‘Call the Midwife’ Recap: Season 8, Episode 5

By Michelle Collins, Ph.D, CNM, FACNM, FAAN
Vanderbilt University School of Nursing

Call the Midwife is back for its eighth season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 19, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

In my post about Episode 8.3, I talked about watching Call the Midwife and thinking about how it seems impossible that things could have been the way they’re portrayed, even if history tells me otherwise. That rang true again in this week’s episode. A young engaged woman had what was then called “testicular feminization syndrome,” now referred to as complete androgen insensitivity syndrome.

Males have an XY chromosomal makeup and females an XX. With complete androgen insensitivity syndrome, XY fetuses (which are genetically “male”) do not respond to male hormones and are born looking female on the outside as a result. On the inside, though, they have a shortened vagina that is more like a pouch and that does not have a cervix (or uterus) at the end of it. These individuals have neither ovaries nor fallopian tubes. They do have testes, which remain undescended, usually in the abdomen. Unfortunately, many times this condition goes undetected until the individual does not begin to menstruate when menarche would be expected.

This brings me back to my opening comments about how things have changed. I was mortified by the way the young woman in this episode was examined by the specialist to whom Dr. Turner referred her. In teaching practices in the past, it was customary for the “sage” (teaching physician) to lead an entourage of medical students on rounds or in office visits particularly to “see” the most unusual of conditions. The teaching physician would then ask questions of the students, in front of the patient, interacting with them in a manner that totally excluded the patient. Patients were treated more as medical specimens than as people deserving empathy. I would like to say that this never happens now; unfortunately, the issue of vaginal examinations being performed on women in surgery and under anesthesia in the name of “education” still pops up in the news today.

Not until the late 1960s did the practice of unauthorized pelvic examinations come under fire. It was then some time before medical organizations began issuing formal statements condemning the practice. Today there are few states that classify these unauthorized procedures as a misdemeanor. (Why not every state?)

In teaching this most delicate of examinations to nurse-midwifery students, we spend as much time on the nuances of how to best perform this delicate exam as we do on the mechanics of the procedure. Those nuances include what the clinician says during the exam. To hear the specialist telling the young woman to “just relax” as he forcibly opened her legs produced in me a visceral response of anger and disgust. “Just relax” ‒ the same words spoken to women when they are being assaulted ‒ are NOT the words that should be used by a professional performing the most intimate of exams.

I wish I could say that women no longer endure exams like this, but I frequently see women in my own practice who have been traumatized by past gynecologic exams. If that woman is you, know that you do not have to tolerate this type of abuse ‒ I cannot even label it as “care.” There are so many options for empathetic gynecologic care; if you currently are not receiving such, I would even highly recommend that you call the midwife!

Michelle Collins Ph.D., CNM, FACNM, FAAN is a Professor of Nursing and Director of the Nurse-Midwifery Program, at Vanderbilt University School of Nursing.

‘Call the Midwife’ Recap: Season 8, Episode 4


Call the Midwife
is back for its eighth season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 19, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

By Hannah Diaz, MSN, CNM
Vanderbilt Nurse-Midwives & Primary Care for Women at Melrose

Call the Midwife never fails to bring tears to my eyes, but this week’s episode left me feeling extra heartbroken. Jeannie (Molly Chesworth) is a vibrant young mother of two in Poplar who struggles with an unplanned and unwanted pregnancy. Trixie and Dr. Turner both counsel her that she’ll adjust to the idea if she just gives herself time to accept the pregnancy. However, Jeannie is desperate and nothing they say persuades her against what she is determined to do. After an illegal backstreet abortion, Jeannie suffers through a horrible infection that ultimately leads to her death.

Illegal abortion seems to be a recurring theme on Call the Midwife this season. It surprised me to see the show tackle this topic again so soon after seeing Kath suffer consequences of a dangerous procedure in this season’s first episode. It was obviously a serious concern in 1964 England and would be until the Abortion Act of 1967. I have a feeling we will see more on the subject in episodes or seasons to come.

Another storyline that tugged on my heartstrings was that of a mother and daughter, both of whom are pregnant, who are estranged at a time when they need each other most. Enid (Niky Wardley) does not approve of her daughter Cilla’s (Hannah Hutch) marriage to Indian immigrant Pardeep (Omar Malik). Enid wants the best for her daughter, but she is blinded by her prejudice. Mother and daughter are thrown together when they end up in the maternity ward due to pregnancy complications.

