“There are days that dawn without clouds – only sunshine is expected and rain shouldn’t come or leave any consequences. There is promise in the air and there are new beginnings. Relish the light and the warmth. Turn your face towards them because these days are beautiful and rare. Too much is unknown. Too much is not within our powers. Too much is yet to be revealed."

Episode 7 dealt with sharing and celebrating new beginnings with our pupil midwives moving into their new roles as nurse midwives. I agree with Sister Monica Joan’s sentiments that the sight of a newly minted midwife stops the heart as their careers commence!! I loved the gifting of the treasured burgundy sweater to identify them in their new role. However, the episode delved into the fact that our first glimpse of things may not be the entire story. There are two sides to every coin and with a human life, there are many angles. There is happiness and light; however, there are also the darker aspects, which at times, can be unknown to others or even hidden. In the show, we witnessed several storylines as their lives and hidden truths began to unfold or become evident. Lives are complicated with ups and downs and many turns and we do not always know the hidden shadows that an individual has faced or is currently facing. I remember feeling a little in awe when I first started my career as a nurse at Toronto General Hospital in Ontario, Canada. I was walking home one night and looked up at a myriad of large apartment buildings with all of these illuminated windows. A life and a story were unfolding behind every door.

In this episode, we learn of several hidden truths. Allison Casey, a young woman with a hidden secret of sexual abuse by her stepfather, gives birth which is further complicated by syphilis. Additionally, Trixie and Matthew have a lack of communication as they experience a crisis. I feel for Trixie as we witness her marriage begin to crumble. The choices and ramifications of Matthew’s financial choices will impact multiple lives along with the entire Nonnatus House community. I was also surprised by the twist that revealed that “Cousin” Sylvester Warren was Joyce’s husband. We discover she escaped domestic violence and started anew by shedding her life as Claudine Warren and instead becoming Nurse Joyce Highland. I smiled as her colleague Nancy Corrigan stated she found Sylvester “smarmy” and did not like his shoes.

Thus, all of the characters – the nurse midwives, nuns, and patients – all have individual stories with many twists and turns, or as I call it: the good, the bad, and the ugly.

It made me reflect on past and current exercises that we do to help us with our clinical work. I remember doing this as a nursing student (at the University of Windsor) and also as a midwifery student (at the University of Illinois at Chicago). The exercises explored who we are and how this impacts the care we deliver or give to our clients and community. How do we self-identify? We come to the table with a family history, nationality, race, gender, culture, possibly a religion which we seek solace within, and other factors that play into who we are and how we present ourselves. We need to be aware of these things and how they can lead to biases along with just making sure of the veil that we have as we visualize our client’s situations.

In one of the reflection exercises I teach at Frontier Nursing University, we have students consider their values, beliefs, and social power as clinicians. We ask them to reflect on how their own cultural background influences how they think about encounters during interactions with clients. We ask them to ponder and write how this may impact or affect how they care for this client or someone facing a similar health issue. We ask them to consider how they think or feel about issues raised in the visit, and how cultural habits of thought, or biases, might impact issues of a) how and what they teach about the topic, b) how they interact with the client/patient, c) what they might recommend. We asked them after doing the exercise if they were unaware of them as well as if there were implications for how the patient might perceive the safety of the visit.

Another exercise that we had students do when I was on faculty at the University of Michigan was an implicit bias exercise. I put an example of one in the resources below entitled the “Implicit Awareness Test” (IAT). As a provider, it is important to realize and embrace that we are a mosaic of identities. We need to really make sure that we create safe spaces for our clients. We need to realize that there are socioeconomic determinants of health—how do we try to bridge gaps!? Additionally, we have some clients that have disabilities and we need to challenge biases associated with them. Call the Midwife has done a really good job of including storylines with individuals with disabilities. It is important in clinical practice to really explore how we adopt disability-inclusive practices. We need to explore our physical settings and ensure they are accessible. Similarly, it is important we examine communication aids (both written and verbal) as well as think of comprehensive support for varying challenges. Diversity training is something that needs to be an ongoing endeavor. Systemic racism has definite impacts on healthcare as we have seen with varying maternal mortality rates amongst Black childbearing women in this country. We need to approach our care from a trauma-informed care lens. Most individuals have been exposed to some type of trauma in their lives and we need to create a supportive and safe environment.

It is so important to regularly assess our attitudes, assumptions, and beliefs. We need to challenge biases as they come up. I have always thought that we need a mindset of continuous learning and improvement. We need to recognize that biases can evolve and have a commitment to overcome them. The more we do these exercises the more that we can pave the way for a more inclusive and equitable healthcare landscape. Life is such a tapestry and we need to champion a true patient-centered approach.

Several comments from the episode stood out to me: Violet’s wise words, “You will find a way out of this and learn things.” Sister Julienne’s compassion as she told Matthew, “You have my respect and you have our love.” The midwives displayed actions where they held sacred space for birth within a realm of safety.

I loved that in the show we saw Fred’s blunder with getting a truckload of turnips but the midwives turned it into a joyful night of community fun with the Scouts and everyone carving them and lighting them. It was like that saying of essentially turning lemons into lemonade.

“Life and love follow patterns of their own. There is never only darkness; but, there is never only light. Flames burn more brightly in any given gloom; there is a spark of the other in everything we feel. Grief contains a moat of hope; joy is flecked with the fear that joy will pass, and happiness shines in the shadow of its opposite. We give, we receive, we steal, we share, we laugh together to keep the beasts at bay because we are formidable and small; we are valued and fragile; we are frail and invincible, and we are only human.”

RESOURCES

Implicit Association Test: https://implicit.harvard.edu/implicit/takeatest.html