Start
nshd_46_tcs
STRICTLY CONFIDENTIAL
MATERNITY SURVEY
ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS AND THE POPULATION INVESTIGATION COMMITTEE
TELL THE MOTHER:-
1. That thousands of mothers all over the country are being asked these questions.
2. That by giving details as to how much it has cost her to have this baby and to clothe it, she will be helping us to work out ways in which the medical and other expenses of bearing children may be lightened.
3. That all information she gives wilt be regarded as absolutely confidential.
HOW TO FILL IN THIS FORM.
1. The questions are printed in light type and the mothers' answers in small capitals. Instructions to the interviewer are in italics.
2. The answers to the questions are shown by putting a ring with a soft pencil round the code number or letter opposite the mother's answer. If the answer does not fit any alternative, write it below the question itself. When comments or opinions are asked for, as far as possible write down the mother's own words. If the mother refuses _to answer any question put a ring round "X" for "No answer."
3. Before you interview the mother, read through the questionnaire and answer as many questions as possible from your records and those of the midwife and sanitary department. However, check all answers you have obtained from the records with the mother when you interview her.
4. It will probably be most convenient to make an appointment with the mother for this interview. If she refuses to be interviewed, try to find out her reasons and write them in the space provided. Then fill in as much of the questionnaire as you can from the records, the essential items to obtain being the mother's age (6), number of children (15), whether she attended for ante-natal care (19), where she was confined (22), and occupation of her husband (48).
IT IS AS IMPORTANT FOR US TO GET BACK REFUSALS AS COMPLETED QUESTIONNAIRES, SO PLEASE DO NOT DESTROY REFUSALS BUT RETURN THEM TO US.
5. Please follow the order of the questions as set out in the questionnaire and keep as close to the phrasing as you can. When any question does not apply to a particular mother, do not ask her it. In such cases do NOT ring "X" for "No answer,'' but STRIKE RIGHT THROUGH THE QUESTION.
6. When interviewing a mother whose baby was still-born or has died since birth, use your own judgment in leaving out any questions that might embarrass her.
7. In filling in the cost questions, please do not bracket items together, but enter costs separately opposite each item.
8. Before leaving the mother, please check through the questionnaire to see that all relevant questions have been answered.
9. When you have completed this questionnaire, do NOT send it to London, but hand it, with any others you may have, by May 10th, to whoever has been delegated by your Medical Officer of Health to receive them.
QUESTIONNAIRE

Mother's Name

Generic text

Address

Generic text

If she has transferred since delivery to another M. and C.W Authority, what is her present address?

Generic text

If mother is not interviewed because she refused, was ill, etc., give reasons

Generic text
Ring with a soft pencil the code number opposite the mother's answer.
Details of this Birth
(To be filled in by Health Visitor, if possible, before interview.)

Date of present baby's birth

Date of birth

Date of birth of last baby (whether alive or dead) preceding this one.

Date of birth
0
NO OLDER CHILD

Result (If baby died, at what age did he die?) DIED AGED ... DAYS

1
BABY LIVING
2
STILL-BORN
Age in days

Sex.

1
MALE
2
FEMALE
3
TWINS (BOTH MALE)
4
TWINS (BOTH FEMALE)
5
TWINS (DIFFERENT SEX)

Legitimate or illegitimate.

1
LEGITIMATE
2
ILLEGITIMATE
The Mother and her Work

Mother's age ... YEARS ... MONTHS

Age
Months

What was the last school or other place of education you attended?

1
ELEMENTARY
2
PRIVATE, SECONDARY OR PUBLIC
3
TECHNICAL OR OTHER COLLEGE
4
UNIVERSITY
*
OTHER, NAMELY
X
NO ANSWER
Other

Were you working when you started this baby?

1
YES
2
NO
X
NO ANSWER
If yes,
qc_8_a == 1

was it a whole or a part-time job?

