Start
bcs_1970
BRITISH BIRTHS
A Survey under the joint auspices of the National Birthday Trust Fund and the Royal College of Obstetricians and Gynaecologists
Please complete the enquiry for all babies born (alive or dead) after the 24th week of gestation from 00.01 hours on Sunday 5th April, 1970 to 24.00 hours on Saturday 11th April, 1970 whether born in hospital, at home or elsewhere.
Part I relates to information not usually included in the clinical records. It will be necessary to interview the mother as soon as possible after the birth.
Part II is concerned with antenatal care and with the delivery. Complete soon after birth using all the available records, discussing with the doctor or anyone else concerned with the care of the mother and baby.
Part III relates to the first seven days after the birth. Keep it up-to-date daily, if possible, so that it is immediately available if the mother moves. If the mother and baby are separated, complete the form for the mother first and then forward it for the baby section to be completed.
Most questions are pre-coded and except where otherwise stated should be answed by ringing one or more numbers as appropriate. Please complete one section at least in each question. Do not leave a question blank.
For Multiple Births, please complete the whole form for the first baby. For each of the other babies, question 1 of Part I should be filled in and then question 25 of Part II onwards, on a seperate form.
When the form is complete it should normally be returned to the supervisor of midwives, the superintendent midwife, or the matron of the hospital unless other arrangements have been made locally.
PART I
With this form there is a letter for the mother. Please hand it to her before starting the questionnaire.
Questions 1-11 should be filled in by interviewing the mother. If you are unable to do this, please use the records.
Name and Address:

Full name of the mother

Generic text

Mother's maiden name

Generic text

Address of mother's normal place of residence

Generic text

County or County Borough

Generic text

Address where this delivery occurred

Generic text

Hospital number

Generic text

Date of birth of mother:

Generic date

Town and Country of birth: Mother of baby

Generic text

Town and Country of birth: Father of baby

Generic text

Town and Country of birth: Mother's mother

Generic text

Age at which full-time education was completed (including college or university) Mother of baby ... years

Age

Age at which full-time education was completed (including college or university) Father of baby ... years

Age

Date of present marriage:

Generic date

Present marital status:

1
Single
2
Married
3
Widowed
4
Divorced
5
Separated
0
Not known
Occupation
Actual job Description of job - -

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text
Husband
Mother of baby (Before this pregnancy)

Does the mother care for children at home (including adopted and foster children)?

1
Yes
2
No
0
Not known
If YES:
qc_8 == 1
give details of who is looking after them now
Number of children
How many
Living at home: Looked after by Home Help
Living at home: With child minder
Living at home: At a day nursery
Living at home: Other
Living at home: Not Known
Living away from home: With friends and relatives
Living away from home: With foster parents
Living away from home: In residential nursery
Living away from home: In residential school
Living away from home: Other

Since January, 1968 was any form of contraception used?

1
Yes
2
No
0
Not known
If YES:
qc_9 == 1

what method was used

1
Pill: Alone
2
Pill: With other method
3
Other methods
0
Not known
If the Pill was used:
qc_9_i == 1 || qc_9_i == 2

How many different brands have been used?

How many
Name(s) of Pills used and period taken
Name Taken from Taken to
Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date
1
2
3
4
5
6

Name(s) of Pills used and period taken

1
Brands not known

What type of antenatal preparation did the mother receive during this pregnancy? In mothercraft (e.g. care of the baby)

1
None
2
Individual instruction
3
Class instruction: L.H.A. Clinic
4
Class instruction: Hospital
5
Other (specify)
0
Not known
Other

What type of antenatal preparation did the mother receive during this pregnancy? In preparation for labour (e.g. exercises, relaxation, etc.)

1
None
2
Individual instruction
3
Class instruction: L.H.A. Clinic
4
Class instruction: Hospital
5
Other (specify)
0
Not known
Other
Smoking:

Does the mother smoke now?

1
Yes
2
No
0
Not known
If NO to 11a,
qc_11_a == 2

did she ever smoke?

1
Yes
2
No
0
Not known
If YES to 11b
qc_11_b == 1

how long ago did she stop? ... Years ... Months

Years Months

How much does/did she smoke? Cigarettes per day

1
1-4
2
5-14
3
15-24
4
25 or more
0
Not known

Has she smoked during this pregnancy?

1
Yes
2
No
0
Not known

Part I was completed by:

1
Interviewing the mother
2
Using records: Hospital
3
Using records: G.P.
4
Using records: Midwife
5
Using records: Co-operation Card
6
Other (specify)
Other
PART II
To be completed from the records or personal communication where necessary.
Previous pregnancies
Date: Month Date: Year Sex Birth Weight - Method of Delivery Record any of the following which occurred : Pre-eclamptic toxaemia, A.P.H., P.P.H., Surgical Induction or a congential abnormalilty of the baby.
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Total number of recorded antenatal visits

Number of

Total number of recorded antenatal visits Date of first visit

Generic date

Total number of recorded antenatal Date of last visit

Generic date

Who undertook the antenatal care?

