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:
1 i

Full name of the mother

Generic text
1 ii

Mother's maiden name

Generic text
1 iii

Address of mother's normal place of residence

Generic text
1 iv

County or County Borough

Generic text
1 v

Address where this delivery occurred

Generic text
1 vi

Hospital number

Generic text
2

Date of birth of mother:

Generic date
3 i

Town and Country of birth: Mother of baby

Generic text
3 ii

Town and Country of birth: Father of baby

Generic text
3 iii

Town and Country of birth: Mother's mother

Generic text
4 i

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

Age
4 ii

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

Age
5

Date of present marriage:

Generic date
6

Present marital status:

1
Single
2
Married
3
Widowed
4
Divorced
5
Separated
0
Not known
7
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)
8

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
8 i
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
9

Since January, 1968 was any form of contraception used?

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

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
9 i(a)

How many different brands have been used?

How many
9 i(b)
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
9 i(b)

Name(s) of Pills used and period taken

1
Brands not known
10 a

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
10 b

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:
11 a

Does the mother smoke now?

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

did she ever smoke?

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

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

Years Months
11 d

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
11 e

Has she smoked during this pregnancy?

1
Yes
2
No
0
Not known
12

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.
13
Previous pregnancies

Give details of all previous pregnancies (including miscarriages and ectopics) in the order of occurence (the earliest first)

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
14 i

Total number of recorded antenatal visits

Number of
14 ii

Total number of recorded antenatal visits Date of first visit

Generic date
14 iii

Total number of recorded antenatal Date of last visit

Generic date
14 iv

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
14 v

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
15 i

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

Generic date
15 ii

Was this date recorded as being

1
Certain
2
Uncertain
0
Not known
16

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

ft
ins
cms
17 i

Mother's blood group

1
O
2
A
3
B
4
AB
0
Not known
17 ii

Rh factor

1
Positive
2
Negative
0
Not known
17 iii

Rh antibodies

1
Present
2
Absent
0
Not known
17 iv

Were haemoglobin estimations done?

1
Yes
2
No
0
Not known
If YES:
qc_17_iv == 1
17 iv(a)

Number of times estimated

How many
17 iv(b)

Highest value ... Date ...

Generic text
Generic date
17 iv(c)

Lowest value ... Date ...

Generic text
Generic date
17 v

W.R. or similar test

1
Negative
2
Positive
3
Not done
0
Not known
18 i
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
18 ii

Blood pressures during antenatal period

1
Not recorded
2
Not known
18 iii

Was there any non-infective proteinuria?

1
Yes
2
No
0
Not known
18 iv

Was pitting oedema present?

1
Yes
2
No
0
Not known
18 v

Were there any eclamptic fits prior to labour?

1
Yes
2
No
0
Not known
19

Has the mother clinical diabetes?

1
Yes
2
No
0
Not known
20

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
20 i

Number of bleeds

How many
20 ii

Date of first (or only) bleed

Generic date
20 iii

Date of last bleed

Generic date
20 iv

Cause

1
Placenta Praevia
2
Accidental Haemorrhage (Abruptio Placentae)
3
Threatened Abortion
4
Other (specify)
Generic text
21

X-rays taken of the mother during pregnancy

1
None
2
Chest
3
Abdomen
4
Pelvis
5
Other (specify)
0
Not known
Other
22

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
22 i

Give date(s) of admission(s)

Generic date
22 ii

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
22 iii

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

Generic date
23 i

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
23 ii

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
23 ii(a)

give the date of booking

Generic date
24 i

Did labour start

1
Spontaneously
2
Induced
0
Not known
If INDUCED,
qc_24_i == 2
24 i(a)

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
24 ii

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
25 i

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).
25 ii

Date of birth

Date of birth
25 iii

Hour of birth

Generic time
25 iv

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
25 v

Sex

1
Male
2
Female
0
Not known
26
Give the length of each stage of labour
Hours Minutes
HoursMinutesHoursMinutes HoursMinutesHoursMinutes
First
Second
Third
27 i

During labour did the fetal heart rate

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

Other recordings made on the fetus

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

Was there passage of meconium?