1
WHOLE-TIME
2
PART-TIME
X
NO ANSWER
Ask working mothers.
qc_8_a == 1

What was your occupation at the time you started this baby?

Generic text

How many weeks before baby came did you stop working? ... WEEKS

How many
YY
DOESN'T KNOW
XX
NO ANSWER

Were you given leave of absence from work because this baby was coming?

1
YES
2
NO
X
NO ANSWER
If "Yes,"
qc_11_a == 1

was it with full pay, part pay, or no pay at all?

1
FULL PAY
2
PART PAY
3
UNPAID
X
NO ANSWER
If you had leave of absence,
qc_11_a == 1

how many weeks in all were you given? ... WEEKS

How many
XX
NO ANSWER

Do you intend to return to work?

1
YES
2
NO
3
UNCERTAIN
X
NO ANSWER
Ask mothers who intend to return to work.
qc_13 == 1

In how many months after the birth of your baby do you intend to return to work? ... MONTHS

How many
YY
UNCERTAIN
XX
NO ANSWER
This Mother's Children
(Include this baby - exclude miscarriages and adopted or step-children.)
Ask all mothers.

Number of children born to this mother who are still alive and under five years old?

How many

Number of children born to this mother who are still alive and five years or older?

How many

Number of children born alive to this mother who have since died?

How many

Number of children still-born to this mother?

How many

Total number of children (alive and dead) born to this mother?

How many
Care of this Baby

Baby's weight at birth. If twins, give weight of each separately. Please check weight from records.) ... POUNDS ... OUNCES

Pounds
Ounces in pound
YY
UNCERTAIN
XX
NO ANSWER

How are you feeding baby?

1
BREAST ONLY
2
BREAST AND BOTTLE
3
BOTTLE ONLY
X
NO ANSWER
Ask mothers who are wholly or partly bottle feeding their babies.
qc_17 == 2 || qc_17 == 3

How old was this baby when you started bottle feeding him? ... DAYS

Age in days
YY
UNCERTAIN
XX
NO ANSWER
Pregnancy and Childbirth
Ask all mothers.

Who gave you ante-natal care and advice?

0
NOBODY AT ALL
1
HOSPITAL ANTE-NATAL CLINIC
2
OTHER ANTE-NATAL CLINIC
3
MUNICIPAL MIDWIFE AT HER OR MOTHER'S HOME
4
PRIVATE MIDWIFE
5
DOCTOR BY ARRANGEMENT WITH LOCAL AUTHORITY
6
OWN PRIVATE DOCTOR
7
OBSTETRIC SPECIALIST
*
OTHER
X
NO ANSWER
Other

How many weeks before baby was born did you first go to a doctor, midwife, or clinic. ... WEEKS

How many
YY
UNCERTAIN
XX
NO ANSWER

How many times did you attend for ante-natal care or advice:- During the first seven months of pregnancy?

How many

How many times did you attend for ante-natal care or advice:- During the last two months of pregnancy?

How many

How many times did you attend for ante-natal care or advice:- Total number of attendances during pregnancy?

How many

Where was this baby born?

1
Domiciliary. OWN HOME
2
Domiciliary. OTHER HOME
3
Institutional. MUNICIPAL MATERNITY HOME
4
Institutional. EMERGENCY MATERNITY HOME
5
Institutional. HOSPITAL (PUBLIC WARD)
6
Institutional. HOSPITAL (PRIVATE WARD)
7
Institutional. HOSPITAL (EMERGENCY CASE)
8
Institutional. PRIVATE NURSING HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
Ask mothers delivered in any institution, including nursing home.
qc_22 != 1 || qc_22 != 2 || qc_22 != X

How many days before the baby was born were you admitted to the hospital or nursing home? ... DAYS

How many
YY
UNCERTAIN
XX
NO ANSWER
Ask all mothers.

Were you given anything during childbirth to relieve the pain?

1
YES
2
NO
Y
DOESN'T KNOW
X
NO ANSWER
If "No",
qc_24_a == 2

was anything offered to you?