To me, this episode isn’t about illegal abortion, family feuds or complicated pregnancies. It is about women needing support in pregnancy; support from family, medical providers and the community. Pregnancy can be the happiest, most meaningful time in a woman’s life; but it is also intense and terrifying if you are alone in your worry or fears. Jeannie, Cilla and Enid are all in serious need of support throughout the episode. Fortunately, Sister Julienne is able to help Cilla and Enid reconcile in the end, but Jeannie never got the understanding she needed, despite the caring efforts that were made.

In my years as a midwife, I have spent a great deal of time listening and being present with my patients. I think one of the greatest strengths of our profession is patience and compassion. I spend a large amount of my time sitting with my patients, listening to their fears, concerns and hopes. I’ve cried with patients and been there when family members couldn’t be. Being present and offering support through the happy, the challenging and the tragic times ‒ these simple acts make such a difference. I love how Call the Midwife demonstrates this support for the families of Poplar.

Hannah Diaz, 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.

NPT’s ‘Next Door Neighbors: Taste of Home’ premieres Thursday, April 25

Taste of Home, the 12th documentary in NPT’s award-winning Next Door Neighbors series, premieres Thursday, April 25, at 8 p.m. The documentary will also be broadcast on Wednesday, May 29, at 1 a.m. and will be available for online viewing at ndn.wnpt.org/documentaries.

This edition of Next Door Neighbors highlights members of Middle Tennessee’s Ethiopian, Palestinian and Venezuelan communities. But this is a different kind of Next Door Neighbors production; this is a story of the role food plays in keeping people connected to their home countries, while also helping them form bonds in their new locations.

Producer Shawn Anfinson said the idea to use food as an entrée (so to speak) to exploring cultures came up in a conversation of possible documentary topics. “Food is always there. Wherever we’d go to meet someone or attend an event, they’d be eager to feed us,” Anfinson said. “That gave us an opportunity to show gratitude, not just for their hospitality, but also for their stories.” Anfinson’s previous Next Door Neighbors documentary was 2018’s Between Two Worlds, about Middle Tennessee’s Indian, Chinese and Filipino communities.

“The aroma of the kitchen, this is something that brings home to you,” Venezuelan native Ramón Cisneros says in Taste of Home. It is something that you probably want to put in your suitcase when you leave your country and you can’t.”

Fidel Vasquez and Ivon Reyes, owners of Caracasville at the Nashville Farmers’ Market, are among the Venezuelan natives featured in Taste of Home. As they and Cisneros they tell their stories, viewers see them prepare such traditional Venezuelan dishes as pabellón criollo and arepas (sandwiches made with a warm, chewy cornbread).

In a segment of Taste of Home featuring the Ethiopian Community Association, the traditional coffee ceremony is transformed into a cross-cultural event. “One of the reasons I love [the] United States is because anything is possible,” Hillina Feleke, ECAN’s director of communications and public relations, says in the documentary. “However, I still hold on to my Ethiopian roots because I feel like that helped build me into who I am today.”

Nashville’s Faith and Culture Center, also uses food to foster connections between disparate communities through its A Seat at the Table programs. FCC was founded by Daoud Abudiab, a Palestinian American who grew up in Jerusalem, and his late friend Bernard Werthan, a member of Nashville’s Jewish community. “It’s about building a community where everyone is welcome, heard, seen,” Abudiab says in Taste of Home. “Israelis and Palestinians, Jews and Christians and Arabs, it’s the same dream, is to be at peace with one another, to respect our differences, to love others, maybe even before we understand them.”

“We can bring people around the table from different backgrounds and we all can agree, you know, on the same values we share here, being neighbors, living in the same community,” says Nadia Owaida Crank, FCC’s program coordinator, near the end of Taste of Home.

NPT’s Next Door Neighbors: Taste of Home is made possible by the generous support of The Nissan Foundation.

NPT’s Next Door Neighbors series looks at Nashville’s status as a destination city for refugees and immigrants and explores the rich diversity of people now calling Nashville home. Through documentaries, extensive outreach and continued relationships with Nashville’s immigrant and refugee communities the Next Door Neighbors project aims to increase understanding of unfamiliar cultures, highlight the experiences and successes of Nashville’s immigrants, and mediate a community-wide conversation about who we are as Nashvillians.

‘Call the Midwife’ Recap: Season 8, Episode 3

By Michelle Collins, Ph.D, CNM, FACNM, FAAN
Vanderbilt University School of Nursing

Call the Midwife is back for its eighth season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 19, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

Sometimes as I watch Call the Midwife I think not much has changed. Other times, what I am watching is so utterly foreign that surely it could never have happened that way, though history tells me otherwise. Such was the case with this week’s episode. We saw a young mother, hyper vigilant about her child’s health, who was tortured by the memory of her first child’s death in infancy.