1
Yes
2
No
0
Not known
28

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
29 i

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
29 ii(a)

Anaesthetics during and after labour Before baby born

1
General
2
Caudal
3
Epidural
4
Local
5
Other
29 ii(b)

Anaesthetics during and after labour After baby born

1
General
2
Caudal
3
Epidural
4
Local
5
Other
30 i

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

1
Yes
2
No
0
Not known
30 ii

Was a blood transfusion given?

1
Yes
2
No
0
Not known
30 iii

Did the mother have a manual removal of the placenta?

1
Yes
2
No
0
Not known
31 i

When was regular respiration established?

1
Less than 1 minute
2
1-3 minutes
3
More than 3 minutes
0
Not known
31 i(a)

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
31 i(b)

Other methods of resuscitation

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

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

1
Yes
2
No
0
Not known
31 iii

Were eye drops used prophylactically?

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

Did the baby have: Lethidrone (Nalorphine)

1
Yes
2
No
0
Not known
31 iv(b)

Did the baby have: Vanillic Acid (Vandid)

1
Yes
2
No
0
Not known
31 v

Other treatments given to baby

1
None
2
Yes (specify)
0
Not known
Other
32 i

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

lbs
ozs
gm
32 ii

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
32 iii

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

lbs
ozs
gm
32 iv

Date of this weighing

Generic date
33

Was there an episiotomy or tear?

1
Episiotomy
2
Third degree tear
3
Other tear
4
None
0
Not known
34

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
35

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
36

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
37 i

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

1
Yes
2
No
0
Not known
37 ii

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

1
Yes
2
No
0
Not known
37 iii

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
37 iv

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
37 v

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
37 vi

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

1
Yes
2
No
0
Not known
38

Was the baby medically examined within the first 24 hours?

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

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
39 i

Was lactation

1
Attempted
2
Not attempted
0
Not known
39 ii

Was it

1
Suppressed
2
Not suppressed
0
Not known
If SUPPRESSED,
qc_39_ii == 1
39 ii(a)

was oestrogen used?

1
No
2
Yes (specify type)
0
Not known
Other
40
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
41

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
42 i

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
42 i(a)

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

1
Yes
2
No
0
Not known
42 ii

Was the baby examined for congenital dislocation of the hip?

1
Yes
2
No
0
Not known
42 ii(a)

Had it been recorded on the case notes?

1
Yes
2
No
0
Not known
42 iii

Was the baby tested for phenylketonuria?

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

Was the baby jaundiced?

1
Yes: Less than 24 hours of life
2
Yes: 24 hours or later
3
No
0
Not known
42 iv(a)

Maximum serum bilirubin level ... date

Generic text
Generic date
42 iv(b)

Cause (if known)

Generic text
42 v

Was the baby's blood sugar level taken?

1
Yes
2
No
0
Not known
42 v(a)

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

Generic text
Generic date
42 v(b)

Age of baby if less than 24 hours

Generic text
42 vi

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

1
Yes (specify)
2
No
0
Not known
Other
42 vii

Did the baby have cyanotic attacks?

1
Yes
2
No
0
Not known
42 viii

Did the baby have any fits or convulsions?

1
Yes
2
No
0
Not known
42 ix

Did the baby have any "cerebral" signs?

1
Yes (specify)
2
No
0
Not known
Other
42 x

Did the baby have any fractures?

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

Did the baby have a cephalhaematoma?

1
Yes
2
No
0
Not known
42 xii

Did the baby have "sticky" eyes?

1
Yes
2
No
0
Not known
42 xiii

Did the baby have a discharge from the umbilicus?

1
Yes
2
No
0
Not known
42 xiv

Were exchange transfusions given?

1
Yes
2
No
0
Not known
42 xv

Were any operations performed?