1
YES
2
NO
Y
DOESN'T KNOW
X
NO ANSWER
Ask mothers given or offered anything to relieve pain.
qc_24_a == 1 || qc_24_b == 1

What were you given or offered? (Health visitors please check if possible.)

1
GAS AND AIR
2
CHLOROFORM
3
GAS AND AIR, AND CHLOROFORM
*
OTHER, NAMELY
Y
DOESN'T KNOW
X
NO ANSWER
Other
Ask mothers delivered in any institution, including nursing home.
qc_22 > 2 && qc_22 < 9

How many days after baby was born did you leave the hospital or nursing home? ... DAYS

99
NOT LEFT YET
XX
NO ANSWER
How many
Ask all mothers.

How many days after baby was born did you start doing a full day's work in the house again? ... DAYS

99
NOT STARTED YET
XX
NO ANSWER
How many
Help in the House and Care of the Children
Ask married mothers only.
qc_5 == 1

Who looked after your husband while you were in bed with this baby?

1
LOOKED AFTER HIMSELF
2
RELATIONS OR FRIENDS
3
CHILDREN
4
MUNICIPAL HOME HELP
5
HUSBAND AWAY FROM HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
Ask mothers with older children.
qc_15_i > '0' || qc_15_ii > '0'

Who looked after your other children while you were in bed with this baby?

1
OLD ENOUGH TO LOOK AFTER THEMSELVES
2
RELATIONS OR FRIENDS
3
HUSBAND
4
MUNICIPAL HOME HELP
5
CHILDREN AWAY FROM HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
Ask all mothers.

Did you have any paid or unpaid help in the house including relations or friends during the last 13 weeks of pregnancy?

1
YES, TAKEN ON SPECIALLY
2
YES, AS ORDINARILY
3
NO
X
NO ANSWER
Ask mothers helped in the house during last 13 weeks of pregnancy.
qc_30 == 1 || qc_30 == 2

For how many weeks were you helped? ... WEEKS

How many
99
ALL THE TIME
YY
UNCERTAIN
XX
NO ANSWER

For how many hours each week were you helped? ... HOURS EACH WEEK

99
HELP LIVED IN
YY
UNCERTAIN
XX
NO ANSWER
Hours in week
Ask all mothers.

Have you had any paid or unpaid help in the house - including relations and friends - since baby was born?

1
YES, TAKEN ON SPECIALLY
2
YES, AS ORDINARILY
3
NO
X
NO ANSWER
Ask mothers helped in the house since baby was born.
qc_33 == 1 || qc_33 == 2

For how many weeks were you helped? ... WEEKS

How many
99
STILL BEING HELPED
YY
UNCERTAIN
XX
NO ANSWER

For how many hours each week were you helped? ... HOURS EACH WEEK

How many
99
HELP LIVED IN
YY
UNCERTAIN
XX
NO ANSWER
Ask all mothers receiving help during last 13 weeks of pregnancy and/or since baby was born.
qc_30 == 1 || qc_30 == 2 || qc_33 == 1 || qc_33 == 2

Who helped you with the housework?

1
RELATIONS OR FRIENDS
2
HUSBAND
3
MUNICIPAL HOME HELP
4
DOMESTIC LIVING IN
5
DAILY HELP OR CHARWOMAN
*
OTHER, NAMELY
X
NO ANSWER
Other
Ask all mothers.

If you have another baby, would you like a municipal home help to assist with the housework?

1
YES
2
NO
3
DOESN'T WANT ANOTHER BABY
Y
DOESN'T KNOW
X
NO ANSWER
If not,
qc_37_a == 2

why not?

Generic text
Ask mothers with older children.
qc_15_i > '0' || qc_15_ii > '0'

Have you sent your children to a day-nursery?

1
YES
2
NO
X
NO ANSWER
Ask all mothers.

Will you send this baby to a day-nursery, assuming that one is available?

