‘Call the Midwife` Recaps: Season 3: Episode 7: Rare Scenarios

For the third season in-a-row, we are honored to have the faculty of the Vanderbilt School of Nursing back to guest blog for us each Monday morning about the previous night’s episode of Call the Midwife, airing on Sundays on NPT and PBS Stations nationwide at 7:00 p.m. Central, March 30-May 18. Check in here every Monday morning for the next eight weeks for historical and contemporary context on the show, and some fun discussion. Plus, this year we’ll have the occasional bonus blog from across the pond to get the British perspective. So be sure to check the blog TWICE on Mondays. SPOILER ALERT: Some posts may contain spoilers, so please be aware of that.

By Michelle Collins PhD, CNM

Picture a group of screenwriters sitting around a table and one says “for this episode, let’s include some really RARE things that happen in childbirth…” Guessing this had to have been the case with this week’s episode because three rare events that occur in relation to childbirth were featured. The first was referred to as a “mermaid’s birth” – in which the baby was born with the amniotic sac intact, (“en caul” as it is commonly known). Legend has it that carrying a piece of the amniotic sac, or caul, is a sort of good luck charm, and a protection to the carrier against drowning. For this reason, pieces of the caul were once highly sought by sailors, as we saw the woman in the show save hers for her husband who worked on the river. Babies born en caul are rumored to have special powers of perception bestowed upon them. Estimates vary, but being born en caul occurs only about one in every 1,000 births. Check out this blog with a very cool video of en caul birth:

The second rare situation featured was that of the prolapsed cord that Jenny Lee discovered on the laboring woman. The majority of the time when a woman’s “water breaks,” the presenting part of the baby (hopefully head) comes down snugly against the cervix. Occasionally, though, the baby’s umbilical cord falls down in front of the baby’s presenting part, and is referred to as prolapsed. The incidence of this is 1 in 1000 births. It is a true emergency, as pressure on the cord from the baby’s body decreases the blood flow, and hence oxygenation, to the baby, creating a life threatening situation for baby. When the prolapsed cord is discovered, the mother is positioned on her hands and knees with her head down low, and rear end up in the air. This position encourages the baby’s body to move to the top pf the mother’s uterus, and is an attempt to keep pressure off of the umbilical cord.

The third rare scenario featured was that of the woman experiencing puerperal psychosis, more commonly known as postpartum psychosis. While “baby blues” are very common – affecting 80% of all women – postpartum depression affects 1 in 100 women, and postpartum psychosis only 1 in 1000. Baby blues are characterized by labile emotions, feelings of being overwhelmed, and occasional weepiness, with the new mother usually still able to care for herself and baby. Postpartum depression is more serious than baby blues; the mother’s ability to function, and to care for herself and her family, may be mildly or severely affected. The new mother may have thoughts of harming herself or others. Postpartum psychosis involves a spectrum of symptoms including everything from behaving in a very chaotic, manic manner, to not having the energy to get out of bed. The new mother may become suspicious of those around her, believing them to be a harm to her/her baby. These women may have hallucinations as well. The woman in the episode was treated with electroconvulsive therapy (ECT), which may have seemed barbaric, but it is actually still considered an effective treatment for postpartum psychosis, after other treatments have failed. The electric current travels through the brain, purportedly altering the brain’s chemicals, thus treating the condition.

What will the screenwriters come up with next? They did provide us with some interesting fodder for thought this go round!

Missed our analysis of the Previous Season’s Episodes? Read them here.