Another season of Call the Midwife is upon us! Season 14 takes off at a blistering pace: Trixie returns from New York to take up her maroon cardigan once again and to help Sister Julienne counter the Board of Health’s disapproval of Nonnatus House. A young girl is “miraculously” pregnant after having been shielded from sex education by her religious parents. And Nurse Crane and pregnant mother Winnie must both navigate fears regarding uterine rupture.
A uterine rupture is a rare but very serious complication wherein the uterus tears during pregnancy or labor. With uterine rupture, both mother and baby are at risk of serious injury and death – the baby due to lack of oxygen and the mother due to hemorrhage. The biggest risk factor for uterine rupture (as seen in this episode) is a history of cesarean delivery. Winnie experienced what is called a “classical” incision with her first birth, which means the uterine muscle was cut in a top to bottom fashion. That method greatly increases the risk of rupture compared to the (now) more common incision termed “low transverse” from one side to the other, just above the pubic bone.
A VBAC or Vaginal Birth After Cesarean is something the midwives at our practice are proud to offer, but it is not without risk. Partnering with patients to provide appropriate counseling and informed consent is an important component of care. That counseling is a fine balance of providing information in an approachable way that is neither unnecessarily fear-inducing nor blasé about uterine rupture. This is not always an easy task.
For midwives and physicians, being skillful at this sort of therapeutic communication is as important as knowledge of obstetrics and gynecology. The Nonnatus House midwives – as well as Dr. Turner – tend to be stellar with their therapeutic communication and it is one of my favorite things about Call the Midwife. I’m excited for another season and looking forward to what is to come!
Una Sammon, CNM, has been a practicing certified nurse-midwife since 2019. She attends births at Vanderbilt University Medical Center.