1
YES
2
NO
3
UNCERTAIN
X
NO ANSWER
Extra Nourishment during Pregnancy

Were you able to get your full extra ration of a pint of milk a day?

1
YES
2
NO
X
NO ANSWER
If not,
qc_40_a == 2

why not?

Generic text

Were you able to get your full allocation of orange juice? (1 bottle every 9-12 days)

1
YES
2
NO
X
NO ANSWER
If not,
qc_41_a == 2

why not?

Generic text

Did you get your full allocation of cod liver oil or vitamins? (Bottle or packet every six weeks.)

1
COD LIVER OIL
2
VITAMINS
3
NEITHER
X
NO ANSWER
If neither,
qc_42_a == 3

why not?

Generic text
The House and those who live in it

How many bedrooms and living rooms (excluding kitchen and scullery) are there in the part of this dwelling occupied by your household (including relations and lodgers living with you)?

How many
How many people are there living with you in these rooms?
NUMBER
How many
THIS MOTHER, FATHER, AND THEIR CHILDREN?
RELATIONS AND FRIENDS?
LODGERS AND DOMESTICS?
TOTAL IN HOUSEHOLD?
Maternity Benefits, etc.
(Please do not bracket items together, but enter benefits separately opposite each item.)
How much did you receive from:-
POUNDS SHILLINGS
PoundsShillingsPoundsShillings PoundsShillingsPoundsShillings
HUSBAND'S NATIONAL HEALTH INSURANCE MATERNITY BENEFIT
WIFE'S NATIONAL HEALTH INSURANCE MATERNITY BENEFIT
N.H.I. SICK BENEFIT DURING PREGNANCY
MOTHER'S PAY DURING LEAVE OF ABSENCE FROM WORK ON ACCOUNT OF PREGNANCY
OTHER MATERNITY GRANTS, BENEFITS, AND LUMP SUMS, INCLUDING SERVICE PRE-NATAL ALLOWANCE
TOTAL BENEFITS AND ALLOWANCES
The Cost of Pregnancy
(All costs and fees is the total due from the mother after assessment and before deduction of maternity benefit or other statutory contribution to the cost. Please do not bracket items together, but enter costs separately opposite each item.)
In connection with this baby coming, what did you pay to:-
POUNDS SHILLINGS
PoundsShillingsPoundsShillings PoundsShillingsPoundsShillings
MIDWIFE
DOCTOR
HOSPITAL OR NURSING HOME
INCLUSIVE PAYMENT OF DOCTOR, MIDWIFE, AND INSTITUTION IF NOT KNOWN SEPARATELY
NURSE RESIDENT IN THE HOME
AMBULANCE OR CAR TO HOSPITAL
EXTRA HELP IN THE HOUSE
TOTAL OF ABOVE ITEMS
EXTRA LAUNDRY
CHEMISTS BILLS
STERILISED OUTFIT
ANAESTHETICS AND ANAESTHETIST
TOTAL OF ABOVE 4 ITEMS
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?
Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Napkins
Vests
Petticoats
Nightgowns
Dresses
Knickers or pilches
Matinee coats
Pairs of bootees
Pairs of leggings
Pairs of gloves
Bonnets
Shawls
Rubber sheets
Covers, blankets and mattresses for pram and cot

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on above items ... POUNDS ... SHILLINGS

How many
How many 2
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?
Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Smocks
Skirts and dresses specially bought because of pregnancy
Nightdresses ditto
Coats ditto
Dressing gown ditto
Corsets and brassiere ditto
Knickers ditto

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on maternity garments ... POUNDS ... SHILLINGS

How many
How many 2
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?
Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Pram
Cot
Baby's bath
Carry cot

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on prams, etc. ... POUNDS ... SHILLINGS

How many
How many 2
Occupation of Father
(If husband is temporarily in the Forces, retired, unemployed or dead, these answers should refer to his previous occupation. All these questions relate only to mother's present husband).
Ask married mothers.
qc_5 == 1

What does your husband do?

