Call the Midwife’s fifth season has more great nursing
The BBC show’s 2016 season again featured nurse midwives providing skilled and usually autonomous care to a range of poor patients in 1960s London–with a clear focus on the hard lives of women in the era.
December 2016 – The BBC’s Call the Midwife has presented another season of skilled technical and psychosocial care from the Nonnatus House nurse midwives. They confronted urgent health issues in early 1960s London and (briefly) at a rural South African clinic, in this month’s holiday special. Every episode featured the midwives’ expert care and advocacy for poor mothers, babies, and families. Examples included strong psychosocial care by head midwife Sister Julienne in helping a mother cope with the devastating effects of Thalidomide; Trixie Franklin’s skilled management of an inverted uterus while calming the distraught teen mother; and Patsy Mount’s impressive work in spotting a typhoid outbreak and helping the carrier remain connected to her family. As usual, the show focused on the difficult road faced by women in that era. In one episode, the midwives dealt with the terrible effects of an unwanted pregnancy out of wedlock. The midwives did on occasion defer too much to physicians, and not all issues were handled ideally. One plotline featured an unduly negative image of a breastfeeding advocate, in this case the often-overbearing midwife Sister Evangelina, with no counterexample. But on the whole, the season again portrayed nurses as serious, autonomous professionals who save lives. The show has been renewed for multiple seasons, so there is much more to come. We thank show creator Heidi Thomas and everyone else responsible for Call the Midwife.
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Under pressure
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One theme in the season that illustrated some aspects of nursing in the early 1960s involved the anti-nausea drug Thalidomide, which caused serious birth complications until its harmful effects became known. In the first episode of the season, nurses Shelagh Turner and Sister Mary Cynthia deliver a baby girl with incompletely formed limbs (phocomelia), although they do not yet know what has caused it. The midwives seem to have some trouble bringing themselves to tell the parents about the child’s condition. But after they do, they provide good psychosocial care and support, helping family members adjust to their new life, particular the father, who at first describes his infant daughter as a “monster.”
The fourth episode finds Sister Julienne doing a temporary stint at St. Cuthbert’s Hospital. One patient there is a mother the Nonnatus midwives know well, but who has to give birth in hospital because her long labor at home is not going well. Sister Julienne is present at the emergency C-section of this mom, but the baby is very ill, with no limbs or genitalia. The regular hospital staff are disgusted by “it” and they leave the baby to die in the cold by an open window. But Julienne holds and prays for the child as it dies, baptizing it. Later she breaks the news of the baby’s death to the mother, deciding to tell her that the baby was a daughter as the mother wanted, and stressing that Julienne held the baby as she died. This is excellent psychosocial care. Meanwhile, the physician Patrick Turner and nurse Shelagh (who are married) discuss what may be causing these birth issues, reviewing the cases they know of, but there is a lack of good information.
In the eighth and last episode of the regular season, Shelagh and Patrick finally learn that the Thalidomide he has been prescribing is likely the cause of the birth issues. Both of them are wracked with guilt; they and the midwives must tell the affected mothers about the drug. Again, these scenes show the nurses to be sensitive caregivers.
Under pressure
In many episodes, the nurse midwives provide not only excellent physical care to mothers and babies but also holistic care for the families, usually in the face of real adversity. One case in the second episode involves a couple having their first baby. In the past the father has done dock work, but he is not getting many shifts any more, spending his days in a pub. Everyone, including his wife, thinks he is just lazy. But after he collapses, it turns out that he has advanced leukemia and he is dying. The mother insists that the midwives induce the birth, even though that is not necessary for maternal or child health reasons, so that the father can meet his son before he dies. The attending midwife Barbara Gilbert, usually pretty meek, advocates strongly for the induction and for the family generally, including with the father’s employer at the dock.
The third episode includes the typhoid plotline, which involves a new mother in a large, close-knit family. It is Patsy who basically diagnoses typhoid. Testing reveals that the carrier is actually the formidable family matriarch, who greets the news by overreacting in her personal hygiene and basically isolating herself. The disease does actually kill one older male relative. But Patsy persuades the matriarch to adopt a more measured approach, finding her a modern flat where she can maintain good hygiene and some distance but remain connected to her family.
In the fifth episode, one plotline involves a young pregnant woman named Roseanne. She lives with her well-off older husband, but she seems very unsure about the birth. When she goes into labor, midwife Phyllis Crane is delayed in arriving. Patsy’s girlfriend Delia, a nurse but not a midwife, coaches the mother through the delivery over the phone, counseling her to get the newborn breathing by rubbing the baby’s back. But Roseanne remains troubled, abandoning the baby because she feels unworthy. It turns out that she grew up in an orphanage herself and was later jailed for prostitution, a life she runs back to. But the midwives track her down, and Phyllis convinces her to return to the baby, relating that Phyllis’s own mother had been abandoned as a child but still made a great mother. Phyllis displays persistence, sensitivity, and a holistic vision.
