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The BBC's Call the Midwife offers more great care from 1950s nurse midwives

 
December 29, 2013 -- The second season of the BBC drama Call the Midwife, capped off by the Christmas special that aired tonight in the United States, featured more portrayals of skilled, autonomous nurse midwives caring for a poor community in late 1950's London. The 8-episode regular season was broadcast in the U.S. on PBS between March and May 2013. It included several notable examples of the nurses' work, which ranged from skilled birthing to managing community-wide issues, with a good deal of spirited patient advocacy. In one April episode, the midwives cared effectively for a pregnant woman whose twin sister favored traditional remedies and was very hostile to the midwives' modern health practice for most of the episode. In that same episode, nurse Jenny Lee was temporarily assigned to an understaffed local hospital, where a bullying surgeon showed disdain for her operating room skills. Yet Jenny caught a nearly fatal error by that same surgeon, who had failed to run a test that would have enabled proper diagnosis of a patient. And Jenny later informed her receptive nurse manager that the surgeon might have neurological issues, which seemed to be confirmed after the surgeon apparently removed himself from practice. In an early May episode, Sister Bernadette joined physician colleague Patrick Turner in advocating persuasively before a local health authority for X-ray equipment for much-needed community tuberculosis screenings. And in the May season finale, nurse Chummy astutely diagnosed pre-eclampsia in a woman who was not even her patient, allowing a healthy birth. The show's nurse characters occasionally display undue deference to physicians, but we have no reason to doubt the accuracy of those scenes given the time period involved. In fact, the show probably has the best overall portrayal of nursing autonomy of any major health-related series shown in the United States in recent years. So far, Call the Midwife has avoided suggestions that the nurses report to physicians. Instead, the junior nurses report to senior ones, and for the most part, they provide skilled care on their own in the community. The show was created by Heidi Thomas, who wrote some of this season's episodes, and based on a memoir by Jennifer Worth.

In the third episode of the season, broadcast in the U.S. on April 14, 2013, several of the midwives care for a pregnant woman named Maeve who seems to be inseparable from her ornery twin sister Meg; they even appear to share a husband. Meg (right) invokes traditional remedies and is extremely hostile to modern health care, perhaps in part because her own mother died in late-in-life childbirth giving birth to her and her sister. It is a struggle for the midwives even to get Maeve to accept their care. But eventually they push through the resistance and, collaborating with the kind but strong physician Turner, manage to deliver Maeve's twins safely despite some serious complications with the second baby. In doing so, the midwives provide skilled physical and psychosocial care, and in the end they even seem to reconcile the difficult Meg to their work.

Meanwhile, in this same episode, Jenny is temporarily assigned to a short-staffed London Hospital. There she meets an arrogant surgeon named Tracey (right), who abuses the nurses. He shows disdain for Jenny's own tentative operating room skills, and he also appears to be the major reason one of Jenny's nurse colleagues is leaving nursing. The show makes pretty clear that Tracey has too much power, and he seems to operate with impunity.. But Jenny soon notices that Tracey makes serious errors, including at least one critical one:  He has failed to properly diagnose a serious condition affecting Jenny's former quasi-boyfriend Jimmy, nearly resulting in his death. Jimmy will survive after an emergency operation. Jenny has also noticed that Tracey seems to have a tremor. She goes to her senior sister (nurse manager) about him, explaining that she believes Tracey may have a neurological condition that is endangering patients. The manager says that the surgeon has just removed himself from practice in order to determine what is causing his apparent condition. And the manager expresses appreciation for Jenny's skills and advocacy, noting that she would be glad to have Jenny back at the hospital in the future. Overall this is a good demonstration of Jenny's nursing skills and her patient advocacy, which are on display in her focus on both Jimmy's condition and the surgeon's condition. And the depiction of her reporting to a seemingly strong nurse manager is also a helpful indication of nursing autonomy, however unfortunate the surgeon's apparent impunity is. Given the context, it may be unrealistic to expect Jenny to push back strongly against the powerful surgeon's abuse, although the character might resisted a bit more.