Generic text

In what trade or industry does he work?

Generic text

Is he:-

1
AN EMPLOYER OF TEN OR MORE PEOPLE
2
WORKING FOR HIMSELF OR EMPLOYING LESS THAN TEN PEOPLE
3
EMPLOYED AND EARNING A MONTHLY SALARY
4
EMPLOYED AND EARNING A WEEKLY WAGE
X
NO ANSWER

If your husband is not an employer or working for himself, what is his employer's business?

Generic text

Date of interview

Generic date

Time taken for interview ... minutes

How many
End

nshd_46_tcs

STRICTLY CONFIDENTIAL
MATERNITY SURVEY
ROYAL COLLEGE OF OBSTETRICIANS & GYNAECOLOGISTS AND THE POPULATION INVESTIGATION COMMITTEE
TELL THE MOTHER:-
1. That thousands of mothers all over the country are being asked these questions.
2. That by giving details as to how much it has cost her to have this baby and to clothe it, she will be helping us to work out ways in which the medical and other expenses of bearing children may be lightened.
3. That all information she gives wilt be regarded as absolutely confidential.
HOW TO FILL IN THIS FORM.
1. The questions are printed in light type and the mothers' answers in small capitals. Instructions to the interviewer are in italics.
2. The answers to the questions are shown by putting a ring with a soft pencil round the code number or letter opposite the mother's answer. If the answer does not fit any alternative, write it below the question itself. When comments or opinions are asked for, as far as possible write down the mother's own words. If the mother refuses _to answer any question put a ring round "X" for "No answer."
3. Before you interview the mother, read through the questionnaire and answer as many questions as possible from your records and those of the midwife and sanitary department. However, check all answers you have obtained from the records with the mother when you interview her.
4. It will probably be most convenient to make an appointment with the mother for this interview. If she refuses to be interviewed, try to find out her reasons and write them in the space provided. Then fill in as much of the questionnaire as you can from the records, the essential items to obtain being the mother's age (6), number of children (15), whether she attended for ante-natal care (19), where she was confined (22), and occupation of her husband (48).
IT IS AS IMPORTANT FOR US TO GET BACK REFUSALS AS COMPLETED QUESTIONNAIRES, SO PLEASE DO NOT DESTROY REFUSALS BUT RETURN THEM TO US.
5. Please follow the order of the questions as set out in the questionnaire and keep as close to the phrasing as you can. When any question does not apply to a particular mother, do not ask her it. In such cases do NOT ring "X" for "No answer,'' but STRIKE RIGHT THROUGH THE QUESTION.
6. When interviewing a mother whose baby was still-born or has died since birth, use your own judgment in leaving out any questions that might embarrass her.
7. In filling in the cost questions, please do not bracket items together, but enter costs separately opposite each item.
8. Before leaving the mother, please check through the questionnaire to see that all relevant questions have been answered.
9. When you have completed this questionnaire, do NOT send it to London, but hand it, with any others you may have, by May 10th, to whoever has been delegated by your Medical Officer of Health to receive them.
QUESTIONNAIRE
Mother's Name
Generic text
Address
Generic text
If she has transferred since delivery to another M. and C.W Authority, what is her present address?
Generic text
If mother is not interviewed because she refused, was ill, etc., give reasons
Generic text
Ring with a soft pencil the code number opposite the mother's answer.

