Call the Midwife is back for its 12th 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 May 7. SPOILER ALERT: Some posts may contain plot details.
A recent Nashville cover story exposed “the other Nashville,” a local explosion of homelessness and opioid use. Like Poplar, my community has limited affordable housing, families with precarious or no shelter, and people struggling with drug addiction and its consequences. As Call the Midwife does so well, episode seven distills these overwhelming social issues into heart-wrenching intertwining stories.
This week we watch as the O’Connor family loses their only shelter – a camper parked in a construction site – as Imelda approaches her due date with her second baby. The family squats in a filthy abandoned tenement while she grits her teeth through an unattended childbirth. In another storyline, we encounter Leon who lives on the streets, sick with both hepatitis and addiction, estranged from his birth mother.
Imelda gives birth in a rat-infested ruin out of fear that her children will be taken into foster care if she doesn’t have housing. Ultimately, that’s exactly what happens when she’s admitted to the maternity home for much-needed care. In Poplar, apparently, no shelters honor the integrity of a family. Here in Nashville there is one shelter for families that includes fathers, with just 10 spots. So, Nashville’s families face the same dilemma as the O’Connors: luck into public housing or a coveted shelter spot, or split up to survive. Over the years I’ve cared for families living in tents, motels, and vehicles. I’ve served families crammed into the homes of family or friends. I have little to offer these struggling families beyond a social service referral and bus tokens.
It’s particularly frustrating because the data are clear: Homelessness is bad for pregnancies, newborns, and families. Women who are unhoused during pregnancy have higher rates of preterm birth, more NICU admissions for their newborns, and low birthweight babies. Mothers with unstable housing begin pregnancy with higher rates of diabetes and hypertension, initiate prenatal care later, have more complications with childbirth, and require longer hospital stays. And precarious housing threatens parental custody, with all the economic, emotional, and social consequences of family separation. Stable, affordable housing would be a potent prescription for pregnant patients.
This episode in fact deals with two outbreaks in Poplar – homelessness and hepatitis, a viral infection of the liver. It’s no coincidence: Poor sanitation is associated with transmission of hepatitis, and the close confines of shelters facilitate disease spread. Hepatitis can spread by exposure to contaminated blood via needles, likely the source of Leon’s infection. Person-to-person transmission carried the infection to beloved Sister Monica Joan, still very sick at the close of the episode. But here we can claim progress: while hepatitis cases and outbreaks still occur today, vaccines developed since 1981 offer universal protection. Most babies are vaccinated on the day of delivery, protecting them and their communities from the miseries of “infectious jaundice.”
Kate Virostko, 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.