This week’s Call the Midwife episode explores concepts of loneliness and community. Violet struggles with the decision about serving another year as borough mayor. Sister Monica Joan proves that she still has something to contribute as she assembles an arrangement for the flower festival. Rosalind attempts to show a homeless man that he’s still worthy of inclusion in society.
The two larger storylines in the episode follow these same themes. A gonorrhea outbreak is identified, and the Nonnatus team engages in the intimate and difficult work of contact tracing in Poplar. Meanwhile, Trixie cares for a pregnant mother with a history of manic depression. This woman had been left virtually alone to understand and manage her complex mental health, while also navigating life as a single mother. I wish that I could say that in the last 55 years, the care of mothers with mental illness has drastically improved, but the struggles Arlene faces in this episode feel all too familiar.
There continues to be significant stigma and shame surrounding mental health. This still causes mothers to withhold important aspects of their medical histories out of fear they will be deemed “unfit” to care for their children. I identified with Trixie, frustrated by the lack of research to guide decision-making with mothers with mental illness. To this day, mothers feel stuck between wanting to protect and nurture their mental health during pregnancy and wanting to protect and nurture their growing babies.
There have, however, been some meaningful advances in research since 1970, thanks in large part to mothers like Arlene who, over the last five decades, have participated in studies related to the effects of psychotropic medications in pregnancy. We know a lot more about the effects of lithium in pregnancy, and for many mothers, it remains an effective and safe option for treatment of bipolar disorder even while pregnant. Studies like these enable me as a midwife to have conversations with mothers about the risks medications may pose to a developing baby in pregnancy, but also the real risks untreated psychiatric disorders pose to them and their babies. When equipped with the facts, these mothers can make informed, empowered decisions for themselves.
I found myself wondering if Arlene may have chosen to continue taking the lithium if someone had explained to her that untreated manic depression also carried real, known risks to her and her baby’s health. Instead of acting out of a place of information and empowerment, she was forced to act out of fear. I hope she was reunited with her baby after a short separation. And I hope that there continue to be advances in the care and support of mental health in pregnancy, because we still have a long way to go.
Lila Humbert, CNM, began practice as a certified nurse-midwife in 2018. Her entire midwifery career has been at Vanderbilt Birth Center.