To be clear, women never, ever forget the details of the births they have experienced. Studies have shown that well into advanced age, women can recount the fine details of the births they have had, and particularly the details of births wherein they encountered significant emotional distress.

Discussing death ‒ particularly the loss of a child ‒ has historically just not been something that was done. Throughout time, women have suppressed and then carried the burden of deeply buried grief through their entire lives. In years past, babies born with genetic syndromes or anomalies (birth defects) that were considered to be incompatible with life were separated from their mothers at birth, placed in cribs at the back of the newborn nursery (or in a separate nursery), and left alone until they died. Mothers were “not allowed,” nor encouraged, to spend any time with a baby whose life was predicted to last only hours or days. Babies died alone and devoid of ever knowing a mother’s touch. Mothers left hospitals with empty, aching arms, without as much as the memory of a touch, a glimpse, or the scent of their newborn to comfort them.

Fortunately, time has brought change. We have evolved from the notion that speaking about perinatal loss is taboo to having perinatal hospice services. Multi-disciplinary hospice services provide support for families who have been given the prenatal diagnosis that their baby has a condition incompatible with life. There are now protocols and policies in place for women who give birth to stillborn babies or those with very short life expectancies.

These babies are respectfully bathed and dressed in gowns often made by the loving hands of volunteers, or donated by organizations like the Littlest Angels Gowns, which turns used bridal gowns into infant burial gowns. We prepare memory boxes for the family containing locks of hair, pictures, hand- and footprints – anything tangible that will ease their pain in the days and years to come. Professional photographers volunteer their time and talent to photograph these precious little ones and their families to provide the first, and last, portraits the family will ever have through organizations like Now I Lay Me Down to Sleep organization.

Thank goodness we have come to realize that NOT acknowledging a child’s loss only magnifies the heartbreak. In regard to this aspect of maternity care at least, we have grown by leaps and bounds since the 1960s when the episode is set. As Elizabeth Edwards wisely said, “If you know someone who has lost a child and you’re afraid to mention them because you think you might make them sad by reminding them that they died, they didn’t forget they died. You’re not reminding them. What you’re reminding them of is that you remember that they lived, and that’s a great, great gift.”

Michelle Collins Ph.D., CNM, FACNM, FAAN is a Professor of Nursing and Director of the Nurse-Midwifery Program, at Vanderbilt University School of Nursing.

‘Call the Midwife’ Recap: Season 8, Episode 2

By Hannah Diaz, MSN, CNM
Vanderbilt Nurse-Midwives & Primary Care for Women at Melrose

Call the Midwife is back for its eighth season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 19, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

After an emotional and dramatic first episode of the season, Call the Midwife continues to highlight heart-wrenching storylines in both physical and mental health. Episode 2 opens on a loving Ghanaian family that has recently gained British citizenship. As the episode progresses, we learn that the Aidoo family all suffer from a genetic condition known as sickle cell disease (SCD). For Flora Aidoo (Jessica Kennedy), this is a serious concern during pregnancy and labor.

Even today with our knowledge of the disease, Flora would have been considered a high-risk pregnancy. Among several other concerns, we midwives worry about anemia and blood loss – both of which Flora experiences. Trixie (Helen George) and Dr. Turner (Stephen McGann) work through their limited knowledge of SCD and Flora receives a life-saving blood transfusion. It was nice to see this familiar collaboration between a midwife and a physician. Today, this is a common occurrence – midwives communicate closely with our physician colleagues to treat higher risk patients.

I was also struck by Dr. Turner’s frustration when he realized there wasn’t adequate information to help him care for the Aidoo family. As a medical provider, it can be maddening to recognize a problem and not know how to solve it. In 1964, little was known about sickle cell disease in the medical community. The first formal description of SCD was published by James Herrick in 1910; sadly, it would take decades for progress to be made. It wasn’t until 1995 before the FDA approved a medication, called Hydroxyurea, to treat the painful complications of the disease.

At first, SCD was thought to affect the African population only; it was many years later that researchers determined that while people of African heritage are at greater risk, any ethnicity could be a carrier of this molecular disease. Thankfully today we can screen patients for sickle cell disease and provide them with helpful management and treatment.

