3820 Charlotte Ave

Ste 146-23
Nashville, TN 37209
Website: https://www.birthingculturalrigor.com/
Email: info@birthingculturalrigor.org

A Patient Guide for The PREM-OB Scale™ Survey

Thank you for your interest in helping us better understand and explain how hospitals harm or
hurt Black mothers and birthing people during childbirth. We need Black mothers and birthing
people to take our survey only if they went to the hospital for their labor, birth, and postpartum
care on or after January 1, 2021.
You must agree to take part in all three steps to help us.
Step One: Online Screening
Before you can take part in the hospital birthing survey, you must answer a few easy questions
about you who you are, when you gave birth, and where you gave birth. You must also show
proof of who you are, using one of four forms of ID that show your name and photo: work ID,
student ID, state ID, or driver’s license. You must upload the correct photo ID onto our online
survey.
Next, you will also be asked to read and then electronically sign your name on TWO different
forms. One form, called an informed consent form, lets us know that you agree to take part in our
hospital birthing survey on your own, without any force or control. The second form is called a
non-disclosure agreement which protects ideas and information about the hospital birthing
survey from being stolen by or shared with other people or groups.
Step Two: Video Verification
If your information and photo match our program goals, then a member of our quality and safety
team will reach out to you by phone call, text message, or email to schedule a date and time for a
video call. The goal of the video call is to learn more about you and check your information. The
video call will take about seven minutes. You will need to use a smart phone, tablet, laptop, or
desktop computer with a working camera to take part in the video call. Our program goals
include keeping your information safe and using real honest information about Black women and
people, for us, by us.
Step Three: Online Final Survey
After your video call with a BCR team member, you will be asked to take part in the hospital
birthing survey called The PREM-OB Scale™ suite. You will be asked questions about your life
inside and outside your home, your family, work, money, health, and pregnancy. Based on your
answers, The PREM-OB Scale™ creates three scores: humanity, kinship, and racism. These
three scores tell us how well or how poorly the hospital team cared for you, your baby, and your
support team during labor, birth, and postpartum.
 3820 Charlotte Ave
Ste 146-23
Nashville, TN 37209
Website: https://www.birthingculturalrigor.com/
Email: info@birthingculturalrigor.org

A Patient Guide for The PREM-OB Scale™ Survey

The survey can take up to one hour. You can also start and then pause the survey if you need
more time. You will be able to save the survey and go back to the survey when you are ready.
We do ask that you finish the survey in fourteen days or two weeks from when you started the
survey.

What happens after you complete the hospital birthing survey?

After you complete all three steps, a member of BCR’s team will check your survey and contact
information. Then we will send you an electronic gift card for $50. The gift card will arrive in
your email within fourteen business days from the date you finished the final survey. Remember
that we do not count Saturdays, Sundays, or holidays in the fourteen-day window.
Any questions or concerns?
The information you share about your hospital birth will help change birthing quality and safety
for Black birthing people in U.S. hospitals. Thank you for joining the movement to end obstetric
racism! If you have any questions or concerns, please email the BCR team at
info@birthingculturalrigor.org