This week’s Call the Midwife episode brings a moment we’ve all been waiting for: Rosalind and Cyril finally share their feelings for each other in the wake of Cyril’s decision to divorce Lucille. However, Rosalind’s joy is checked by Joyce’s warnings of the difficulties she will face being in an interracial relationship.
We’ve seen Joyce wade through her own difficulties as a midwife of color, and in this episode, she’s met with outright racism as she attempts to care for a postpartum mother. That patient, Mrs. Midgely, is pleasant enough until she’s encouraged to get out of bed for gentle exercise. This is part of a new initiative led by Trixie and is a stark deviation from the previous recommendation for new mothers to remain in bed for 10 days after birth.
During her seminar, Trixie cites the resumption of normal bladder and bowel function, faster involution of the uterus, and fewer respiratory complications as the benefits of early ambulation. We know today that one of the most important benefits of early ambulation is reduction in blood clot formation. Mrs. Midgely, though, was uninterested in early ambulation and wanted to rest as she had done after the births of her first two children. This, combined with her prejudice towards Joyce, led her to leave the maternity home early to recover at home.
Once home, she continued to decline Joyce’s midwifery attentions and continued to refuse to get out of bed. There are several physiologic changes that occur during pregnancy that make the first six weeks postpartum high risk for clot formation. So, Mrs. Midgely was already at risk of developing a blood clot at baseline, but she also had additional risk factors like prolonged immobility, smoking, and a BMI greater than 25. All of these combined to result in a large clot forming in her calf. While such a clot is extraordinarily painful, the real danger is the possibility that the clot could dislodge and travel up into the lung causing a pulmonary embolism, which can be fatal. Gentle ambulation and exercise is an effective way to help prevent this dangerous condition.
Mrs. Midgley appears to have dodged the most serious complications, but instead of feeling grateful that Joyce made sure she received the care she needed, she’s choosing to level unfair accusations against the midwife. We can only hope that justice will have the last word.dy copy here
Lila Humbert, CNM, began practice as a certified nurse-midwife in 2018. Her entire midwifery career has been at Vanderbilt Birth Center.
