Have you had a medical condition start during or after pregnancy?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
2.
Do you feel you have digestive issues that have worsened since the birth of your child? These issues may include constipation/diarrhea, flatulence/abdominal pain, and/or lethargy associated with meals.
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
3.
Do you experience severe fatigue?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
4.
Do you feel exhausted on waking?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
5.
Do you fall asleep unintentionally when putting the children to bed?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
6.
Do you have sensitivity to bright light (or repetitive sounds) and are you easily startled?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
7.
Are you experiencing levels of anxiety that are way above your norm?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
8.
Do you feel you are a “light sleeper” and are overly aware while you’re sleeping?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
9.
Do you have any sex drive or a healthy libido?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
10.
Do you experience severe brain fog?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
11.
Are you struggling to keep up with basic self-care, such as showering, grooming, and preparing meals for yourself?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
12.
Are you experiencing a significant loss of confidence and self-esteem?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
13.
Do you have a sense of isolation and lack of support?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
14.
Do you feel that “there is no time for me”?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
15.
Do you feel overwhelmed and unable to cope?
A.
No
B.
Sometimes
C.
Frequently
D.
All the time
16.
Do you feel a sense of guilt/shame or failure around your role as a mother?
