‘Call the Midwife’ Recap: Season 4, Episode 4

For the fourth 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 Sundays on NPT and PBS Stations nationwide at 7 p.m. CDT through May 17. Check in every Monday morning for historical and contemporary context on the show along with some fun discussion. SPOILER ALERT: Be aware that some posts may contain spoilers.


Sister Winifred (Victoria Yeates)
Sister Winifred (Victoria Yeates)


By Bethany Domzal Sanders

Bethany SandersAt the beginning of this episode of Call the Midwife, we hear the voice of Jennifer Worth, upon whose memoirs the series is based, setting the scene with a mention of “pain as well as joy.” That certainly is what this episode was all about. There was so much packed into this hour I felt like I needed to watch it over again to make sure I didn’t miss anything! The pain of gender disappointment was so eloquently shown in this episode. Trixie’s heartache and struggle with her own demons showed the depth of her vulnerability. The tragedy of prostitution had us rooting for Bridget despite her “wickedness.” And yet, it was Norah who I wanted to know more about and who felt the most broken to me.

Syphilis has a long and storied history, dating back to before the days of Christopher Columbus. Primarily a sexually transmitted disease, syphilis starts as a painless ulceration to the skin. Without treatment syphilis progresses to secondary syphilis, which is characterized by a rash, and then becomes latent with the infected person showing no symptoms. Throughout the first four years after contracting syphilis the disease can be spread to others. Tertiary syphilis occurs as the disease continues to effect different parts of the body, including the brain and heart. This is where the skin growths called gummas are seen (like what afflicted Norah’s neck and chest). Syphilis can also be transmitted in pregnancy to the developing baby; up to 75 percent of babies born to mothers with active infections contract the disease. Thankfully, syphilis is treatable. Interestingly, the recommended medication has not changed since the 1940s so the same penicillin that Bridget received is still given today as a series of weekly injections.

While syphilis is not a new disease, and we know how to treat it effectively, infection rates in the U.S. recently began to increase for the first time since the 1940s. As part of a public health campaign you may see billboards around Nashville urging people to get tested. Use of condoms, or “sheaths” as the earnest Sister Winifred calls them, can prevent the spread of the disease. In 2013, Tennessee reported 214 cases of primary and secondary syphilis to the Centers for Disease Control and Prevention. Two of these cases were in infants infected during pregnancy. All pregnant women should be tested by a simple blood test at least once during pregnancy, just as the midwives of Popular were administering over 50 years ago.

As for the joy part of the episode, it is truly a delight to see images on television of women giving birth in positions other than on their backs. Most women in labor find laying on their backs to be more painful and uncomfortable, which makes sense because of the very mechanics of birth. So many media images of birth, however, show women in what is called the lithotomy position – flat on their backs, legs up and pulled back, often in stirrups. My midwifery heart smiled when I saw Bridget squatting for the birth of her baby, a position that increases the space in the pelvis. Mrs. Robbins laying on her side demonstrated another position favored by midwives, especially for tired mamas after a long hard labor. The experience of labor and birth can often be summarized best as Romans 8:18, “The pain that you’ve been feeling can’t compare to the joy that’s coming.”

Bethany Domzal Sanders, MSN, CNM, is a member of the Vanderbilt Nurse-Midwives, the clinical practice of the Vanderbilt University School of Nursing.

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