1
Hospital medical staff
2
L.H.A. M.O.
3
G.P.
4
Midwife: Hospital
5
Midwife: G.P. Unit
6
Midwife: Domiciliary
7
Other (specify)
Other

If mother delivered in hospital and the antenatal care shared, was this

1
By previous arrangement
2
Because of some abnormality which arose during pregnancy
3
Some other reason
0
Not known

What was the first day of the last normal menstrual period?

Generic date

Was this date recorded as being

1
Certain
2
Uncertain
0
Not known

Standing height of the mother ... ft. ... ins or ... cms.

ft
ins
cms

Mother's blood group

1
O
2
A
3
B
4
AB
0
Not known

Rh factor

1
Positive
2
Negative
0
Not known

Rh antibodies

1
Present
2
Absent
0
Not known

Were haemoglobin estimations done?

1
Yes
2
No
0
Not known
If YES:
qc_17_iv == 1

Number of times estimated

How many

Highest value ... Date ...

Generic text
Generic date

Lowest value ... Date ...

Generic text
Generic date

W.R. or similar test

1
Negative
2
Positive
3
Not done
0
Not known
Blood pressure during antenatal period
Reading Date
Generic textGeneric dateGeneric textGeneric date Generic textGeneric dateGeneric textGeneric date
First (or only)
Highest systolic
Highest diastolic
Last before labour

Blood pressures during antenatal period

1
Not recorded
2
Not known

Was there any non-infective proteinuria?

1
Yes
2
No
0
Not known

Was pitting oedema present?

1
Yes
2
No
0
Not known

Were there any eclamptic fits prior to labour?

1
Yes
2
No
0
Not known

Has the mother clinical diabetes?

1
Yes
2
No
0
Not known

Was there any bleeding from the genital tract after the last period and before the onset of labour?

1
Yes
2
No
0
Not known
If YES:
qc_20 == 1

Number of bleeds

How many

Date of first (or only) bleed

Generic date

Date of last bleed

Generic date

Cause

1
Placenta Praevia
2
Accidental Haemorrhage (Abruptio Placentae)
3
Threatened Abortion
4
Other (specify)
Generic text

X-rays taken of the mother during pregnancy

1
None
2
Chest
3
Abdomen
4
Pelvis
5
Other (specify)
0
Not known
Other

Did the mother have any inpatient care during the antenatal period (excluding admissions in labour or false labour?)

1
Yes
2
No
0
Not known
If YES:
qc_22 == 1

Give date(s) of admission(s)

Generic date

Place of admission

1
N.H.S. Consultant Hospital: Consultant bed
2
N.H.S. Consultant Hospital: G.P. bed
3
N.H.S. G.P. Maternity Unit without resident medical officer
4
Private
5
Other (specify)
6
Not known
Other

If discharged prior to labour date(s) of discharge(s)

Generic date

Where was the mother delivered?

1
At home
2
In an N.H.S. Consultant Hospital: Consultant bed
3
In an N.H.S. Consultant Hospital: G.P. bed
4
N.H.S. G.P. Maternity Unit without resident medical officer
5
Private
6
Other (specify)
Other

Was the mother booked for delivery at the place where her confinement occurred?

1
Yes
2
No
0
Not known
If YES,
qc_23_ii == 1

give the date of booking

Generic date

Did labour start

1
Spontaneously
2
Induced
0
Not known
If INDUCED,
qc_24_i == 2

what methods were used?

1
Oxytocic Drugs: Intravenous Drip
2
Oxytocic Drugs: Buccal
3
Oxytocic Drugs: Other
4
Artifical rupture of membranes
5
Other (specify)
0
Not known
Other

What was the time interval between the rupture of the membranes and the delivery?

1
Less than 24 hours
2
24-47 hours
3
48 hours or more
0
Not known

Was the birth

1
Single
2
Twin
3
Triplet
4
Other (specify)
Other
(NOTE: A separate form is required for each baby. For babies other than the first complete question 1 (Part I) and then the remainder of the form from this question onward).

Date of birth

Date of birth

Hour of birth

Generic time

What was the outcome of the delivery?

1
Prior to 28 weeks of gestation: Abortion
2
Prior to 28 weeks of gestation: Livebirth
3
28 weeks or more gestation: Stillbirth
4
28 weeks or more gestation: Livebirth

Sex

1
Male
2
Female
0
Not known
Give the length of each stage of labour
Hours Minutes
HoursMinutesHoursMinutes HoursMinutesHoursMinutes
First
Second
Third

During labour did the fetal heart rate

1
Remain between 120 and 160
2
Rise above 160
3
Fall below 120
0
Not known

Other recordings made on the fetus

1
None
2
Fetal E.C.G.
3
Scalp blood sampling
4
Sonar records
5
Other (specify)
Other

Was there passage of meconium?