Details of this Birth

(To be filled in by Health Visitor, if possible, before interview.)
Date of present baby's birth
Date of birth
Date of birth of last baby (whether alive or dead) preceding this one.
Date of birth
0
NO OLDER CHILD
Result (If baby died, at what age did he die?) DIED AGED ... DAYS
1
BABY LIVING
2
STILL-BORN
Age in days
Sex.
1
MALE
2
FEMALE
3
TWINS (BOTH MALE)
4
TWINS (BOTH FEMALE)
5
TWINS (DIFFERENT SEX)
Legitimate or illegitimate.
1
LEGITIMATE
2
ILLEGITIMATE

The Mother and her Work

Mother's age ... YEARS ... MONTHS
Age
Months
What was the last school or other place of education you attended?
1
ELEMENTARY
2
PRIVATE, SECONDARY OR PUBLIC
3
TECHNICAL OR OTHER COLLEGE
4
UNIVERSITY
*
OTHER, NAMELY
X
NO ANSWER
Other
Were you working when you started this baby?
1
YES
2
NO
X
NO ANSWER
was it a whole or a part-time job?
1
WHOLE-TIME
2
PART-TIME
X
NO ANSWER
What was your occupation at the time you started this baby?
Generic text
How many weeks before baby came did you stop working? ... WEEKS
How many
YY
DOESN'T KNOW
XX
NO ANSWER
Were you given leave of absence from work because this baby was coming?
1
YES
2
NO
X
NO ANSWER
was it with full pay, part pay, or no pay at all?
1
FULL PAY
2
PART PAY
3
UNPAID
X
NO ANSWER
how many weeks in all were you given? ... WEEKS
How many
XX
NO ANSWER
Do you intend to return to work?
1
YES
2
NO
3
UNCERTAIN
X
NO ANSWER
In how many months after the birth of your baby do you intend to return to work? ... MONTHS
How many
YY
UNCERTAIN
XX
NO ANSWER

This Mother's Children

(Include this baby - exclude miscarriages and adopted or step-children.)
Number of children born to this mother who are still alive and under five years old?
How many
Number of children born to this mother who are still alive and five years or older?
How many
Number of children born alive to this mother who have since died?
How many
Number of children still-born to this mother?
How many
Total number of children (alive and dead) born to this mother?
How many

Care of this Baby

Baby's weight at birth. If twins, give weight of each separately. Please check weight from records.) ... POUNDS ... OUNCES
Pounds
Ounces in pound
YY
UNCERTAIN
XX
NO ANSWER
How are you feeding baby?
1
BREAST ONLY
2
BREAST AND BOTTLE
3
BOTTLE ONLY
X
NO ANSWER
How old was this baby when you started bottle feeding him? ... DAYS
Age in days
YY
UNCERTAIN
XX
NO ANSWER

Pregnancy and Childbirth

Who gave you ante-natal care and advice?
0
NOBODY AT ALL
1
HOSPITAL ANTE-NATAL CLINIC
2
OTHER ANTE-NATAL CLINIC
3
MUNICIPAL MIDWIFE AT HER OR MOTHER'S HOME
4
PRIVATE MIDWIFE
5
DOCTOR BY ARRANGEMENT WITH LOCAL AUTHORITY
6
OWN PRIVATE DOCTOR
7
OBSTETRIC SPECIALIST
*
OTHER
X
NO ANSWER
Other
How many weeks before baby was born did you first go to a doctor, midwife, or clinic. ... WEEKS
How many
YY
UNCERTAIN
XX
NO ANSWER
How many times did you attend for ante-natal care or advice:- During the first seven months of pregnancy?
How many
How many times did you attend for ante-natal care or advice:- During the last two months of pregnancy?
How many
How many times did you attend for ante-natal care or advice:- Total number of attendances during pregnancy?
How many
Where was this baby born?
1
Domiciliary. OWN HOME
2
Domiciliary. OTHER HOME
3
Institutional. MUNICIPAL MATERNITY HOME
4
Institutional. EMERGENCY MATERNITY HOME
5
Institutional. HOSPITAL (PUBLIC WARD)
6
Institutional. HOSPITAL (PRIVATE WARD)
7
Institutional. HOSPITAL (EMERGENCY CASE)
8
Institutional. PRIVATE NURSING HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
How many days before the baby was born were you admitted to the hospital or nursing home? ... DAYS
How many
YY
UNCERTAIN
XX
NO ANSWER
Were you given anything during childbirth to relieve the pain?
1
YES
2
NO
Y
DOESN'T KNOW
X
NO ANSWER
was anything offered to you?
1
YES
2
NO
Y
DOESN'T KNOW
X
NO ANSWER
What were you given or offered? (Health visitors please check if possible.)
1
GAS AND AIR
2
CHLOROFORM
3
GAS AND AIR, AND CHLOROFORM
*
OTHER, NAMELY
Y
DOESN'T KNOW
X
NO ANSWER
Other
How many days after baby was born did you leave the hospital or nursing home? ... DAYS
99
NOT LEFT YET
XX
NO ANSWER
How many
How many days after baby was born did you start doing a full day's work in the house again? ... DAYS
99
NOT STARTED YET
XX
NO ANSWER
How many

