British Births Survey (BBS) , 1970
BCS70 began in 1970 when data were collected about the births and families of 17,198 babies born in England, Scotland, Wales and Northern Ireland in a particular week in April. At this time, the study was named the British Births Survey (BBS) and it was sponsored by the National Birthday Trust Fund in association with the Royal College of Obstetricians and Gynaecologists. The aims of the survey were to look at the social and biological characteristics of the mother in relation to nenoatal morbidity, and to compare the results with those of the 1958 National Child Development Study.
Organisation of the survey
It was felt important that the Survey should be as comprehensive as possible and not be confined to patients cared for under the National Health Service. A working party was formed to consider the administration of the Survey.
Wide publicity was given by the professional organisations to all doctors, midwives and nurses working in the maternity services. Articles were published in the midwifery and nursing journals and, following a request by the British Medical Association, the Chief Medical Officers of England, Wales, Scotland and Northern Ireland agreed to write to individual general practitioners asking them to co-operate with the enquiry.
Within the National Health Service the Boards of Governors of Teaching Hospitals and Senior Administrative Medical Officers agreed to co-operate in the enquiry. As a result, all but one of the NHS hospitals in the United Kingdom took part in the Survey.
Only two of the Medical Officers of Health of the major and delegated local health authorities were unable to take part. In one of these areas the Regional Hospital Board kindly arranged to check that all the hospital births were included so that only a small number of domiciliary births would be missed and, despite a staff shortage, the other local health authority arranged for the domiciliary midwives to complete the forms for all the "early discharges" from hospital but was unable to include the few domiciliary births.
In Northern Ireland the Ministry of Health and Social Services appointed a special committee under the chairmanship of Professor Macafee to organise the survey in their area. They conformed to the standard administrative pattern, collecting and checking the completed forms in their department before returning them to the British Births Survey (BBS) so that they could be analysed with the data from the other countries.
The Director-General of Army Medical Services and the Director-General of Medical Services, Royal Air Force arranged for the Service hospitals to take part. (The Royal Navy has no obstetric hospitals). Arrangements were also made by the Prison Medical Service for forms to be completed in the unlikely event of any baby being born in one of their hospitals. Through the National Association for the Unmarried Mother and her Child and the local health authorities the majority of mother and baby homes who undertook the care of mothers during delivery were contacted. Medical Officers of Health also enlisted the help of many of the private maternity homes in their areas. In addition, the wide publicity given by the national press resulted in one or two midwives in private practice writing to ask for forms.
Distribution of Forms
For National Health Service hospitals, the forms were distributed through the Group Secretaries of Hospital Management Committees and the Secretaries of the Boards of Governors in England and Wales, and the Medical Superintendents in Scotland. For domiciliary births the forms were sent to the Medical Officers of Health of the major local health authorities, who usually supplied them to the local mother and baby homes and some of the private maternity homes. The remainder were sent direct from the Survey.
In Northern Ireland the distribution and collection of the questionnaires was undertaken by the Ministry of Health and Social Services.
Each mother was given a letter asking if she would take part in the enquiry, and whether she would answer the questions in the first part of the form. Any mother who did not wish to take part was excluded from the Survey.
Completion of the Forms
Each form was completed by the midwife who had undertaken the delivery, or in some hospitals by a senior midwife. If the mother moved at any time during the first seven days after childbirth to another hospital, to her home or to any other address, she was usually handed the questionnaire in a sealed envelope to be given to the midwife. Sometimes it was sent on direct. Where the mother and baby were cared for in different places, the form was first filled in for the mother and then sent on to the staff caring- for the baby, for completion. In this way information was collected on all events which occurred during the first week of life.
The senior midwives in the hospital and domiciliary services were asked to check that all the questions had been answered before the forms were finally sent to the departments of the Medical Officers of Health. Here, they were matched against the notification of birth returns so that any missing births could be identified.
The questionnaire was in three parts. Part I was normally completed by the midwife in an interview with the mother shortly after the birth. Where there were language difficulties, relatives and friends often helped to interpret. The remainder was completed from the records and from personal experience. Part III related to the first seven days after the birth, some portions being filled in as a diary. For multiple births separate forms were completed for each child.
Period Covered by the Survey
Information was requested on all babies born (alive or dead) after the 24th week of gestation from 00.01 hours on Sunday, 5th April to 24.00 hours on Saturday, 11 April, 1970.
Every attempt has been made to identify the births which were missing from the enquiry. Official statistics of the exact number of children born in any particular week are not available, but as already stated the majority of local authorities matched their returns against the notification of births and were able to identify those missing, in many cases stating the reasons.
It is not possible to state exactly how many births are missing, but reasons why 315 of the babies were not included have been published. An analysis is also given of the missing deaths by cause and social class 3 From these estimates it appears that probably not more than five percent and not less than two percent of the births have been missed. It also appears unlikely that the missing deaths affect the conclusions, except that the death rates among the higher social classes are probably underestimated.