1
Yes
2
No
0
Not known

Delivery

1
Spontaneous cephalic: anterior
2
Spontaneous cephalic: posterior
3
Spontaneous breech
4
Operative delivery: Forceps: Cephalic
5
Operative delivery: Forceps: With Breech
6
Operative delivery: Forceps: Other (specify)
7
Operative delivery: Caesarean Section
8
Operative delivery: Vacuum Extraction
9
Operative delivery: Other (specify)
0
Other (specify)
Other

Relief of pain during labour

1
Analgesics: Inhalation: Gas/Oxygen
2
Analgesics: Inhalation: Gas/Air
3
Analgesics: Inhalation: Trilene
1
Analgesics: Drugs: Pethidine
2
Analgesics: Drugs: Pethilorfan
3
Analgesics: Drugs: Morphia
4
Analgesics: Drugs: Fortral
1
Psychoprophylaxis
2
Hypnosis
3
Decompression
4
Other (specify)
Other

Anaesthetics during and after labour Before baby born

1
General
2
Caudal
3
Epidural
4
Local
5
Other

Anaesthetics during and after labour After baby born

1
General
2
Caudal
3
Epidural
4
Local
5
Other

Did a postpartum haemorrhage of 500 ml. or more occur?

1
Yes
2
No
0
Not known

Was a blood transfusion given?

1
Yes
2
No
0
Not known

Did the mother have a manual removal of the placenta?

1
Yes
2
No
0
Not known

When was regular respiration established?

1
Less than 1 minute
2
1-3 minutes
3
More than 3 minutes
0
Not known

Administration of oxygen

1
None
2
Face funnel
3
Face mask
4
Nasal tube
5
Endotracheal tube
6
Incubator
7
Other (specify)
0
Not known
Generic text

Other methods of resuscitation

1
None
2
Mouth to mouth resuscitation
3
Mucus extraction
4
Stomach aspiration
5
Other (specify)
0
Not known
Other

Was Vitamin K (e.g. Synkavit, Konakion) given?

1
Yes
2
No
0
Not known

Were eye drops used prophylactically?

1
None
2
Albucid
3
Silver Nitrate
4
Other (specify)
0
Not known
Other

Did the baby have: Lethidrone (Nalorphine)

1
Yes
2
No
0
Not known

Did the baby have: Vanillic Acid (Vandid)

1
Yes
2
No
0
Not known

Other treatments given to baby

1
None
2
Yes (specify)
0
Not known
Other

Birthweight of the baby ... lbs. ... ozs. or ... gm

lbs
ozs
gm

Age of baby when weighed

1
Under 12 hours
2
12-23 hours
3
24-35 hours
4
36 hours or more
0
Not known

Lowest recorded weight of baby ... lbs. ... ozs. or ... gm

lbs
ozs
gm

Date of this weighing

Generic date

Was there an episiotomy or tear?

1
Episiotomy
2
Third degree tear
3
Other tear
4
None
0
Not known

Who undertook the delivery?

1
Midwife: Domiciliary
2
Midwife: Hospital
3
Pupil Midwife
4
Consultant Obstetrician
5
Registrar
6
House Officer
7
G.P.
8
Medical Student
9
Other (specify)
Other

Part II was completed by

1
Using records: Hospital
2
Using records: G.P.
3
Using records: Midwife
4
Using records: Co-operation Card
5
Personal Communication: Hospital Doctor
6
Personal Communication: G.P.
7
Personal Communication: Midwife
8
Other (specify)
Other
PART III

Did the mother have any evidence of eclampsia occuring for the first time in labour or the puerperium?

1
Yes
2
No
0
Not known

During the first seven days after the delivery did the mother: Have any urinary infection?

1
Yes
2
No
0
Not known

During the first seven days after the delivery did the mother: Have any genital tract infection?

1
Yes
2
No
0
Not known

During the first seven days after the delivery did the mother: Have any venous complication of the legs?

1
None
2
In superficial veins
3
In deep veins
0
Not known

During the first seven days after the delivery did the mother: Have any operations in puerperium?

1
None
2
Sterilisation
3
Other (specify)
0
Not known
Other

During the first seven days after the delivery did the mother: Have any other morbidity or illness?

1
No
2
Yes (specify)
0
Not known
Other

During the first seven days after the delivery did the mother: Have a haemoglobin estimation done?

1
Yes
2
No
0
Not known

Was the baby medically examined within the first 24 hours?

1
Yes
2
No
0
Not known
If YES,
qc_38 == 1

by whom?

1
Consultant Obstetrician
2
Obstetric Registrar
3
Obstetric House Officer
4
Consultant Paediatrician
5
Paediatric Registrar
6
Paediatric House Officer
7
G.P.
8
Other (specify)
0
Not known
Other

Was lactation

1
Attempted
2
Not attempted
0
Not known

Was it

1
Suppressed
2
Not suppressed
0
Not known
If SUPPRESSED,
qc_39_ii == 1

was oestrogen used?

1
No
2
Yes (specify type)
0
Not known
Other
What type of feed did the baby have during each of the 24 hour periods after birth?
- Other Specify

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other
1st
2nd
3rd
4th
5th
6th
7th

Congenital Abnormalities of the baby:

1
No abnormality
2
Anencephaly
3
Spina bifida with hydrocephalus
4
Spina bifida without hydrocephalus
5
Hydrocephalus only
6
Cleft lip and/or palate
7
Down's syndrome (Mongolism)
8
Talipes
9
Abnormalities of the hip
1
Extra digits
2
Naevi
3
Other (specify)
Other

What was the lowest recorded rectal temperature?