1
Yes (specify)
2
No
0
Not known
Other
42 xvi

Were there any other illnesses or conditions of the baby?

1
Yes
2
No
0
Not known
43

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

Generic date
43 i

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
44
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
45
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
46
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
47

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
48

Name of baby (if known)

Generic text
48 i

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
49 i

Date of death

Generic date
49 ii

Was a postmortem performed?

1
Yes
2
No
0
Not known
49 iii

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

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

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

s_intro_i
A Survey under the joint auspices of the National Birthday Trust Fund and the Royal College of Obstetricians and Gynaecologists
s_intro_ii
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.
s_intro_iii
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.
s_intro_iv
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.
s_intro_v
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.
s_intro_vi
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.
s_intro_vii
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.
s_intro_viii
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

s_part_I_i
With this form there is a letter for the mother. Please hand it to her before starting the questionnaire.
s_part_I_ii
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:

1 i
Full name of the mother
Generic text
1 ii
Mother's maiden name
Generic text
1 iii
Address of mother's normal place of residence
Generic text
1 iv
County or County Borough
Generic text
1 v
Address where this delivery occurred
Generic text
1 vi
Hospital number
Generic text
2
Date of birth of mother:
Generic date
3 i
Town and Country of birth: Mother of baby
Generic text
3 ii
Town and Country of birth: Father of baby
Generic text
3 iii
Town and Country of birth: Mother's mother
Generic text
4 i
Age at which full-time education was completed (including college or university) Mother of baby ... years
Age
4 ii
Age at which full-time education was completed (including college or university) Father of baby ... years
Age
5
Date of present marriage:
Generic date
6
Present marital status:
1
Single
2
Married
3
Widowed
4
Divorced
5
Separated
0
Not known
7

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)
8
Does the mother care for children at home (including adopted and foster children)?
1
Yes
2
No
0
Not known
8 i

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
If YES:
9
Since January, 1968 was any form of contraception used?
1
Yes
2
No
0
Not known
9 i
what method was used
1
Pill: Alone
2
Pill: With other method
3
Other methods
0
Not known
If YES:
9 i(a)
How many different brands have been used?
How many
If YES:
If the Pill was used:
9 i(b)

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
If YES:
If the Pill was used:
9 i(b)
Name(s) of Pills used and period taken
1
Brands not known
If YES:
If the Pill was used:
10 a
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
10 b
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:

11 a
Does the mother smoke now?
1
Yes
2
No
0
Not known
11 b
did she ever smoke?
1
Yes
2
No
0
Not known
If NO to 11a,
11 c
how long ago did she stop? ... Years ... Months
Years Months
If NO to 11a,
If YES to 11b
11 d
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
11 e
Has she smoked during this pregnancy?
1
Yes
2
No
0
Not known
12
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

s_part_II
To be completed from the records or personal communication where necessary.
13

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
14 i
Total number of recorded antenatal visits
Number of
14 ii
Total number of recorded antenatal visits Date of first visit
Generic date
14 iii
Total number of recorded antenatal Date of last visit
Generic date
14 iv
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
14 v
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
15 i
What was the first day of the last normal menstrual period?
Generic date
15 ii
Was this date recorded as being
1
Certain
2
Uncertain
0
Not known
16
Standing height of the mother ... ft. ... ins or ... cms.
ft
ins
cms
17 i
Mother's blood group
1
O
2
A
3
B
4
AB
0
Not known
17 ii
Rh factor
1
Positive
2
Negative
0
Not known
17 iii
Rh antibodies
1
Present
2
Absent
0
Not known
17 iv
Were haemoglobin estimations done?
1
Yes
2
No
0
Not known
17 iv(a)
Number of times estimated
How many
If YES:
17 iv(b)
Highest value ... Date ...
Generic text
Generic date
If YES:
17 iv(c)
Lowest value ... Date ...
Generic text
Generic date
If YES:
17 v
W.R. or similar test
1
Negative
2
Positive
3
Not done
0
Not known
18 i