Help in the House and Care of the Children

Who looked after your husband while you were in bed with this baby?
1
LOOKED AFTER HIMSELF
2
RELATIONS OR FRIENDS
3
CHILDREN
4
MUNICIPAL HOME HELP
5
HUSBAND AWAY FROM HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
Who looked after your other children while you were in bed with this baby?
1
OLD ENOUGH TO LOOK AFTER THEMSELVES
2
RELATIONS OR FRIENDS
3
HUSBAND
4
MUNICIPAL HOME HELP
5
CHILDREN AWAY FROM HOME
*
OTHER, NAMELY
X
NO ANSWER
Other
Did you have any paid or unpaid help in the house including relations or friends during the last 13 weeks of pregnancy?
1
YES, TAKEN ON SPECIALLY
2
YES, AS ORDINARILY
3
NO
X
NO ANSWER
For how many weeks were you helped? ... WEEKS
How many
99
ALL THE TIME
YY
UNCERTAIN
XX
NO ANSWER
For how many hours each week were you helped? ... HOURS EACH WEEK
99
HELP LIVED IN
YY
UNCERTAIN
XX
NO ANSWER
Hours in week
Have you had any paid or unpaid help in the house - including relations and friends - since baby was born?
1
YES, TAKEN ON SPECIALLY
2
YES, AS ORDINARILY
3
NO
X
NO ANSWER
For how many weeks were you helped? ... WEEKS
How many
99
STILL BEING HELPED
YY
UNCERTAIN
XX
NO ANSWER
For how many hours each week were you helped? ... HOURS EACH WEEK
How many
99
HELP LIVED IN
YY
UNCERTAIN
XX
NO ANSWER
Who helped you with the housework?
1
RELATIONS OR FRIENDS
2
HUSBAND
3
MUNICIPAL HOME HELP
4
DOMESTIC LIVING IN
5
DAILY HELP OR CHARWOMAN
*
OTHER, NAMELY
X
NO ANSWER
Other
If you have another baby, would you like a municipal home help to assist with the housework?
1
YES
2
NO
3
DOESN'T WANT ANOTHER BABY
Y
DOESN'T KNOW
X
NO ANSWER
why not?
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Have you sent your children to a day-nursery?
1
YES
2
NO
X
NO ANSWER
Will you send this baby to a day-nursery, assuming that one is available?
1
YES
2
NO
3
UNCERTAIN
X
NO ANSWER

Extra Nourishment during Pregnancy

Were you able to get your full extra ration of a pint of milk a day?
1
YES
2
NO
X
NO ANSWER
why not?
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Were you able to get your full allocation of orange juice? (1 bottle every 9-12 days)
1
YES
2
NO
X
NO ANSWER
why not?
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Did you get your full allocation of cod liver oil or vitamins? (Bottle or packet every six weeks.)
1
COD LIVER OIL
2
VITAMINS
3
NEITHER
X
NO ANSWER
why not?
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The House and those who live in it

How many bedrooms and living rooms (excluding kitchen and scullery) are there in the part of this dwelling occupied by your household (including relations and lodgers living with you)?
How many

How many people are there living with you in these rooms?