Generic text
Generic date
1
Less than 24 hours of life
2
24 hours or later
3
Not recorded

Was a low reading thermometer i.e. recording 85 degrees F (30 degrees C) or lower used?

1
Yes
2
No
0
Not known

Was the baby examined for congenital dislocation of the hip?

1
Yes
2
No
0
Not known

Had it been recorded on the case notes?

1
Yes
2
No
0
Not known

Was the baby tested for phenylketonuria?

1
Yes (specify method used)
2
No
0
Not known
Generic text
Generic date

Was the baby jaundiced?

1
Yes: Less than 24 hours of life
2
Yes: 24 hours or later
3
No
0
Not known

Maximum serum bilirubin level ... date

Generic text
Generic date

Cause (if known)

Generic text

Was the baby's blood sugar level taken?

1
Yes
2
No
0
Not known

Was the baby's blood sugar level taken? Minimum level ... date

Generic text
Generic date

Age of baby if less than 24 hours

Generic text

Did the baby develop any breathing difficulties, including respiratory distress syndrome?

1
Yes (specify)
2
No
0
Not known
Other

Did the baby have cyanotic attacks?

1
Yes
2
No
0
Not known

Did the baby have any fits or convulsions?

1
Yes
2
No
0
Not known

Did the baby have any "cerebral" signs?

1
Yes (specify)
2
No
0
Not known
Other

Did the baby have any fractures?

1
Yes (specify)
2
No
0
Not known
Generic text

Did the baby have a cephalhaematoma?

1
Yes
2
No
0
Not known

Did the baby have "sticky" eyes?

1
Yes
2
No
0
Not known

Did the baby have a discharge from the umbilicus?

1
Yes
2
No
0
Not known

Were exchange transfusions given?

1
Yes
2
No
0
Not known

Were any operations performed?

1
Yes (specify)
2
No
0
Not known
Other

Were there any other illnesses or conditions of the baby?

1
Yes
2
No
0
Not known

If the baby was discharged during the first seven days, what was the date of the last medical examination?

Generic date

Examined by

1
Consultant Obstetrician
2
Obstetric Registrar
3
Obstetric House Officer
4
Consultant Paediatrician
5
Paediatric Registrar
6
Paediatric House Officer
7
G.P.
8
Other (specify)
0
Not known
Other
Where was the baby cared for each day?
Date - - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other
Day of Birth
Days following birth: 1st
Days following birth: 2nd
Days following birth: 3rd
Days following birth: 4th
Days following birth: 5th
Days following birth: 6th
Days following birth: 7th
Where was the mother during the first seven days?
Date - Other (specify)
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Day of Birth
Days following birth: 1st
Days following birth: 2nd
Days following birth: 3rd
Days following birth: 4th
Days following birth: 5th
Days following birth: 6th
Days following birth: 7th
If the mother moved who was informed?
- How were they informed? When were they informed? Other (Specify) Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

First Move
Second Move
Third Move

Part III was completed by:

1
Using records: Hospital
2
Using records: G.P.
3
Using records: Midwife
4
Using records: Co-operation Card
5
Personal Communication: Hospital Doctor
6
Personal Communication: G.P.
7
Personal Communication: Midwife

Name of baby (if known)

Generic text

ANY OTHER RELEVANT INFORMATION:

Long text
WE ARE GRATEFUL FOR THE TIME YOU HAVE GIVEN. THANK YOU FOR YOUR HELP
ABORTIONS, STILLBIRTHS AND NEONATAL DEATHS ONLY

Date of death

Generic date

Was a postmortem performed?

1
Yes
2
No
0
Not known

Cause of death (attach P.M. report if available)

Generic text
STILLBIRTHS AND NEONATAL DEATHS ONLY (For Medical Officer of Health only)

Registered cause of death

Generic text
If full P.M. report or registered cause of death not available: please send copies direct to 'The Secretary, National Birthday Trust Fund, 57 Lower Belgrave Street, London, SW1' as soon as possible
End

bcs_1970

BRITISH BIRTHS

A Survey under the joint auspices of the National Birthday Trust Fund and the Royal College of Obstetricians and Gynaecologists
Please complete the enquiry for all babies born (alive or dead) after the 24th week of gestation from 00.01 hours on Sunday 5th April, 1970 to 24.00 hours on Saturday 11th April, 1970 whether born in hospital, at home or elsewhere.
Part I relates to information not usually included in the clinical records. It will be necessary to interview the mother as soon as possible after the birth.
Part II is concerned with antenatal care and with the delivery. Complete soon after birth using all the available records, discussing with the doctor or anyone else concerned with the care of the mother and baby.
Part III relates to the first seven days after the birth. Keep it up-to-date daily, if possible, so that it is immediately available if the mother moves. If the mother and baby are separated, complete the form for the mother first and then forward it for the baby section to be completed.
Most questions are pre-coded and except where otherwise stated should be answed by ringing one or more numbers as appropriate. Please complete one section at least in each question. Do not leave a question blank.
For Multiple Births, please complete the whole form for the first baby. For each of the other babies, question 1 of Part I should be filled in and then question 25 of Part II onwards, on a seperate form.
When the form is complete it should normally be returned to the supervisor of midwives, the superintendent midwife, or the matron of the hospital unless other arrangements have been made locally.

