‘Call The Midwife’ Recap: Season 10, Episode 3

Call the Midwife: Season 10, Episode 3.

Call the Midwife is back for its 10th season and so are the faculty of the Vanderbilt University School of Nursing to provide historical and contemporary context in a weekly recap blog. Watch the show Sundays at 7 p.m. through Nov. 14. Each new episode will be available to stream for free from its broadcast premiere through Dec. 21. A 10th anniversary retrospective airs Nov. 21 at 8 p.m. SPOILER ALERT: Some posts may contain plot details.

I really felt drawn to one storyline in Sunday’s episode, the one in which Lucille (Leonie Elliott) and Shelagh (Laura Main) meet and help care for an overweight patient, Mrs. Patricia Williams (Sandra Martin), during her third pregnancy. The midwives are immediately concerned about her weight gain and the estimated large size of the baby, which leads them to recommend that she have a planned hospital delivery. Shelagh also recommends that the patient does a glucose tolerance test, which is something we now recommend and perform on all our patients during pregnancy.

The consulting physician is dismissive of the midwives’ concerns and tells the patient she “just needs to eat less” – a statement that is both rude and unhelpful. Fortunately, the midwives are in tune to the situation and know it is more than a problem of overeating. The patient doesn’t follow the advice of the midwives and calls them too late in labor to make it to the hospital. Later, despite her best pushing efforts the baby is not descending, and Mrs. Williams ends up being transported to the hospital for a cesarean section. Low and behold, the baby weighs a whopping 13 lbs., 8 oz.!

In the episode, Mrs. William’s condition is referred to as latent diabetes. We now know this as gestational diabetes – which is a significant high-risk disease of pregnancy that affects both mother and baby. While patients with obesity are at increased risk of developing the condition, anyone can be diagnosed with gestational diabetes during pregnancy. Midwives and obstetricians alike recommend that all pregnant patients be screened between 24 to 28 weeks along with a glucose tolerance test to determine how well their body processes sugar. Being able to diagnose gestational diabetes and keep good control of blood sugars during the pregnancy is key to minimizing risks. We want to keep the patient and her baby safe and healthy!

Uncontrolled glucose levels in the mother lead to increased transfer of glucose through the placenta, causing the baby to grow larger than it should. This increased risk of having a large baby also increases the risk of cesarean delivery or instrument-assisted delivery and complications with vaginal delivery – like shoulder dystocia where a baby’s shoulders get stuck. Patients with gestational diabetes are also at increased risk of developing other pregnancy complications like preeclampsia and gestational hypertension, polyhydramnios (a high amount of amniotic fluid), and even an increased risk of stillbirth and neonatal complications after birth. Gestational diabetes is also a strong marker for maternal development of type 2 diabetes at some point later in life.

In the 1960s, there had certainly been documented cases of diabetes affecting pregnancy, but not much was known about management or prevention. Patients were not yet routinely tested, and there was much debate over when and how to administer the glucose tolerance test. I often have patients resistant to complete glucose testing but knowing the complications that can come from uncontrolled glucose levels, I am so grateful we have tools to test patients and ensure they do not have gestational diabetes. If our modern testing recommendations had been around in 1966, it is likely Mrs. Williams could have avoided the complications she experienced.

Hannah Diaz

Hannah Diaz, DNP, MSN, CNM, is a member of the Vanderbilt Nurse-Midwives & Primary Care for Women at Melrose, the clinical practice of the Vanderbilt University School of Nursing.

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