By Michelle Collins
Vanderbilt University School of Nursing
Call the Midwife is back for a seventh season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 6, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.
One of the many things I love about Call the Midwife is that issues addressed in 1960s London are often as relevant today as they were then. So it goes with this week’s episode in which a young woman is paralyzed with fear going into her second birth. This extreme fear of pregnancy and childbirth is called tokophobia and may be rooted in past traumatic experience, as in this case, but not always.
The hormone that facilitates labor and birth – namely oxytocin – is directly inhibited by adrenaline, the hormone released when one is afraid. Translated into practical terms, that means a woman who is terrified in labor may encounter any number of problems attributable to just being scared, which include stalled labor, inefficient contractions, and an inability to cope. Creating a culture of fear around childbirth in essence leads to the very outcomes that women fear.
British obstetrician Grantly Dick-Read (1890-1959) was the first to conceptualize the fear-tension-pain cycle as it relates to birth. He observed that the more fear a woman had in labor, the more muscular tension she displayed. The more muscular tension a woman displayed, the more pain she experienced, which increased her fear, hence perpetuating the cycle. We can help women avoid this through prenatal education about labor and birth to reduce fear, teaching breathing and relaxation techniques to facilitate decreasing muscular tension, and offering pharmacologic and non-pharmacologic methods of pain relief. Fear and childbirth may be synonymous in some circles, but they need not be. It reminds me of a quote from Laura Stavoe: “There’s a secret in our culture, and it’s not that birth is painful. It’s that women are strong.”
The other timely issue in this episode concerns the man who is believed to have smallpox, which actually turned out to be leprosy. Thankfully, we no longer have to fear infection with smallpox, as it was eradicated in 1980. However, equally devastating and life threatening infections like rubella, mumps, tetanus, polio, diphtheria, pertussis, and even influenza, still exist. Every year there are outbreaks of these infections in the U.S. as some parents opt not to vaccinate their children. Inevitably deaths occur as a result. Do vaccination reactions occur? Yes, but consider that 2 million to 3 million children worldwide die annually of vaccine preventable disease.
I am grateful for Call the Midwife episodes like this one that remind us of where we have been, lest we forget.
Michelle Collins Ph.D., CNM, FACNM, FAAN is a Professor of Nursing and Director of the Nurse-Midwifery Program, at Vanderbilt University School of Nursing.