PART I

With this form there is a letter for the mother. Please hand it to her before starting the questionnaire.
Questions 1-11 should be filled in by interviewing the mother. If you are unable to do this, please use the records.

Name and Address:

Full name of the mother
Generic text
Mother's maiden name
Generic text
Address of mother's normal place of residence
Generic text
County or County Borough
Generic text
Address where this delivery occurred
Generic text
Hospital number
Generic text
Date of birth of mother:
Generic date
Town and Country of birth: Mother of baby
Generic text
Town and Country of birth: Father of baby
Generic text
Town and Country of birth: Mother's mother
Generic text
Age at which full-time education was completed (including college or university) Mother of baby ... years
Age
Age at which full-time education was completed (including college or university) Father of baby ... years
Age
Date of present marriage:
Generic date
Present marital status:
1
Single
2
Married
3
Widowed
4
Divorced
5
Separated
0
Not known

Occupation

Actual job Description of job - -

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Employed at present

2 - Unemployed at present

Generic textGeneric text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

Generic text

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text

1 - Employed at present

2 - Unemployed at present

1 - Self-employed: Employing 25 or more persons

2 - Self-employed: Employing fewer than 25 persons

3 - Not self employed: Supervising others e.g. foreman, manager etc

4 - Not self employed: Not supervising others

Generic text
Husband
Mother of baby (Before this pregnancy)
Does the mother care for children at home (including adopted and foster children)?
1
Yes
2
No
0
Not known

give details of who is looking after them now

Number of children
How many
Living at home: Looked after by Home Help
Living at home: With child minder
Living at home: At a day nursery
Living at home: Other
Living at home: Not Known
Living away from home: With friends and relatives
Living away from home: With foster parents
Living away from home: In residential nursery
Living away from home: In residential school
Living away from home: Other
Since January, 1968 was any form of contraception used?
1
Yes
2
No
0
Not known
what method was used
1
Pill: Alone
2
Pill: With other method
3
Other methods
0
Not known
How many different brands have been used?
How many

Name(s) of Pills used and period taken

Name Taken from Taken to
Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date Generic dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric date
1
2
3
4
5
6
Name(s) of Pills used and period taken
1
Brands not known
What type of antenatal preparation did the mother receive during this pregnancy? In mothercraft (e.g. care of the baby)
1
None
2
Individual instruction
3
Class instruction: L.H.A. Clinic
4
Class instruction: Hospital
5
Other (specify)
0
Not known
Other
What type of antenatal preparation did the mother receive during this pregnancy? In preparation for labour (e.g. exercises, relaxation, etc.)
1
None
2
Individual instruction
3
Class instruction: L.H.A. Clinic
4
Class instruction: Hospital
5
Other (specify)
0
Not known
Other

Smoking:

Does the mother smoke now?
1
Yes
2
No
0
Not known
did she ever smoke?
1
Yes
2
No
0
Not known
how long ago did she stop? ... Years ... Months
Years Months
How much does/did she smoke? Cigarettes per day
1
1-4
2
5-14
3
15-24
4
25 or more
0
Not known
Has she smoked during this pregnancy?
1
Yes
2
No
0
Not known
Part I was completed by:
1
Interviewing the mother
2
Using records: Hospital
3
Using records: G.P.
4
Using records: Midwife
5
Using records: Co-operation Card
6
Other (specify)
Other

PART II

To be completed from the records or personal communication where necessary.

Previous pregnancies

Date: Month Date: Year Sex Birth Weight - Method of Delivery Record any of the following which occurred : Pre-eclamptic toxaemia, A.P.H., P.P.H., Surgical Induction or a congential abnormalilty of the baby.
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
Generic text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: MonthGeneric textDate: YearGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textDate: YearGeneric textDate: Month

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthDate: YearGeneric textGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: YearDate: MonthGeneric textGeneric textGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Date: MonthGeneric textGeneric textGeneric textDate: YearGeneric textGeneric textDate: MonthGeneric text

1 - Livebirths: Alive Now

2 - Livebirths: Age at Death: Under 7 days

3 - Livebirths: Age at Death: 7 days & over

4 - S.B.

5 - Mis.

6 - Ect.

