`Call The Midwife` The Morning-After Analysis: Episode 4

Call the Midwife Episode 4

This is the fourth in a series of guest blog posts by the faculty of the Vanderbilt School of Nursing about the previous night’s episode of Call the Midwife airing on Sundays on NPT and PBS Stations natiowide at 7:00 p.m. Central, September 30-November 4. Check in here every Monday morning for the next six weeks for historical and contemporary context on the show, and some fun discussion.  SPOILER ALERT: Some may contain spoilers, so please be aware of that.

By Michelle Collins PhD, CNM

Michelle CollinsThe first thing that jumped out at me from this week’s episode was this thought; if you are thinking that the parents whose baby was abducted from outside of their flat (or apartment) were partly at fault for “parking” their baby outside in her pram (or baby buggy), let’s talk about that. In that particular time period (1950’s), it was very common for parents to put their baby out of doors in a buggy or playpen (and out of their site) for fresh air. “Sun baths” were recommended daily for Vitamin D with “plenty of fresh air.” As you may have noticed in watching the series, there are plenty of baby buggies lined up outside the doors of the flats.

On to the abductor of the baby. It made me think about pregnancy and loss and post-partum hormonal states, and how all of that can combine for a particular kind of terrible and sometimes violent storm. During the course of a pregnancy, a woman is bombarded with a terrific change in hormones, one being an abundance of estrogen. In fact, you know those tiny birth control pills which contain estrogen? During a single pregnancy, the placenta produces approximately 600 birth control pills worth of estrogen! That much estrogen contributes to the mood changes (as well as some of the other pregnancy symptoms) that pregnant women feel. Once the pregnancy ends, there is no nice and gentle return to the pre-pregnancy hormone state; in fact, once the placenta is delivered, the hormone levels begin a steep decline, which inevitably contributes to the “baby blues” that 80% of new mothers feel in the first few weeks after birth. Women with baby blues may feel overwhelmed and weepy at times, but are generally able to function and take care of themselves and their babies.

On the other hand, up to 10% of all new mothers may get post-partum depression, which is far more serious than baby blues. Women with post-partum depression may not only feel overwhelmed and have periods of tears, but they actually have great difficulty functioning at all. They have trouble sleeping, eating, concentrating, and even going about daily activities. Lastly, about 1 to 2 women per 1,000 develop what is called post-partum psychosis, in which they may actually have hallucinations, paranoia or unfounded suspicions, which may cause them to behave in ways that would be very uncharacteristic for them. You will remember the abductor in this episode believing that the baby she took was her own; she undoubtedly did believe that. Thankfully we know much more now about post-partum depression and psychosis than was known in the 1950’s, but not nearly as much as we would like to know to be able to help women who develop these conditions. The bottom line is that a woman’s family needs to also be on the lookout for symptoms of post-partum depression, and help their partner get the assistance that they need if signs are noted. Women in these states often will not recognize their own plight. Their families must step in and help get the assistance they need.

Michelle Collins PhD, CNM, is an Associate Professor of Nursing, Director Nurse-Midwifery Program, at Vanderbilt University School of Nursing

Missed our analysis of Previous Episodes? Read them here.

Missed Previous Episodes? Watch them online now through December 4.


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