In this week’s Call the Midwife episode, a young mother, well-prepared for labor and parenthood, is blindsided by her daughter’s unexpected diagnosis of spina bifida. While it may seems that the Lasleys are at least financially situated to raise their child, they are not emotionally prepared and opt to have the baby placed in an orphanage. I generally find Call the Midwife to be pleasantly positive and kept expecting an about-face from the parents; the absence of this surprised me. But, as Rosalind correctly reflected, until presented with a certain obstacle or difficulty, you never truly know how you will react to it. While anger or frustration with these parents might be the initial reaction, empathy is what they need. It seemed clear, especially from Mr. Lasley, that they would never fully recover from this decision – even if they deemed it the right one.
Spina bifida is a type of neural tube defect wherein the spine doesn’t fully close during development. Side effects are generally dependent on the severity of the condition and range from none to mild to full lack of sensation in lower extremities and problems with movement. While the cause of spina bifida is likely multifactorial, a major risk factor is lack of folic acid. All prenatal vitamins contain folic acid, and it is their most important component.
The recommendation for folic acid in pregnancy is also often misunderstood by the general public – the ideal time to begin a prenatal vitamin is two months prior to conception, not after the positive pregnancy test. The neural tube finishes closing about four weeks after conception (when someone would be six weeks pregnant), which is often the time when women realize they are pregnant and begin a prenatal vitamin. Unfortunately, beginning a folic acid supplement at this point isn’t effective for preventing neural tube defects. Luckily for modern society, some of our food (breads, pastas, flours) have been enriched with folic acid to help close this gap, but folic acid supplementation through prenatal vitamins is still recommended!
Modern society also has the benefit of screening tools and ultrasounds to help diagnose these conditions in utero. The AFP or alpha fetal protein screen is a blood test done after 15 weeks that can indicate increased risk for open neural tube defects like spina bifida. Advanced ultrasounds, while not 100% accurate, are also an effective screening tool. When spina bifida is diagnosed in utero, families can begin planning financially, emotionally and alongside their medical care team long before they are holding a baby in their arms.
Sadly, folic acid supplementation, blood tests, and ultrasounds were not available or known in 1970s Poplar. Perhaps it wouldn’t have changed their decision in the end, but it’s interesting to wonder whether education and time to process the diagnosis before baby’s arrival would have changed their course.
Una Sammon, CNM, has been a practicing certified nurse-midwife since 2019. She attends births at Vanderbilt University Medical Center.