Generic textDate: Year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Total number of recorded antenatal visits
Number of
Total number of recorded antenatal visits Date of first visit
Generic date
Total number of recorded antenatal Date of last visit
Generic date
Who undertook the antenatal care?
1
Hospital medical staff
2
L.H.A. M.O.
3
G.P.
4
Midwife: Hospital
5
Midwife: G.P. Unit
6
Midwife: Domiciliary
7
Other (specify)
Other
If mother delivered in hospital and the antenatal care shared, was this
1
By previous arrangement
2
Because of some abnormality which arose during pregnancy
3
Some other reason
0
Not known
What was the first day of the last normal menstrual period?
Generic date
Was this date recorded as being
1
Certain
2
Uncertain
0
Not known
Standing height of the mother ... ft. ... ins or ... cms.
ft
ins
cms
Mother's blood group
1
O
2
A
3
B
4
AB
0
Not known
Rh factor
1
Positive
2
Negative
0
Not known
Rh antibodies
1
Present
2
Absent
0
Not known
Were haemoglobin estimations done?
1
Yes
2
No
0
Not known
Number of times estimated
How many
Highest value ... Date ...
Generic text
Generic date
Lowest value ... Date ...
Generic text
Generic date
W.R. or similar test
1
Negative
2
Positive
3
Not done
0
Not known

Blood pressure during antenatal period

Reading Date
Generic textGeneric dateGeneric textGeneric date Generic textGeneric dateGeneric textGeneric date
First (or only)
Highest systolic
Highest diastolic
Last before labour
Blood pressures during antenatal period
1
Not recorded
2
Not known
Was there any non-infective proteinuria?
1
Yes
2
No
0
Not known
Was pitting oedema present?
1
Yes
2
No
0
Not known
Were there any eclamptic fits prior to labour?
1
Yes
2
No
0
Not known
Has the mother clinical diabetes?
1
Yes
2
No
0
Not known
Was there any bleeding from the genital tract after the last period and before the onset of labour?
1
Yes
2
No
0
Not known
Number of bleeds
How many
Date of first (or only) bleed
Generic date
Date of last bleed
Generic date
Cause
1
Placenta Praevia
2
Accidental Haemorrhage (Abruptio Placentae)
3
Threatened Abortion
4
Other (specify)
Generic text
X-rays taken of the mother during pregnancy
1
None
2
Chest
3
Abdomen
4
Pelvis
5
Other (specify)
0
Not known
Other
Did the mother have any inpatient care during the antenatal period (excluding admissions in labour or false labour?)
1
Yes
2
No
0
Not known
Give date(s) of admission(s)
Generic date
Place of admission
1
N.H.S. Consultant Hospital: Consultant bed
2
N.H.S. Consultant Hospital: G.P. bed
3
N.H.S. G.P. Maternity Unit without resident medical officer
4
Private
5
Other (specify)
6
Not known
Other
If discharged prior to labour date(s) of discharge(s)
Generic date
Where was the mother delivered?
1
At home
2
In an N.H.S. Consultant Hospital: Consultant bed
3
In an N.H.S. Consultant Hospital: G.P. bed
4
N.H.S. G.P. Maternity Unit without resident medical officer
5
Private
6
Other (specify)
Other
Was the mother booked for delivery at the place where her confinement occurred?
1
Yes
2
No
0
Not known
give the date of booking
Generic date
Did labour start
1
Spontaneously
2
Induced
0
Not known
what methods were used?
1
Oxytocic Drugs: Intravenous Drip
2
Oxytocic Drugs: Buccal
3
Oxytocic Drugs: Other
4
Artifical rupture of membranes
5
Other (specify)
0
Not known
Other
What was the time interval between the rupture of the membranes and the delivery?
1
Less than 24 hours
2
24-47 hours
3
48 hours or more
0
Not known
Was the birth
1
Single
2
Twin
3
Triplet
4
Other (specify)
Other
(NOTE: A separate form is required for each baby. For babies other than the first complete question 1 (Part I) and then the remainder of the form from this question onward).
Date of birth
Date of birth
Hour of birth
Generic time
What was the outcome of the delivery?
1
Prior to 28 weeks of gestation: Abortion
2
Prior to 28 weeks of gestation: Livebirth
3
28 weeks or more gestation: Stillbirth
4
28 weeks or more gestation: Livebirth
Sex
1
Male
2
Female
0
Not known

