‘Call the Midwife’ Recap: Season 8, Episode 6

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

Vanessa Redgrave’s soft, maternal voice-over brings me such comfort and is frequently my favorite part of each Call the Midwife episode. She wraps up this week’s show by talking about having a sense of belonging to our families or to the families we create, saying: “Sometimes simply belonging to each other is enough. And what really matters is not the struggle, but where we find our peace.” This sentiment was really touching after watching the sad and frustrating story of young teenage mother, Elaine (Hannah Rae).

We are introduced to the unmarried 17 year old when she presents to the clinic in labor. Elaine has obviously been concealing her pregnancy very well. I had the same thoughts that Lucille (Leonie Elliott) did, that the teen didn’t look pregnant as all! After a beautiful delivery of baby Sarah, Lucille’s suspicions are confirmed ‒ this is not Elaine’s first baby. It was infuriating to watch Elaine’s parents refuse to help or support her decision to keep the child. And it was heart wrenching to see the pain Elaine had gone through giving up her first baby and her utter determination to have another.

While there is far less negative stigma surrounding teenage pregnancy now than there was in 1964, that doesn’t mean it’s any easier. Teenage pregnancy leads to significant long-term social, emotional, health and economic problems not only to the young parents but to their children as well. For this reason, decreasing the rate of teenage pregnancy has long been a national health goal. The U.S. teen birth rate is currently at an all-time low due in large part to better sex education programs and improvements in contraceptive access and use.

According to the Centers for Disease Control and Prevention, a total of 194,377 babies were born to teenagers in 2017. Nearly one in five births to teenage mothers is a repeat birth, meaning that when teens have one pregnancy, they are far more likely to give birth again as a teenager. This is exactly what happened to Elaine. She never dealt with the emotional aspect of having a child at such a young age or the trauma of having to give the child away. She didn’t have access to counseling or education on the repercussions of conceiving again, nor did she have the option to talk to a midwife or other health care provider about contraception.

There are so many great resources for teenagers in 2019, but even more can be done to help prevent teenage pregnancy. It is also essential to provide resources to give pregnant teens adequate social, emotional, medical and academic support. Lucille gave Elaine the best resources she could: a safe place to rent, instructions to request government funding and the means to get a typing job. I wanted so badly for the character to get counseling, find a support group of other teen moms, finish school or as Vanessa Redgrave’s voice-over suggested ‒ find belonging and peace.

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 receives Council on Aging Sage Award for ‘Aging Matters’ project

Bill and Sallie Norton, Thelma Harper, Jackie Cavnar of Mental Health America of the MidSouth, NPT’s Kevin Crane, Julian Bibb. Credit: Mickey Bernal Photography

Nashville Public Television is among the Council on Aging (COA) of Middle Tennessee’s recently announced 28th Annual Sage Awards honorees. NPT is being recognized for its ongoing Aging Matters project.

Presented each year since 1992, the Sage Awards are given to older adults who have made outstanding contributions to Middle Tennessee through a lifelong commitment of working to improve the quality of life in their communities.

The 2019 Sage Awards honorees are: Julian Bibb (Franklin), Thelma Harper (Whites Creek), Bill and Sallie Norton (Nashville) and Gracie Porter (Nashville).

In addition to the individual honorees, COA is also honoring two organizations that have demonstrated a significant impact on the lives of older adults in Middle Tennessee. The 2019 Organization Sage Awards will be presented to NPT and Mental Health America of the MidSouth.

Since 2013, NPT’s Aging Matters project has sought to raise awareness about the critical issues and challenges faced by our growing older population. Through 14 documentaries, short update features, a website and extensive community engagement, the project has informed viewers about how our communities need to change to ensure positive outcomes for all of us as we grow older.

NPT Reports: Aging Matters is hosted by Grammy-winning singer and songwriter Kathy Mattea and is made possible by the generous support of the West End Home Foundation, the Jeanette Travis Foundation, The HCA Foundation and Cigna-HealthSpring. Additional support provided by the Community Foundation of Middle Tennessee and Jackson National Life Insurance Company.

Sage Awardees will be honored at a luncheon held on Oct. 28, 2019, at the Franklin Marriott Cool Springs. To make a reservation for the luncheon, please visit www.coamidtn.org/sage-awards/.

‘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.