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
18 ii
Blood pressures during antenatal period
1
Not recorded
2
Not known
18 iii
Was there any non-infective proteinuria?
1
Yes
2
No
0
Not known
18 iv
Was pitting oedema present?
1
Yes
2
No
0
Not known
18 v
Were there any eclamptic fits prior to labour?
1
Yes
2
No
0
Not known
19
Has the mother clinical diabetes?
1
Yes
2
No
0
Not known
20
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
20 i
Number of bleeds
How many
If YES:
20 ii
Date of first (or only) bleed
Generic date
If YES:
20 iii
Date of last bleed
Generic date
If YES:
20 iv
Cause
1
Placenta Praevia
2
Accidental Haemorrhage (Abruptio Placentae)
3
Threatened Abortion
4
Other (specify)
Generic text
If YES:
21
X-rays taken of the mother during pregnancy
1
None
2
Chest
3
Abdomen
4
Pelvis
5
Other (specify)
0
Not known
Other
22
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
22 i
Give date(s) of admission(s)
Generic date
If YES:
22 ii
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 YES:
22 iii
If discharged prior to labour date(s) of discharge(s)
Generic date
If YES:
23 i
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
23 ii
Was the mother booked for delivery at the place where her confinement occurred?
1
Yes
2
No
0
Not known
23 ii(a)
give the date of booking
Generic date
If YES,
24 i
Did labour start
1
Spontaneously
2
Induced
0
Not known
24 i(a)
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
If INDUCED,
24 ii
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
25 i
Was the birth
1
Single
2
Twin
3
Triplet
4
Other (specify)
Other
s_q25
(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).
25 ii
Date of birth
Date of birth
25 iii
Hour of birth
Generic time
25 iv
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
25 v
Sex
1
Male
2
Female
0
Not known
26

Give the length of each stage of labour

Hours Minutes
HoursMinutesHoursMinutes HoursMinutesHoursMinutes
First
Second
Third
27 i
During labour did the fetal heart rate
1
Remain between 120 and 160
2
Rise above 160
3
Fall below 120
0
Not known
27 ii
Other recordings made on the fetus
1
None
2
Fetal E.C.G.
3
Scalp blood sampling
4
Sonar records
5
Other (specify)
Other
27 iii
Was there passage of meconium?
1
Yes
2
No
0
Not known
28
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
29 i
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
29 ii(a)
Anaesthetics during and after labour Before baby born
1
General
2
Caudal
3
Epidural
4
Local
5
Other
29 ii(b)
Anaesthetics during and after labour After baby born
1
General
2
Caudal
3
Epidural
4
Local
5
Other
30 i
Did a postpartum haemorrhage of 500 ml. or more occur?
1
Yes
2
No
0
Not known
30 ii
Was a blood transfusion given?
1
Yes
2
No
0
Not known
30 iii
Did the mother have a manual removal of the placenta?
1
Yes
2
No
0
Not known
31 i
When was regular respiration established?
1
Less than 1 minute
2
1-3 minutes
3
More than 3 minutes
0
Not known
31 i(a)
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
31 i(b)
Other methods of resuscitation
1
None
2
Mouth to mouth resuscitation
3
Mucus extraction
4
Stomach aspiration
5
Other (specify)
0
Not known
Other
31 ii
Was Vitamin K (e.g. Synkavit, Konakion) given?
1
Yes
2
No
0
Not known
31 iii
Were eye drops used prophylactically?
1
None
2
Albucid
3
Silver Nitrate
4
Other (specify)
0
Not known
Other
31 iv(a)
Did the baby have: Lethidrone (Nalorphine)
1
Yes
2
No
0
Not known
31 iv(b)
Did the baby have: Vanillic Acid (Vandid)
1
Yes
2
No
0
Not known
31 v
Other treatments given to baby
1
None
2
Yes (specify)
0
Not known
Other
32 i
Birthweight of the baby ... lbs. ... ozs. or ... gm
lbs
ozs
gm
32 ii
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
32 iii
Lowest recorded weight of baby ... lbs. ... ozs. or ... gm
lbs
ozs
gm
32 iv
Date of this weighing
Generic date
33
Was there an episiotomy or tear?
1
Episiotomy
2
Third degree tear
3
Other tear
4
None
0
Not known
34
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
35
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