NUMBER
How many
THIS MOTHER, FATHER, AND THEIR CHILDREN?
RELATIONS AND FRIENDS?
LODGERS AND DOMESTICS?
TOTAL IN HOUSEHOLD?

Maternity Benefits, etc.

(Please do not bracket items together, but enter benefits separately opposite each item.)

How much did you receive from:-

POUNDS SHILLINGS
PoundsShillingsPoundsShillings PoundsShillingsPoundsShillings
HUSBAND'S NATIONAL HEALTH INSURANCE MATERNITY BENEFIT
WIFE'S NATIONAL HEALTH INSURANCE MATERNITY BENEFIT
N.H.I. SICK BENEFIT DURING PREGNANCY
MOTHER'S PAY DURING LEAVE OF ABSENCE FROM WORK ON ACCOUNT OF PREGNANCY
OTHER MATERNITY GRANTS, BENEFITS, AND LUMP SUMS, INCLUDING SERVICE PRE-NATAL ALLOWANCE
TOTAL BENEFITS AND ALLOWANCES

The Cost of Pregnancy

(All costs and fees is the total due from the mother after assessment and before deduction of maternity benefit or other statutory contribution to the cost. Please do not bracket items together, but enter costs separately opposite each item.)

In connection with this baby coming, what did you pay to:-

POUNDS SHILLINGS
PoundsShillingsPoundsShillings PoundsShillingsPoundsShillings
MIDWIFE
DOCTOR
HOSPITAL OR NURSING HOME
INCLUSIVE PAYMENT OF DOCTOR, MIDWIFE, AND INSTITUTION IF NOT KNOWN SEPARATELY
NURSE RESIDENT IN THE HOME
AMBULANCE OR CAR TO HOSPITAL
EXTRA HELP IN THE HOUSE
TOTAL OF ABOVE ITEMS
EXTRA LAUNDRY
CHEMISTS BILLS
STERILISED OUTFIT
ANAESTHETICS AND ANAESTHETIST
TOTAL OF ABOVE 4 ITEMS

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?

Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Napkins
Vests
Petticoats
Nightgowns
Dresses
Knickers or pilches
Matinee coats
Pairs of bootees
Pairs of leggings
Pairs of gloves
Bonnets
Shawls
Rubber sheets
Covers, blankets and mattresses for pram and cot
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on above items ... POUNDS ... SHILLINGS
How many
How many 2

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?

Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Smocks
Skirts and dresses specially bought because of pregnancy
Nightdresses ditto
Coats ditto
Dressing gown ditto
Corsets and brassiere ditto
Knickers ditto
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on maternity garments ... POUNDS ... SHILLINGS
How many
How many 2

How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy?

Total Number Owned Cost of items bought and made during this pregnancy: POUNDS Cost of items bought and made during this pregnancy: SHILLINGS
PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds PoundsHow manyShillingsPoundsHow manyShillingsHow manyShillingsPounds
Pram
Cot
Baby's bath
Carry cot
How many of the following baby clothes, maternity garments, and other articles do you own? What was the cost of those bought and made during this pregnancy? Total amount spent during this pregnancy on prams, etc. ... POUNDS ... SHILLINGS
How many
How many 2

Occupation of Father

(If husband is temporarily in the Forces, retired, unemployed or dead, these answers should refer to his previous occupation. All these questions relate only to mother's present husband).
What does your husband do?
Generic text
In what trade or industry does he work?
Generic text
Is he:-
1
AN EMPLOYER OF TEN OR MORE PEOPLE
2
WORKING FOR HIMSELF OR EMPLOYING LESS THAN TEN PEOPLE
3
EMPLOYED AND EARNING A MONTHLY SALARY
4
EMPLOYED AND EARNING A WEEKLY WAGE
X
NO ANSWER
If your husband is not an employer or working for himself, what is his employer's business?
Generic text
Date of interview
Generic date
Time taken for interview ... minutes
How many