We are always learning in medicine. As midwives, we strive to keep up with the latest evidence and ensure we are using the most current guidelines to give our patients the absolute best care we can. We also have a great resource in our collaborating physicians for high-risk issues. While it took far too long to make any advances in our understanding of SCD, the disease is now recognized as a public health challenge and there are ongoing efforts to improve palliative care and seek a cure.

Hannah Diaz, 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.

NPT tapes ‘Opioids: NPT Reports Town Hall’ April 9; premieres April 18

As our country grapples with the opioid epidemic, NPT will hold a public forum about how Middle Tennesseans are dealing with this public health crisis. Join us on Tuesday, April 9, from 6 to 8 p.m. for Opioids: NPT Reports Town Hall, a discussion with concerned citizens, individuals and families affected by opioid misuse and addiction, as well as health care and treatment experts who are trying to address the problem.

The event takes place in NPT’s Studio A (161 Rains Ave. Nashville 37203). Doors open for a reception at 6 p.m.; the taping begins promptly at 6:30 p.m. This event is FREE, but RSVPs are required at opioidstownhall-npt.eventbrite.com.

Opioids: NPT Reports Town Hall will be recorded for broadcast and will premiere Thursday, April 18, at 9 p.m. on NPT. The discussion with then be available for online viewing at wnpt.org/town-hall.

‘Call the Midwife’ Recap: Season 8, Episode 1

By Michelle Collins, Ph.D, CNM, FACNM, FAAN
Vanderbilt University School of Nursing

Call the Midwife is back for its eighth season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 19, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.

 

History does not repeat itself, but it does rhyme.

Mark Twain’s bon mot rings true in this season’s first episode. The year is 1964, and Poplar is abuzz with the anticipation and excitement of a royal birth. Just as the world eagerly awaited Queen Elizabeth’s delivery of her fourth child, the arrival of Prince Harry and Meghan’s royal baby this spring incites a similar level of interest.

This Call the Midwife storyline deals with another issue that is as topical now as it was then. Elective termination of pregnancy was illegal in 1964. Women would seek out unskilled (and often dangerous) “practitioners” who used a variety of methods, which included crude instrumentation or the ingestion of substances like Epsom salt, pennyroyal, or turpentine. As happened to the woman in this episode, these options often resulted in significant harm, complications like severe infections or hemorrhage, or even death to the woman.

In this episode, a young woman experiencing complications after pregnancy termination is brought to Nonnatus House for care. Nonnatus House, home to the nuns (and midwives) of the Catholic Order of St. Nonnatus, claims Raymond Nonnatus (whose own mother died at his birth) as the patron saint of childbirth, midwives, children and pregnant women. It may seem like the least likely place to which a woman in this situation would be drawn. However, as Sister Julienne says in the episode, “midwife means ‘with women.’ Midwives have always ‒ and WILL always ‒ care for women, regardless of the circumstances by which they need our care. It is simply what we do.”

The history of midwifery has always included care of the most vulnerable; a legacy that we are proud to carry today. The midwifery model of care is not one of patriarchy (which is characteristic of the medical model of care); rather, it is relationship-based. We walk side by side with our clients regardless of their circumstances, delivering care that is holistic, compassionate and non-judgmental. The women of London’s East End knew that then, just as our clients know that today.

The issue of elective termination has been debated since the dawn of time ‒ literally. Midwives have long stood passionately on both sides. It is not uncommon for nurses, physicians and midwives to face ethical situations wherein personal morals and convictions are put to the test. As I’ve written before in these posts, it’s easy to “armchair quarterback” other people’s decisions; in reality decisions are usually less black-and-white when you’re in the middle of the pain, angst and despair that life sometimes brings.

Jennifer Worth’s voice-over at the start of the episode notes: “Every day dawns anew; every morning begins afresh. We seek to be cleaner, brighter, more polished versions of ourselves. We will be better. We will be beyond reproach. We will strive to be perfect, leave nothing to chance, and believe everything is possible.” None of us has the answers to life’s toughest questions; the best we can do is to strive to be better versions of ourselves, every day – caring for each other regardless of our circumstances.

Michelle Collins Ph.D., CNM, FACNM, FAAN is a Professor of Nursing and Director of the Nurse-Midwifery Program, at Vanderbilt University School of Nursing.

NPT’s Indie Lens Pop-Up series concludes April 11 with ‘Charm City’

NPT’s final free Indie Lens Pop-Up event of the season is Thursday, April 11, at Watkins College of Art (2298 Rosa L. Parks Blvd., Nashville TN 37228). Indie Lens Pop-Up, presented by ITVS, Independent Lens, and Nashville Public Television, will present Charm City, a documentary by Marilyn Ness. The event is free, but RSVPs are required at charm-city-npt.eventbrite.com. Doors open at 5:30 p.m. and the screening begins at 6 p.m. with a discussion to follow the documentary.

