Birth reflections form

Birth reflections service

Please complete all fields marked with an astrix (*)

Birth Reflections provides people who have given birth at Stoke Mandeville Hospital with the opportunity to talk about their birth experience and explore their feelings and thoughts with a midwife.

We suggest waiting a minimum of six weeks after the delivery to give yourself time to process what happened - we can offer you an appointment up to a year after the birth, or more if you are currently pregnant or are planning to become pregnant again

Appointments are usually held via MS Teams or telephone, however, face to face appointments at Stoke Mandeville Hospital and Wycombe Hospital are also available on request.

Your name

Your date of birth

Your baby's date of birth

Contact number

Email address

Do you have any communication requirements:

I would like an interpreter - please include details below. I have a learning disability I am deaf / have a hearing impairment I am blind / have a sight impairment Other - please include details below. I don’t have any specific communication requirements

Please give relevant details:

What would you like to discuss at your birth reflections appointment?

Please note: this service is not for formal complaints. If you have any concerns with regards to the care you’ve received, please contact bht.pals@nhs.net who will make sure your concerns are appropriately addressed.

Thank you for requesting a birth reflections appointment. One of our midwives will contact you within the next 4 weeks. If you don’t hear from us, please call 01296 255760.