It was a fresh spring evening in London. The capital was quieter than usual, undisturbed by the evening newspaper hawkers who had recently joined their Fleet Street colleagues on a month-long national newspaper strike.
In the west of the city, just a stone’s throw from Buckingham Palace, a Georgian terraced house was to be the setting for a monumental meeting of the nation’s most talented and influential medical minds.
Senior representatives from Britain’s most important medical bodies had been called together to discuss an extremely pressing matter regarding the health and welfare of the nation’s mothers and children. Namely, why were so many babies still dying during their first week of life?
Around a decade before, the charity funders, the National Birthday Trust Fund and Dr James Douglas had masterminded the 1946 birth cohort study, the first-ever national survey of mothers and babies. The evidence generated from this endeavour had informed the design and provision of maternity services introduced as part of the newly formed NHS in 1948.
However, by the mid-1950s almost 30,000 babies were still dying each year during their first seven days of life. The National Birthday Trust Fund, Dr Douglas and the British medical community realised it was now time to launch a new survey to reassess the state of maternity services, the costs of childbirth and the risks of home and hospital delivery.
Before the meeting, Dr Douglas, and an up-and-coming paediatrician based at London’s Great Ormond Street Hospital, Dr Neville Butler had circulated memos to committee members outlining their suggestions for a new national birth survey.
Douglas and Butler’s modest notes would be the focus of the evening’s discussions, helping to lay the foundations for a new birth survey. Little did they know the incredible impact their ideas would have on the lives of so many.
In his proposal, Dr Douglas reminded his colleagues of the legacy of his 1946 study, but humbly suggested that this new survey could help us learn much more. He proposed following the same format as his earlier project by studying all births in England, Wales and Scotland during a single week.
Douglas said:
“It will be remembered that in 1946 a joint committee […] made a national enquiry into the maternity services and the costs of childbirth. This survey took place before the introduction of the NHS and many changes have occurred since then. By repeating the maternity survey in 1956 […] we would have the opportunity to look at changes in analgesia, in the use of antenatal and postnatal services, in breastfeeding and many other aspects of maternity.”
Just as importantly, Douglas hoped to use this new survey to improve our understanding of how women’s socioeconomic circumstances influenced their reproductive rights and health, and their child’s fortunes.
“During the past ten years great social changes have taken place. There has been an increase in the number of married women in employment, housing conditions have improved for many sections of the community and there have been great alterations in prices and wages. It would accordingly be desirable to repeat questions on the costs of childbirth, home environment and on the extent and nature of employment during pregnancy.”
Douglas was keen to get the survey underway as soon as March 1956 and suggested making his Department of Public Health and Social Medicine at the University of Edinburgh the study headquarters. Here, the latest computing technology – Hollerith tabulating machines and punch cards – would be made available for the statistical analysis.
In contrast to Douglas’s measured proposal, Dr Butler was overflowing with exciting but seemingly incongruous ideas that were in various stages of development.
His first plan was to recruit a cohort of mothers early in pregnancy with prospective follow-up surveys to check on different stages of pregnancy, labour and the fate of mother and baby. During the meeting, Dr Butler admitted that this approach would be prohibitively expensive.
His second proposal was no less ambitious. While the 1946 survey had studied 13,600 births, Butler suggested this new study would need 90,000 babies to accurately compare the differences in perinatal foetal mortality between home and hospital delivery.
Butler was keen to tell the committee that he had had fruitful discussions with the Ministry of Health, obstetricians and medical officers of health in England and Wales about this mammoth project, which was due to be launched the previous November.
Although pilot schemes were successfully launched in London, Norfolk and Cambridge, he regretfully informed his colleagues that the full study had been postponed.
However, for Dr Butler there was no time for disappointment. He was eager to strike while the iron was hot to get a new national study underway.
“There is some urgency in proceeding with the survey,” he said, “in order to keep the interest of the large number of authorities who had been willing to cooperate as recently as November 1954”.
With the committee reassured by this support from the British medical establishment, there had still been no discussion about how much the study would cost and if the National Birthday Trust Fund could provide the necessary finances.
All eyes must have then turned to Dr Douglas. Holding court over the committee, he explained that the 1946 survey had cost just over £5,000 (£180,000 in today’s money), so it was likely that a decade on a new study would incur greater expenses.
Then the funders dropped a bombshell: they could only contribute £2,000.
By the conclusion of the meeting the committee had agreed that a new maternity survey was desirable. There was no time to waste. Within a month, Dr Douglas, Dr Butler and the key players in British science would meet again to work out a detailed plan for the survey.
But whose proposal would they decide to follow, and how would they raise the necessary funds?
