Call the Midwife is back for a sixth season Sundays at 7 p.m., through May 21. Read the Vanderbilt University School of Nursing guest blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.
By Bethany Domzal Sanders
Vanderbilt University School of Nursing
Many of us watching the Season 6 finale of Call the Midwife were not alive during a time when birth control was either unavailable, taboo or restricted to married women. These days advertisements for intrauterine systems appear in women’s and parenting magazines and Planned Parenthood is frequently mentioned in the press. The Center for Disease Control and Prevention estimates that in 2014, more than 60 percent of American women between the ages of 15 and 44 used some form of birth control. So it may be hard to appreciate what women like this episode’s Wilma Goddens (Olivia Darnley) felt when they received their first pack of oral contraceptive pills.
Birth control pills first became available in the United States in 1961, but only to married women. The first marketed birth control pill contained 75 micrograms of synthetic estrogen and 10 milligrams of synthetic progestin. Not long after the introduction of the pill, reports of women with venous thrombosis, pulmonary embolism, myocardial infarction (heart attack) and stroke – conditions all related to blood clots – began to surface. Researchers and scientists came to realize that the hormones in birth control pills, particularly the estrogen, induced prothrombotic changes; that is, changes to clotting factors that can promote the formation of blood clots. Drug companies worked to create newer versions of birth control pills with lowered estrogen doses.
Currently women have an array of hormonal contraceptive options from which to choose. Pills with estrogen as low as 10 micrograms and several different types of progestins; pills without any estrogen; the patch; the shot; the ring; an implantable rod; and intrauterine devices with and without hormones are all available by prescription to women regardless of their marital status. These options allow women to work with their health care providers to try to match their unique needs to an effective form of birth control with the fewest possible side effects for them.
Despite advances in formulations and newer delivery systems, there are still side effects to hormonal birth control. The risks of blood clots for women using hormonal birth control remains higher at approximately 1 in 1,000 compared to women not on hormonal birth control at approximately 1 in 5,000. (It is also important to note that the risk of a blood clot during pregnancy is much higher than the risk of one from using hormonal birth control.) Women who are prescribed hormonal birth control should be counseled about the warning signs and symptoms of blood clots and should also be screened for smoking and hypertension, as this can also increase the risk of blood clots.
Women experiencing signs or symptoms should notify their health care provider. An easy way to remember what to look for is the acronym ACHES:
A: abdominal pain
C: chest pain
H: headaches
E: eye problems
S: severe leg pain
While we don’t live in an era where birth control pills are available over the counter (at least not in the United States) as Nurse Trixie (Helen George) first wished for, we are fortunate to have a variety of choices. As midwives, we strive to empower women to make educated decisions about their own bodies and health care. Sadly, this season of Call the Midwife showed us the consequences of unknown risk, whether with thalidomide prescribed to combat nausea or early-generation birth control pills. Season 6 also showed us hope, though, with new babies, new midwives and new relationships. The 1960s keep marching on in Poplar, and I’m only too happy to be along for the ride.
Bethany Domzal Sanders, MSN, CNM, is a member of the Vanderbilt Nurse-Midwives, the clinical practice of the Vanderbilt University School of Nursing located at West End Women’s Health Center.