Give the length of each stage of labour

Hours Minutes
HoursMinutesHoursMinutes HoursMinutesHoursMinutes
First
Second
Third
During labour did the fetal heart rate
1
Remain between 120 and 160
2
Rise above 160
3
Fall below 120
0
Not known
Other recordings made on the fetus
1
None
2
Fetal E.C.G.
3
Scalp blood sampling
4
Sonar records
5
Other (specify)
Other
Was there passage of meconium?
1
Yes
2
No
0
Not known
Delivery
1
Spontaneous cephalic: anterior
2
Spontaneous cephalic: posterior
3
Spontaneous breech
4
Operative delivery: Forceps: Cephalic
5
Operative delivery: Forceps: With Breech
6
Operative delivery: Forceps: Other (specify)
7
Operative delivery: Caesarean Section
8
Operative delivery: Vacuum Extraction
9
Operative delivery: Other (specify)
0
Other (specify)
Other
Relief of pain during labour
1
Analgesics: Inhalation: Gas/Oxygen
2
Analgesics: Inhalation: Gas/Air
3
Analgesics: Inhalation: Trilene
1
Analgesics: Drugs: Pethidine
2
Analgesics: Drugs: Pethilorfan
3
Analgesics: Drugs: Morphia
4
Analgesics: Drugs: Fortral
1
Psychoprophylaxis
2
Hypnosis
3
Decompression
4
Other (specify)
Other
Anaesthetics during and after labour Before baby born
1
General
2
Caudal
3
Epidural
4
Local
5
Other
Anaesthetics during and after labour After baby born
1
General
2
Caudal
3
Epidural
4
Local
5
Other
Did a postpartum haemorrhage of 500 ml. or more occur?
1
Yes
2
No
0
Not known
Was a blood transfusion given?
1
Yes
2
No
0
Not known
Did the mother have a manual removal of the placenta?
1
Yes
2
No
0
Not known
When was regular respiration established?
1
Less than 1 minute
2
1-3 minutes
3
More than 3 minutes
0
Not known
Administration of oxygen
1
None
2
Face funnel
3
Face mask
4
Nasal tube
5
Endotracheal tube
6
Incubator
7
Other (specify)
0
Not known
Generic text
Other methods of resuscitation
1
None
2
Mouth to mouth resuscitation
3
Mucus extraction
4
Stomach aspiration
5
Other (specify)
0
Not known
Other
Was Vitamin K (e.g. Synkavit, Konakion) given?
1
Yes
2
No
0
Not known
Were eye drops used prophylactically?
1
None
2
Albucid
3
Silver Nitrate
4
Other (specify)
0
Not known
Other
Did the baby have: Lethidrone (Nalorphine)
1
Yes
2
No
0
Not known
Did the baby have: Vanillic Acid (Vandid)
1
Yes
2
No
0
Not known
Other treatments given to baby
1
None
2
Yes (specify)
0
Not known
Other
Birthweight of the baby ... lbs. ... ozs. or ... gm
lbs
ozs
gm
Age of baby when weighed
1
Under 12 hours
2
12-23 hours
3
24-35 hours
4
36 hours or more
0
Not known
Lowest recorded weight of baby ... lbs. ... ozs. or ... gm
lbs
ozs
gm
Date of this weighing
Generic date
Was there an episiotomy or tear?
1
Episiotomy
2
Third degree tear
3
Other tear
4
None
0
Not known
Who undertook the delivery?
1
Midwife: Domiciliary
2
Midwife: Hospital
3
Pupil Midwife
4
Consultant Obstetrician
5
Registrar
6
House Officer
7
G.P.
8
Medical Student
9
Other (specify)
Other
Part II was completed by
1
Using records: Hospital
2
Using records: G.P.
3
Using records: Midwife
4
Using records: Co-operation Card
5
Personal Communication: Hospital Doctor
6
Personal Communication: G.P.
7
Personal Communication: Midwife
8
Other (specify)
Other

PART III

Did the mother have any evidence of eclampsia occuring for the first time in labour or the puerperium?
1
Yes
2
No
0
Not known
During the first seven days after the delivery did the mother: Have any urinary infection?
1
Yes
2
No
0
Not known
During the first seven days after the delivery did the mother: Have any genital tract infection?
1
Yes
2
No
0
Not known
During the first seven days after the delivery did the mother: Have any venous complication of the legs?
1
None
2
In superficial veins
3
In deep veins
0
Not known
During the first seven days after the delivery did the mother: Have any operations in puerperium?
1
None
2
Sterilisation
3
Other (specify)
0
Not known
Other
During the first seven days after the delivery did the mother: Have any other morbidity or illness?
1
No
2
Yes (specify)
0
Not known
Other
During the first seven days after the delivery did the mother: Have a haemoglobin estimation done?
1
Yes
2
No
0
Not known
Was the baby medically examined within the first 24 hours?
1
Yes
2
No
0
Not known
by whom?
1
Consultant Obstetrician
2
Obstetric Registrar
3
Obstetric House Officer
4
Consultant Paediatrician
5
Paediatric Registrar
6
Paediatric House Officer
7
G.P.
8
Other (specify)
0
Not known
Other
Was lactation
1
Attempted
2
Not attempted
0
Not known
Was it
1
Suppressed
2
Not suppressed
0
Not known
was oestrogen used?
1
No
2
Yes (specify type)
0
Not known
Other

What type of feed did the baby have during each of the 24 hour periods after birth?