36
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
37 i
During the first seven days after the delivery did the mother: Have any urinary infection?
1
Yes
2
No
0
Not known
37 ii
During the first seven days after the delivery did the mother: Have any genital tract infection?
1
Yes
2
No
0
Not known
37 iii
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
37 iv
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
37 v
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
37 vi
During the first seven days after the delivery did the mother: Have a haemoglobin estimation done?
1
Yes
2
No
0
Not known
38
Was the baby medically examined within the first 24 hours?
1
Yes
2
No
0
Not known
38 i
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
If YES,
39 i
Was lactation
1
Attempted
2
Not attempted
0
Not known
39 ii
Was it
1
Suppressed
2
Not suppressed
0
Not known
39 ii(a)
was oestrogen used?
1
No
2
Yes (specify type)
0
Not known
Other
If SUPPRESSED,
40

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
41
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
42 i
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
42 i(a)
Was a low reading thermometer i.e. recording 85 degrees F (30 degrees C) or lower used?
1
Yes
2
No
0
Not known
42 ii
Was the baby examined for congenital dislocation of the hip?
1
Yes
2
No
0
Not known
42 ii(a)
Had it been recorded on the case notes?
1
Yes
2
No
0
Not known
42 iii
Was the baby tested for phenylketonuria?
1
Yes (specify method used)
2
No
0
Not known
Generic text
Generic date
42 iv
Was the baby jaundiced?
1
Yes: Less than 24 hours of life
2
Yes: 24 hours or later
3
No
0
Not known
42 iv(a)
Maximum serum bilirubin level ... date
Generic text
Generic date
42 iv(b)
Cause (if known)
Generic text
42 v
Was the baby's blood sugar level taken?
1
Yes
2
No
0
Not known
42 v(a)
Was the baby's blood sugar level taken? Minimum level ... date
Generic text
Generic date
42 v(b)
Age of baby if less than 24 hours
Generic text
42 vi
Did the baby develop any breathing difficulties, including respiratory distress syndrome?
1
Yes (specify)
2
No
0
Not known
Other
42 vii
Did the baby have cyanotic attacks?
1
Yes
2
No
0
Not known
42 viii
Did the baby have any fits or convulsions?
1
Yes
2
No
0
Not known
42 ix
Did the baby have any "cerebral" signs?
1
Yes (specify)
2
No
0
Not known
Other
42 x
Did the baby have any fractures?
1
Yes (specify)
2
No
0
Not known
Generic text
42 xi
Did the baby have a cephalhaematoma?
1
Yes
2
No
0
Not known
42 xii
Did the baby have "sticky" eyes?
1
Yes
2
No
0
Not known
42 xiii
Did the baby have a discharge from the umbilicus?
1
Yes
2
No
0
Not known
42 xiv
Were exchange transfusions given?
1
Yes
2
No
0
Not known
42 xv
Were any operations performed?
1
Yes (specify)
2
No
0
Not known
Other
42 xvi
Were there any other illnesses or conditions of the baby?
1
Yes
2
No
0
Not known
43
If the baby was discharged during the first seven days, what was the date of the last medical examination?
Generic date
43 i
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
44

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
45

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
46

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
47
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
48
Name of baby (if known)
Generic text
48 i
ANY OTHER RELEVANT INFORMATION:
Long text
s_q48i
WE ARE GRATEFUL FOR THE TIME YOU HAVE GIVEN. THANK YOU FOR YOUR HELP

ABORTIONS, STILLBIRTHS AND NEONATAL DEATHS ONLY

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

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

49 iv
Registered cause of death
Generic text
s_q49
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