A girl in trouble is a temporary thing

Call the Midwife returns to PBS tonight

Call the Midwife Jenny birthingMarch 29, 2015 — Tonight the BBC drama Call the Midwife begins airing its fourth season on PBS, as the show enters the 1960s. Last year’s third season featured more great scenes of nursing autonomy and skill, and it’s worth reviewing those. The show’s nurse characters continued to deliver babies and provide a range of effective care in their London neighborhood. Several plotlines in the third season find the midwives struggling mightily to help pregnant women who are in desperate straits, even by the standards of their poor community. They include prison inmates, unwed mothers, and women who face severe mental challenges. This season is the last one for lead character Jenny Lee, who will move on to hospice care. But new major character Patsy Mount is a highly competent and tenacious midwife. In fact, in the sixth episode, Patsy goes well beyond the call of duty to diagnose and treat a case of roundworm that has lain dormant in a World War II veteran for 16 years. Call the Midwife Sister Monica Joan with books researching cystic fibrosisAnd in the season premiere Sister Monica Joan, a veteran midwife with some symptoms of dementia, diagnoses a case of cystic fibrosis that had everyone else stumped. Sometimes, in order to ensure the health of a new baby, the midwives must address critical health issues in family members–which are great examples of nursing’s holistic focus. In the seventh episode, Sister Julienne and Cynthia Miller care for a new mother with a post-natal psychosis that makes her paranoid and increasingly unstable. The midwives manage to save the baby from harm, and while the mother ends up in an institution where she gets electroshock therapy, that seems to moves her closer to being reunited with her baby and husband. The season also includes some very dated examples of nurses deferring to physicians–as well as a lot of tobacco smoking by health workers in clinical settings–but we like to think the show is simply presenting those elements as signs of the time rather than endorsing them. We thank show creator Heidi Thomas and her colleagues. See all the episodes free online here!

What will she do for love?

Doctor thinks

Transitional endeavors

What will she do for love?

The season includes many portrayals of the midwives’ expertise and their substantial contributions to the community’s health. In the first episode, Jenny cares for a woman whose baby is failing to thrive. But the cause is elusive, and everyone including the physician Turner is stumped. Shelagh Call the MidwifeEventually it is none other than the Sister Monica Joan who realizes that the baby has symptoms she has seen before. She gives Turner an old book documenting a similar case, and he explains that the baby seems to have what is now called cystic fibrosis. In the fifth episode, Sister Julienne decides to take leave as a result of exhaustion. She asks Shelagh Turner to temporarily take her place in managing the midwives. In fact, the gifted Shelagh had always seemed destined to take over. But now that she has married Turner, it appears she is no longer able to be a midwife, although she does seem to play some administrative role at the midwives’ clinic (right). Shelagh does well managing difficult issues, notably Sister Evangelina’s jubilee, marking her 50 years in religious life. Evangelina resists this attention, partly because she is trying to keep a low profile since her long-absent alcoholic brother has reappeared and is staying nearby. She evidently fears he will come to the event and cause problems. But with help from Constable Noakes, Chummy’s husband, Evangelina manages some reconciliation with her brother. Sister Evangelina and Constable Noakes Call the MidwifeAnd the jubilee celebration itself features a series of touching thank yous to the no-nonsense Evangelina from the many members of Poplar she has delivered over the years. In the holiday special airing on PBS at the end of 2014, the midwives have occasion to transfer several unwed pregnant patients to a home to which they are consigned pre- and post-birth. This facility is run, badly, by a nasty, alcohol abusing matron. After a tough young expecting mother blows the whistle, the matron flees. Patsy and Chummy temporarily take over the facility, providing holiday cheer and high quality care. They expertly manage the whistle-blower’s birth, which includes a compound presentation (arm first), and Chummy persuades her, with great effort, to bond with her baby.

Patsy with WW II veteranThe midwives also display some tenacious patient advocacy. In the third episode, Sister Julienne and Trixie Franklin take over for a group of midwives who normally care for pregnant prisoners. Their main patient is a woman who has actually invented a fiancé to try to persuade prison authorities to let her keep her baby when she is released. That does not work, and even with all her experience and authority, Julienne struggles to help the woman. The midwives do manage to deliver her boy healthy and help her learn to read. Finally, Julienne finds a place for mother and baby. In the fifth episode, Cynthia and Chummy care for a pregnant patient with Down’s syndrome who lives in an institution with the baby’s father, her boyfriend. The episode shows the prejudices of the time, and the couple is split up after the baby is stillborn. Still, the nurses, especially Cynthia, push for more enlightened care. In the sixth episode, the very competent if somewhat brusque Patsy detects roundworm in a World War II veteran who contracted the condition while serving in the Pacific 16 years earlier. Patsy makes a difficult journey to get the right treatment for this patient, driven partly by her own awful experience in the war, during which she was raised in a kind of prisoner of war camp and lost her family. Call the Midwife patient thinking about throwing baby in waterIn the seventh episode, Julienne and Cynthia try to help a new mother who is overtaken by a post-natal psychosis that makes her paranoid and increasingly unstable. The midwives push through her resistance and save the baby from harm, barely–they persuade the mother to hand the baby over after she has taken the infant out on a dock that does not seem safe for a baby. The mother ends up in an institution where she gets electroshock therapy. But the mother then seems to improve, and the show suggests that she is on the road to being reunited with husband and baby.