The main clinical plotline in the sixth episode involves a mother who is only pretending to be pregnant in order to cover up the pregnancy of her unmarried teenage daughter. This interest in concealment extends to declining midwife help. But when the birth approaches and there are complications, including a retained placenta, the grandmother desperately reaches out to the midwives. Trixie and Sister Mary Cynthia arrive to discover that the grandmother has been yanking on the cord, and the daughter is in great pain. Trixie determines that she has pulled the whole womb out with the placenta, causing an inverted uterus. They call for an ambulance, but in the meantime Trixie is a model of calm and strength for the panicked teen. At the same time, Trixie deploys her considerable skills to get the womb back in. Later, at the hospital, Trixie ably counsels the remorseful grandmother, who proceeds to bond with her recovering daughter and baby.
And in the seventh episode, Patsy provides some strong care for a pregnant woman who lives with her family on a barge. They are very independent, if not suspicious, but the mother agrees to let Patsy help with this birth because she is getting older and having a harder time than in the past. The mother goes to the midwives’ regular pregnancy clinic and even accepts bed rest, tests and supplements, and schooling for her kids. But she grows uncomfortable with the outside “interference” and pulls away. Still, when her labor comes during a terrible storm, her daughter gets Patsy, who responds with fine physical and emotional care under difficult conditions.
The show focuses on how hard things are for women. In the third episode, a school teacher accidently becomes pregnant by a married fellow teacher. Sister Winifred, a former teacher herself, helps the woman, though not very warmly, evidently disapproving of her. The best the father can do is give the mother some money for an abortion. The mother’s landlady finds out about the pregnancy and kicks her out, and her employer finds out and fires her. The midwives find the mother a place in a hostel, but in desperation, she tries to abort with a coat-hanger, gravely injuring herself. Winifred feels terrible for judging her and she visits tearfully in the hospital. The teacher survives, but she must move elsewhere. Winifred completes the teacher’s class term.
There are more difficult patient interactions in the second episode. Here a first-time mother is having a lot of trouble breastfeeding. Sister Evangelina insists that she stick with it, to such as an extent that the mother reaches the point of breakdown trying to do so, still without much success. Sister Mary Cynthia is more moderate and eventually rescues the mother and baby from Evangelina’s dangerous extremism, with formula; the baby has become dehydrated. Meanwhile, in other scenes, we see a well-groomed woman dressed in a white lab coat giving a presentation about how great modern infant formula is at the clinic that the midwives and Patrick run for pregnant mothers. Evangelina brands the formula promoters charlatans and advocates that breastfeeding is best. But the episode sets this up as too dogmatic a view, indicating that some women just can’t breastfeed (but not indicating whether that number is more like 2% or 50%). Some of the midwives explicitly accept the formula as a good option. Evangelina is so chastened by the harm she’s caused by being “all mouth” in this case that she leaves for a long stint in a severe religious order. There is no mention of any science to support her view of formula (presumably there is not much yet) and her assistance with lactation is limited. She comes off as a backwards traditionalist resisting science. No one mentions that formula itself undermines breastfeeding. And the nurses could have done a better job of counseling the mother on how to breastfeed. Of course, however problematic the messages about formula may be, viewers will not necessarily think worse of the profession of nursing, because the episode presents most of the nurses as sensibly accepting of formula, and they do end up saving mother and baby.
Some of the season’s portrayals of the nurses’ relation with physicians are also problematic. In the holiday episode, the midwives and Patrick travel to a poor clinic for blacks in South Africa, partly to conduct a polio clinic and partly to take over for a midwife who has died. There they find great need in the shadow of apartheid, as well as a difficult longtime expatriate physician who runs the place assertively, if not dismissively. Not incidentally, she orders the midwives around. No one explicitly says this is out of line. The expat physician appears to be ill in some way, but consistent with the rest of her character, she resists letting anyone explore that problem. Eventually, with great persistence and patience, Shelagh persuades the physician to allow Patrick to examine her. She has liver disease, and after some back and forth about the specific diagnosis, and a draining of an abscess, Patrick manages to pack her off to a hospital for a new drug that may help further. These interactions do have a little too much about how special physicians are.
On the other hand, that leaves the midwives to run the clinic without a physician—and without enough water, because a nearby farmer has been refusing to let the clinic build a water pipe across his land. The farmer holds the expat physician and her clinic responsible for the deaths of his wife and child soon after childbirth years ago. But Sister Julienne persuades him to relent with some great advocacy and psychosocial care, in recognition of his pain. Meanwhile, Trixie performs a C-section! In that case, the mother has had difficulty delivering because of a narrow pelvis, and the midwives determine that she will have a rupture if they do not act soon, even though the physicians have not returned. Julienne, Barbara, and Phyllis all play key roles. This is not to suggest that nurses achieve by doing physician tasks, but they do a great job under serious pressure here. And the rest of the episode has other examples of strong autonomous nursing, including Phyllis delivering a baby basically out in the open, with the mother leaning against a tree, and Barbara providing good psychosocial care to a mother with a phantom pregnancy.
On the whole, Call the Midwife’s fifth season offered more strong, expert nursing care in a variety of settings, and we thank all of those responsible.
Call the Midwife is on PBS. Previous seasons are on Netflix, Amazon Prime, Vudu, YouTube, and iTunes.
Send your thoughts to the show’s creators Heidi Thomas, Pippa Harris, Christopher Aird, Elizabeth Kilgarrif
Mona Qureshi, and Donald Thoms at post@nealstreetproductions.com and please copy us at letters@truthaboutnursing.org. Thank you!
