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.
Based on the one-sentence summary of this episode, I waited to be introduced to the recalcitrant patient refusing medical involvement or guidance. Toward the end, I realized the description must refer to Sarita Gupta, the heavily pregnant first-time mother originally from India. We meet Sarita when the Nonnatus midwives respond to her neighbor’s postpartum hemorrhage after an unattended childbirth. As the midwives treat the hemorrhage, we viewers get a peek into a community that typically gives birth without the expert care of the neighborhood midwives.
Sarita has not had prenatal care and doesn’t have a delivery provider, maybe because of the cultural norm, certainly due to debilitating anxiety. She is haunted by her experiences during Partition, the chaotic 1947 division of India and forced displacement of people between India and Pakistan. To me, Sarita doesn’t refuse medical care so much as she experiences layered barriers to care, both cultural and personal. It is satisfying for this modern midwife to watch the Nonnatus team and Dr. Turner provide both culturally competent care and trauma-informed care to Sarita and her husband as they welcome a healthy son.
Trauma-informed care is multidisciplinary, but the idea began in medicine in the 1970s when Vietnam veterans presented to our medical system with physical and mental health consequences of wartime trauma. Culturally competent care is a modern idea, a concept born in academia but adopted by healthcare organizations and practitioners in the 1990s. It’s delightful to see Dr. Turner and Sister Frances provide effective health care with these skills and insights long before they were taught in medical and nursing schools.
Sarita’s story demonstrates how essential both approaches are in care of complicated patients. When the midwives become aware of Sarita, Sister Frances has just begun an outreach program to the local Indian community: a series of childbirth education classes offered just for Indian mothers, taught in their own language via an interpreter. Of course, this isn’t a perfect system — it would be best to have trained midwives from the same ethnic/cultural background, speaking the language fluently, etc. — but the Nonnatus nurses do provide respectful outreach. Instead of seeing Indian culture as a monolith, they recognize that their immigrant neighbors speak multiple languages and have varied customs. Their classes are a dialogue, with the midwives seeking to learn as well as teach. It is fortuitous that the midwives can invite Sarita to join in, overcoming one barrier to care.
Meanwhile Dr. Turner and Sister Frances recognize that Sarita’s childhood trauma impacts her decisions, her well-being, her ability to birth and to mother. They offer themselves as a dedicated team for Sarita’s pregnancy and birth, cultivating trust with her. They appropriately refer her for on-going mental health care. They empower her with the information necessary to make decisions about birth preparation and birth setting. Their gentle invitations to care succeed: Sarita copes well with the intensity of birth and delivers a vigorous baby boy. She found a safe place in the maternity home, under the care of trusted providers.
I only wish the Nonnatus midwives could offer the same compassionate care to one of their own, student midwife Nancy Corrigan, who has also survived multiple traumas. The episode ends with one traumatized woman building a family and a life in a new country, and another one at risk of losing her profession and her hope for life as a family with her daughter.
Kate Virostko, MSN, CNM, is a member of the Vanderbilt Nurse-Midwives & Primary Care for Women at West End, the clinical practice of the Vanderbilt University School of Nursing.