid attention?
21. Did you feel the doctors, nurses or other staff at the facility took the best care of you?
22. Do you feel the doctors or nurses did everything they could to help control your pain?
23. Did you feel you could completely trust the doctors, nurses or other staff at the facility with regards to your care?
24. In general, did you feel safe in the health facility?
25. Do you think there was enough health staff in the facility to care for you?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3

26. Thinking about the wards, washrooms and the general environment of the health facility, will you say the facility was very clean, clean, dirty, or very dirty?

Response Options:
Very dirty - 0
Dirty - 1
Clean - 2
Very clean - 3

27. Did the doctors, nurses or other staff at the facility ask you or your family for money other than the official cost?

Response Options:
No, never - 0
Yes, a few times - 1
Yes, most of the time - 2
Yes, all the time - 3