The season's sixth episode, broadcast on May 5, highlights the devastating effects that tuberculosis has had on the poor London community the nurse midwives serve. In one scene, the very bright Sister Bernadette and physician Turner appear side-by-side before a local decision-making body, successfully urging them to obtain X-ray equipment so there can be a mass screening of the community to try to stem the disease. Sister Bernadette is young, but her advocacy is strong and articulate. It seems to startle those assembled, and it is a rare, albeit brief, example of effective public health advocacy by a nurse character in a popular television drama.

The seventh episode, which aired on May 12, also finds the lay midwives advocating forcefully, in different contexts. In one plotline, nurse Cynthia Miller is caring for John Lacey, an abusive man with diabetes who resists their care and who verbally abuses his wife Annie. The midwives give Lacey insulin injections, which is itself a challenge; in an early visit, the reliably tough Sister Evangelina basically gives him one over his protestations. But the midwives also urge Lacey to control the disease with his diet. And eventually, Cynthia can no longer watch his abuse of his wife. She defends Annie strongly before John, and, it appears, helps inspire Annie to stand up to him. Meanwhile, Jenny is caring for a pregnant Caribbean immigrant named Monique, who is subject to racial discrimination by other mothers in the neighborhood. When one tells Jenny that she should check on the pregnant white women first, Jenny tells her off and goes on providing equally good care to Monique. In both plotlines, the midwives are thinking holistically and advocating for people whose health or general wellbeing are threatened by abuse.

In the second season finale, broadcast on May 19, nurse Chummy (a.k.a. Camilla Cholomondley-Browne) and her police officer husband have their own baby, under the expert care of the midwives, at least until Chummy has a placental abruption and is rushed to the hospital. But before all that, Chummy observes that Dolly, the pregnant daughter of the midwives' caretaker Fred, has swollen ankles. Acting on her own, Chummy takes a urine sample and ultimately diagnoses pre-eclampsia--using test tubes and everything! The baby is delivered without incident. This is a great example of skilled and autonomous care by a nurse midwife.

And in the 2013 Christmas special, nurses Jenny and Trixie independently care for and deliver the baby of the young Yvonne Bridges, who is very close to her husband Alan. The midwives eventually realize that Alan has been deeply affected by his prior service in the Korean War, and he appears to have what we might now call post-traumatic stress disorder. The midwives, thinking holistically as ever, try to provide emotional support to Alan, and they argue for him to be able to attend his wife's delivery, which was not the usual thing in the late 1950s. In fact, the young midwives meet some resistance from the senior midwives, but the all-wise Sister Julienne eventually allows it, and it seems to really help the young couple, whose baby is healthy.

Meanwhile, after a long internal struggle, Sister Bernadette has decided to give up the religious life and marry the kind Patrick Turner, or "Dr. Turner," as she seems to still call him, at least in front of others. And they do finally marry in this episode. We might be skeptical of such a plotline, which could reinforce the idea that nurses are just looking to marry physicians. But this plotline is about as far from that stereotype as you could get. Sister Bernadette--now back to her birth name Shelagh--has always been a committed, positive, supremely competent midwife and administrator, the one who seemed destined to succeed Sister Julienne as head of Nonnatus House. Sister Bernadette's turn away from her vows and toward Turner was so slow and hard for her that there is little doubt that it was the result of a deep mutual love.

On the whole, the second season of Call the Midwife continued to present nurse midwives as skilled health professionals and tough patient advocates trying to help a troubled community, with considerable success.

Send your thoughts about Call the Midwife to the creators!

Contact executive producers Heidi Thomas and Pippa Harris at post@nealstreetproductions.com and please copy us at letters@truthaboutnursing.org so we can hear your thougts too. Thank you!