Start
























Ask married women only.
qc_5 == 1

If "Yes,"
qc_9_a == 1
Ask working mothers only.
qc_9_a == 1
If "Yes,"
qc_12_a == 1
If you had leave of absence,
qc_12_a == 1
Ask mothers who intend to return to work.
qc_14 == 1






If "Yes,"
qc_23_a == 1
Ask mothers who did not attend an ante-natal clinic (even if they had other ante-natal care)
qc_24_iii == '0'


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
If "No,"
qc_28_a == 2
Ask mothers delivered in any institution, including nursing home.
qc_26_b != 1 || qc_26_b != 2 || qc_26_b != X
Ask all mothers admitted more than three days before baby was born.
qc_30 > '3 days'

Who actually delivered you baby?
If "No,"
qc_34_a == 2
Ask mothers given or offered anything to relieve pain.
qc_34_a == 1 || qc_34_b == 1


Ask mothers delivered in any institution, including nursing home.
qc_26_b != 1 || qc_26_b != 1 || qc_26_b != X

If "No,"
qc_40_a == 2
If "No,"
qc_41_a == 2
Ask mothers who do not intend to take baby to baby clinic.
qc_41_a == 2 && qc_41_b == 2




Ask married mothers.
qc_5 == 1
If your husband is not an employer, or working for himself
qc_45_c == 1 || qc_45_c == 2
End
nshd_46_tms
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 (16), whether she attended for ante-natal care (21), where she was confined (26), and occupation of her husband (45).
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 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 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
Mother's age at (first) marriage ... YEARS ... MONTHS
Age
Months
Ask married women only.
Ask all mothers.
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
If "Yes,"
What was your occupation at the time you started this baby?
Generic text
Ask working mothers only.
How many weeks before baby came did you stop working? ... WEEKS
How many
YY
DOESN'T KNOW
XX
NO ANSWER
Ask working mothers only.
Were you given leave of absence from work because this baby was coming?
1
YES
2
NO
X
NO ANSWER
Ask working mothers only.
was it with full pay, part pay, or no pay at all?
1
FULL PAY
2
PART PAY
3
UNPAID
X
NO ANSWER
Ask working mothers only.
If "Yes,"
how many weeks in all were you given? ... WEEKS
How many
XX
NO ANSWER
Ask working mothers only.
If you had leave of absence,
Do you intend to return to work?
1
YES
2
NO
Y
UNCERTAIN
X
NO ANSWER
Ask working mothers only.
In how many months after the birth of your baby do you intend to return to work? ... MONTHS
How many
YY
UNCERTAIN
X
NO ANSWER
Ask working mothers only.
Ask mothers who intend to return to work.
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
The 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? ... DAYS
Age in days
YY
UNCERTAIN
XX
NO ANSWER
Ask mothers who are wholly or partly bottle feeding their babies.
Why are you wholly or partly bottle feeding him?
Generic text
Ask mothers who are wholly or partly bottle feeding their babies.
Ante-Natal Care.
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
Have you had any difficulties in the care of yourself and your baby which you feel could have been avoided if you had been able to have more ante-natal advice?
1
YES
2
NO
X
NO ANSWER
give details (Write in exactly what the mother says)
Generic text
If "Yes,"
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
What were your reasons for not attending an ante-natal clinic? (Write in exactly what the mother says.)
Generic text
Ask mothers who did not attend an ante-natal clinic (even if they had other ante-natal care)
The Confinement.
Ask all mothers.
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
Why did you have your baby there? (Write in exactly what the mother says)
Generic text
If you have another baby would you like to have him in the same place as this one?
1
YES
2
NO
3
DOESN'T WANT ANOTHER BABY
Y
UNCERTAIN
X
NO ANSWER
where would you like to have him?
1
OWN HOME
2
OTHER HOME
3
HOSPITAL
4
PRIVATE NURSING HOME
*
OTHER
Y
UNCERTAIN
X
NO ANSWER
Other
If "No,"
How long before baby was born did you book your bed? ... WEEKS
How many
YY
UNCERTAIN
XX
NO ANSWER
Ask mothers delivered in any institution, including nursing home.
How many days before the baby was born were you admitted? ... DAYS
How many
YY
UNCERTAIN
XX
NO ANSWER
Ask mothers delivered in any institution, including nursing home.
Why were you admitted more than three days before baby was born?
Generic text
Ask mothers delivered in any institution, including nursing home.
Ask all mothers admitted more than three days before baby was born.
Ask all mothers.
Who was in charge of your confinement?
1
OBSTETRIC SPECIALIST
2
HOSPITAL DOCTOR (NOT SPECIALIST)
3
OWN DOCTOR BY PREVIOUS ARRANGEMENT
4
DOCTOR CALLED IN FOR EMERGENCY
5
MUNICIPAL MIDWIFE
6
PRIVATE MIDWIFE
*
OTHER PERSON, NAMELY
X
NO ANSWER
Other
Who actually delivered you baby?
0
BORN BEFORE ATTENDANT ARRIVED
1
OBSTETRIC SPECIALIST
2
HOSPITAL DOCTOR (NOT SPECIALIST)
3
OWN DOCTOR BY PREVIOUS ARRANGEMENT
4
DOCTOR CALLED IN FOR EMERGENCY
5
MEDICAL STUDENT
6
MUNICIPAL MIDWIFE
7
PRIVATE MIDWIFE
8
PUPIL MIDWIFE
*
OTHER PERSON, NAMELY
Y
DOESN'T KNOW
X
NO ANSWER
Other
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
If "No,"
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 given or offered anything to relieve pain.
Ask all mothers.
Do you think that anything more could have been done to make your delivery or confinement more satisfactory? If so, give details. (Write in exactly what the mother says)
Generic text
Getting Up, etc.
How many days after baby was born were you able to get up and dress? ... DAYS
99
NOT UP YET
XX
NO ANSWER
How many
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 mothers delivered in any institution, including nursing home.
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
Have you been examined by a doctor since your baby was born?
1
YES
2
NO
X
NO ANSWER
have you made arrangements to be examined?
1
YES
2
NO
X
NO ANSWER
If "No,"
Are you taking your baby to a baby clinic?
1
YES
2
NO
X
NO ANSWER
have you made arrangements to take him to one?
1
YES
2
NO
X
NO ANSWER
If "No,"
What are your reasons for not intending to take baby to a baby clinic? (Write in exactly what the mother says)
Generic text
Ask mothers who do not intend to take baby to baby clinic.
The House and those who live in it.
Ask all mothers.
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? |
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
Ask married mothers.
In what trade or industry does he work?
Generic text
Ask married mothers.
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 OR OTHER WAGE
X
NO ANSWER
Ask married mothers.
If your husband is not an employer, or working for himself, what is his employer's business?
Generic text
Ask married mothers.
Date of interview
Generic date
Time taken for interview ... minutes
How many
Name
1946 The Maternity Services Study
External Instrument Location