Filmed during three years of unparalleled violence in Baltimore, Charm City delivers a powerfully candid portrait of those on the front lines. With grit, fury, and compassion, a group of police, citizens, community leaders, and government officials grapple with the consequences of violence and try to reclaim their city’s future. Former Nashville resident Katy Chevigny is one of the film’s producers.

Independent Lens airs Mondays at 9 p.m. on NPT.

NPT’s ‘Aging Matters: Legal Help’ documentary premieres March 28

Just over half of all older adults have had at least one civil legal problem in the last year and 87 percent of seniors seeking legal assistance had difficulty finding or affording it. Yet benefits and resources available to older adults are underutilized. Aging Matters: Legal Help, the fourteenth documentary in Nashville Public Television’s NPT Reports: Aging Matters series, sheds light on resources and where to turn when legal assistance is needed.

Aging Matters: Legal Help premieres Thursday, March 28, at 8 p.m. on NPT.

A free preview screening of Aging Matters: Legal Help will be held on Wednesday, March 27, at FiftyForward’s Patricia Hart Building in Nashville. The event will include lunch and a panel discussion with Sonya Bellafant, director of the Tennessee Senior Law Alliance/Legal Aid Society of Middle Tennessee and the Cumberlands; Stephanie Edwards, attorney with Howard, Mobley, Hayes and Gontarek; and Rhonda Yaeger, advocate from the Jean Crowe Advocacy Center. Ashley Hunter, director of the FiftyForward Victory Over Crime program, will serve as moderator. RSVPs are no longer being accepted for the event, which has reached capacity.

The most common legal issues faced by older adults revolve around access to healthcare, housing, maintaining income and planning for the future. Navigating benefits and eligibility on your own is incredibly complicated and the resources that exist for older adults are often underutilized.

“Unfortunately, most of the ways the seniors enter the legal system is in a crisis. They’re usually not entering the legal system because they’re doing advanced planning or preventative measures,” Fay Gordon, project manager with the National Center on Law & Elder Rights/Justice, says in Aging Matters: Legal Help. “There’s a huge disconnect between the need and people linking up with lawyers.”

Matt Schwimmer, an attorney with West Tennessee Legal Services, agrees. “It gets exponentially more difficult as you get older. The housing issues and the debt issues pile on to what are now healthcare issues and problems with transportation,” he says in the documentary. “Whatever the case may be, there’s tons of stuff they have to deal with, not to mention benefits, which they figure when you retire it’s going to be simple….But the fact is, you have to fight for them a lot of the time.”

Aging Matters: Legal Help offers insights from attorneys, advocates and policy experts ‒ some with personal experience similar to those of their clients ‒ as well as individuals navigating these areas. Appearing in the documentary are representatives from: the American Bar Association; the Center for Medicare Advocacy; Justice in Aging; the National Council on Aging; the National Health Law Program; the Tennessee Justice Center; the Tennessee Senior Law Alliance; the Tennessee State Health Insurance Program (SHIP); Vanderbilt Law School; and West Tennessee Legal Services.

Additional broadcast times for Aging Matters: Legal Help are below; the documentary will also be available for online viewing at wnpt.org/agingmatters/.

  • Tuesday, April 2, at 12 a.m.
  • Monday, April 8, at 12:30 a.m.
  • Friday, April 19, at 9:30 p.m.
  • Monday, April 29, at 12:30 a.m.

Aging Matters: Legal Help was produced by NPT executive producer Will Pedigo, whose previous projects in the series include Aging & the Workplace and Economics of Aging.

The NPT Reports: Aging Matters series is hosted by Grammy-winning singer and songwriter Kathy Mattea. Funding for Aging Matters: Legal Help was provided through a grant awarded by the Davidson County Chancery Court, Part III from the SeniorTrust/ElderTrust settlement (Case No. 11-1548-III) and through a contract administered by the Tennessee Commission on Aging and Disability.

NPT Reports: Aging Matters is a major initiative designed to open a community-based conversation about what older citizens in Middle Tennessee need to optimize their quality of life and what the community needs to do to prepare for a coming explosion in our aging population. Over the course of several years, NPT has focused on issues such as caregiving, finances, end-of-life issues, dementia and Alzheimer’s through documentaries, televised town halls or panel discussions, Aging Matters updates, community engagement conversations, a project website, interactive online screenings and DVD distribution.