- Other Specify

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other

1 - None

2 - Water

3 - Sugar solution

4 - Breast Milk

5 - Dried milk: Full Cream

6 - Dried milk: Half Cream

7 - Dried milk: Humanised

8 - Evaporated milk

9 - Other Specify

0 - Not known

Other
1st
2nd
3rd
4th
5th
6th
7th
Congenital Abnormalities of the baby:
1
No abnormality
2
Anencephaly
3
Spina bifida with hydrocephalus
4
Spina bifida without hydrocephalus
5
Hydrocephalus only
6
Cleft lip and/or palate
7
Down's syndrome (Mongolism)
8
Talipes
9
Abnormalities of the hip
1
Extra digits
2
Naevi
3
Other (specify)
Other
What was the lowest recorded rectal temperature?
Generic text
Generic date
1
Less than 24 hours of life
2
24 hours or later
3
Not recorded
Was a low reading thermometer i.e. recording 85 degrees F (30 degrees C) or lower used?
1
Yes
2
No
0
Not known
Was the baby examined for congenital dislocation of the hip?
1
Yes
2
No
0
Not known
Had it been recorded on the case notes?
1
Yes
2
No
0
Not known
Was the baby tested for phenylketonuria?
1
Yes (specify method used)
2
No
0
Not known
Generic text
Generic date
Was the baby jaundiced?
1
Yes: Less than 24 hours of life
2
Yes: 24 hours or later
3
No
0
Not known
Maximum serum bilirubin level ... date
Generic text
Generic date
Cause (if known)
Generic text
Was the baby's blood sugar level taken?
1
Yes
2
No
0
Not known
Was the baby's blood sugar level taken? Minimum level ... date
Generic text
Generic date
Age of baby if less than 24 hours
Generic text
Did the baby develop any breathing difficulties, including respiratory distress syndrome?
1
Yes (specify)
2
No
0
Not known
Other
Did the baby have cyanotic attacks?
1
Yes
2
No
0
Not known
Did the baby have any fits or convulsions?
1
Yes
2
No
0
Not known
Did the baby have any "cerebral" signs?
1
Yes (specify)
2
No
0
Not known
Other
Did the baby have any fractures?
1
Yes (specify)
2
No
0
Not known
Generic text
Did the baby have a cephalhaematoma?
1
Yes
2
No
0
Not known
Did the baby have "sticky" eyes?
1
Yes
2
No
0
Not known
Did the baby have a discharge from the umbilicus?
1
Yes
2
No
0
Not known
Were exchange transfusions given?
1
Yes
2
No
0
Not known
Were any operations performed?
1
Yes (specify)
2
No
0
Not known
Other
Were there any other illnesses or conditions of the baby?
1
Yes
2
No
0
Not known
If the baby was discharged during the first seven days, what was the date of the last medical examination?
Generic date
Examined by
1
Consultant Obstetrician
2
Obstetric Registrar
3
Obstetric House Officer
4
Consultant Paediatrician
5
Paediatric Registrar
6
Paediatric House Officer
7
G.P.
8
Other (specify)
0
Not known
Other

Where was the baby cared for each day?

Date - - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

OtherGeneric date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

Generic date

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Generic date

1 - In a cot

2 - In an incubator

3 - Elsewhere (specify)

1 - By mother's bed: Day and night

2 - By mother's bed: Day only

3 - In a ward nursery

4 - In a special care unit

5 - In a neonatal surgical unit

6 - Elsewhere (specify)

Other
Day of Birth
Days following birth: 1st
Days following birth: 2nd
Days following birth: 3rd
Days following birth: 4th
Days following birth: 5th
Days following birth: 6th
Days following birth: 7th

Where was the mother during the first seven days?

Date - Other (specify)
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Other

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic date

1 - N.H.S. Consultant Hospital: Consultant bed

2 - In an N.H.S. Consultant Hospital: G.P. bed

3 - N.H.S. G.P. Maternity Unit without resident medical officer

4 - Private Maternity Home

5 - Own home or other private household

6 - Other (specify)

Generic dateOther
Day of Birth
Days following birth: 1st
Days following birth: 2nd
Days following birth: 3rd
Days following birth: 4th
Days following birth: 5th
Days following birth: 6th
Days following birth: 7th

If the mother moved who was informed?

- How were they informed? When were they informed? Other (Specify) Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Generic textOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

OtherOtherGeneric text

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

Other

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

Generic text

1 - G.P.

2 - Local Health Department

3 - Midwife: Domiciliary

4 - Midwife: G.P. Unit

6 - Other (Specify)

5 - Hospital or G.P. Unit

OtherOther

1 - Letter

2 - Telephone

3 - Personal Communication

4 - Other (Specify)

First Move
Second Move
Third Move
Part III was completed by:
1
Using records: Hospital
2
Using records: G.P.
3
Using records: Midwife
4
Using records: Co-operation Card
5
Personal Communication: Hospital Doctor
6
Personal Communication: G.P.
7
Personal Communication: Midwife
Name of baby (if known)
Generic text
ANY OTHER RELEVANT INFORMATION:
Long text
WE ARE GRATEFUL FOR THE TIME YOU HAVE GIVEN. THANK YOU FOR YOUR HELP

ABORTIONS, STILLBIRTHS AND NEONATAL DEATHS ONLY

Date of death
Generic date
Was a postmortem performed?
1
Yes
2
No
0
Not known
Cause of death (attach P.M. report if available)
Generic text

STILLBIRTHS AND NEONATAL DEATHS ONLY (For Medical Officer of Health only)

Registered cause of death
Generic text
If full P.M. report or registered cause of death not available: please send copies direct to 'The Secretary, National Birthday Trust Fund, 57 Lower Belgrave Street, London, SW1' as soon as possible
Name

BCS70 Birth Sweep Questionnaire