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.

I loved the advice Mother Mildred (played by Miriam Margolyes) gave to Sister Frances (Ella Bruccoleri) as she headed out on her first “solo” birth. “Don’t forget your most essential instruments: courage and humility. If you leaven one with the other, you cannot fail.” Sage advice from such a wise mentor.

As midwives, our hands are our most valuable asset. More than any single tool of modern technology could, our hands facilitate us being able to diagnose, comfort, treat, and accept life into them. Yet an individual midwife could be the best diagnostician, the most capable “baby catcher,” but without courage and humility he/she would be a very incapable midwife. Courage is what we draw upon to stand beside women in whatever phase of life they need us. Courage is required to challenge the status quo in advocacy for our clients.

With every baby we catch, humility reminds us that it is not the midwife who causes the healthy birth. Instead, it is the strength of the women we care for, in combination with the innate knowledge that birth is normal, that brings about the healthy birth. Midwives recognize this, which is why we prefer to say that we catch rather than deliver babies. To use “deliver” shifts the credit of the work in birth from the real hero – the momma.

This episode highlighted several key issues. We saw a young husband who, during the course of his wife’s pregnancy, slid back into risky sexual behavior. Why would a man who seemingly has it all (a beautiful, devoted wife; a child on the way) slide into such a destructive pattern of sex addiction? The answer is multifaceted. The prospect of change, in this case that of becoming a parent, can cause a regression of behavior in a recovered/recovering addict. Whatever the addiction, because it brings comfort, the addict may fall back into destructive patterns in times of stress. It’s a timely topic, as the number of those with a sex addiction is currently nearly equal to that of those with cardiovascular disease.¹ Thankfully, sex addiction is much more openly discussed now than it was in 1960s London.

The other topic I wanted to mention regarding this week’s Call the Midwife episode concerns the young woman whose birth Sister Frances attended. On a routine postpartum visit, Sister Frances found a party in full bloom in the woman’s flat, arranged by the husband. The new mother was huddled in her room, frazzled by the prospect of having to return to normalcy and act as though she hadn’t just gone through such a powerfully exhausting experience as childbirth.

Midwives like to tell patients that it takes nine months for a woman’s body to get to the point that it is ready for birth – and another nine months to get back to a semblance of a “new” normal. So many women find themselves in the position of having no time to recover after childbirth; out of necessity they must return to work, or to full-time care of their children, sometimes within just days of giving birth.

We spend a great deal of time and effort showering women with gifts during pregnancy. Wouldn’t it be something if we routinely gave new mommas really valuable gifts after babies were born; gifts like time to take a nap, freshly washed laundry, a cleaned house – or even better, adequate follow-up medical care once baby arrives, and appropriate paid leave from work. Now those would be valuable gifts!

1. Protect Patients First. AARP website. http://www.aarp.org/content/dam/aarp/politics/advocacy/2017/06/patients-first-national-fact-sheet-june-12-2017-aarp.pdfPublished June 12, 2017. Accessed May 5, 2019 via https://www.recoveryranch.com/resources/sex-addiction-and-intimacy-disorders/sex-addiction-america-common/

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.

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.

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.