Doctor thinks

The season also includes some interesting nurse-physician interactions. In the first episode, Turner arranges for the midwives to get a new location for their weekly clinic and to get it for two days a week, which he says will allow them to do more patient education. This might be interpreted as a physician directing nurses to educate patients, and Sister Evangelina’s apparent resentment at being given more to do doesn’t exactly help. Call the Midwife Trixie, Patsy and Cynthia riding bikesBut Jenny and Cynthia soon make positive, well-informed comments about the importance of educating patients that should make clear enough that this is not just a physician idea. In the second episode, Cynthia develops an interest in the work of a relaxation therapy expert who seems to be a physician. Cynthia even arranges for him to come speak to a class of her pregnant patients, later leading a class herself. And before long Cynthia is called upon to put these theories into practice in a very difficult birth, with a baby who presents in breech position. The mother, whose own mother has recently died, panics. But Cynthia manages the situation, over the course of hours, ultimately winning over even the skeptical Sister Evangelina. There is some irony in an apparent physician character teaching midwives about holistic birthing techniques, but even so, Cynthia shows real clinical expertise and autonomy. In the holiday special, Cynthia cares for a mentally-challenged couple. The woman thinks she is pregnant, but it turns out to be menopause. Years earlier, when she was institutionalized and had a brain operation (presumably a lobotomy), the surgeon also eliminated her ability to have children, or so Turner speculates based on her scarring. Cynthia delivers all of this bad news to the patient and her companion, and she does so in an impressively sensitive and articulate way. But Cynthia repeatedly prefaces her statements with the phrase “doctor thinks,” as if she was unable to come up with any of it herself or her views don’t matter, while Turner stands by. This seems to point up nursing’s tradition of self-effacement and the excessive deference accorded to physicians; whether most viewers will see it that way is unclear.

Call the Midwife Sister EvangelinaThere are other scenes that we hope are conscious efforts to illustrate, but not endorse, the state of health care in the late 1950s. In a clinic scene in the fourth episode, we see Turner inform Jenny that there is no ashtray in his office. Jenny assures him, without irony, that she will get one right away. Yikes. Of course the show creators know that the smoking element would be outrageous in modern settings, and we hope that the scene conveys that the handmaiden treatment would be equally inappropriate today. In the seventh episode, Jenny returns from a leave of absence she has taken following the death of her fiancé. She starts with a stint at a hospital maternity ward, where nurses seem completely beholden to a set of rules designed to keep order regardless of their bad effects on patients. For example, Jenny can’t continue to see a patient after her shift is over, can’t visit her later, and can’t show the patient the patient’s own baby for a certain length of time, for no apparent good reason. Not surprisingly, these seemingly arbitrary rules are enforced by a proto-battleaxe nurse manager. Perhaps this is not an unrealistic vision of some of the hospital care of the day. Jenny concludes that her place is back in Poplar with the midwives.

Transitional endeavors

Call the MidwifeBut not for long. In the eighth episode, the now-expert Jenny handles her last midwifery patients, including one with a retained placenta. But Jenny reveals that she has become intrigued by the nascent hospice care ideas of Cicely Saunders. She will be leaving midwifery to pursue work in that field. This is an appropriate move for an ambitious nurse of the day, and in fact the show might have made more explicit that Saunders was a nurse, physician, and internationally-recognized palliative care pioneer. (Jenny’s move actually suggests the same link between midwifery and palliative care, both endeavors to help patients through key life transitions, that was made in a December 2013 piece in The Atlantic called “Midwives for the Dying.”) In the holiday special, a retired Jenny looks back sentimentally on her days as a midwife. This is her last episode. In other new directions, Cynthia decides to continue her midwifery–as a nun.

The new season of Call the Midwife will begin airing in the United States on March 29, 2015. See all episodes of Call the Midwife for free online here.

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