It’s a new day at Nonnatus House and we’re kicking off this episode on a gloomy note. We know... that intro music really lulls you into a false sense of security. It gets us every time. It’s 1966 and England is grappling with the high profile murder trial of Ian Brady and Myra Hindley, Poplar is dealing with housing shortages, and Nonnatus House continues their quest to keep up with modern hospitals aka the competition.

So far though, the midwives have held their heads high amidst adversity, and when we last left off, they were venturing into private practice for the first time. Here’s what they’re up to now:

Jacinta O’Malley’s Precarious Family Situation

As Trixie continues her service for Lady Emily Clinic, the rest of her friends manage the local community patients over at the Iris Knight Institute. Already well into her first trimester, Jacinta O’Malley tries to stealth her way into Tuesday clinic for her first checkup for baby number three. Though she’s a returning patient, she manages to go *mostly* undetected by the more veteran midwives and sneaks her way onto the books with Sister Frances.

Despite getting off to a rocky start, Jacinta opens up to Sister Frances about personal struggles at home that have stopped her from coming in earlier for prenatal care and for her decision to give her third child up for adoption. She explains that she had a brief affair with another man while her husband Dessy was out at sea, and that she hopes to deliver the baby before he returns.

A Family In Need

Speaking of sticky situations... last episode, Cyril was faced with a housing crisis when his home was condemned and he was forced to quickly find a new place to live. Thanks to the generosity of Lucille, his church, and the Buckle family, he was able to acquire new accommodations, and now he’s passing it forward to the community. After learning that a couple that he’s ministering to has been ousted from their home and has no alternative but to live in a squat with their children, he quickly takes them under his wing.

It’s not long before his recruits grow, and after hearing about the family’s predicament, Fred doesn’t hesitate to join him and Lucille in their mission to provide them with food to get by. Though Cyril offers to pay for any goods from the Buckle’s store, Fred refuses and starts a tab for the family instead, allowing them to pay the shop back on their own time.

Naturally, it’s not long before Violet catches wind of this and reprimands him for all the freebies, worrying that with the amount of food they’re giving away, it’ll hurt them financially. To ease her mind, Fred urges her to join him on his next food delivery to the Clarkes so she can see the true extent of their housing conditions. If it wasn’t obvious already, we stan Fred.

Two Different Paths in Life

Following their gals’ one-on-one at the clinic, Jacinta grows closer to Sister Frances. She opens up to her about the future she and Dessy had envisioned for their family and points out how drastically different the two women’s lives are despite being of similar age. Frances is struck by their conversation and later confides in Sister Monica Joan. Though she admits she doesn’t feel like she made many sacrifices when she first joined the order at 17, she recognizes that the experiences she missed out on might make it harder for her to understand her patients’ struggles.

Overhearing their discussion, Sister Hilda offers a solution for her troubles, suggesting that Sister Frances pick up a women’s lifestyle magazine - or two - to gain better insight on the everyday life of a Poplar woman like Jacinta. Unsurprisingly after her Maria von Trapp moment during Season 9, Sister Julienne approves of the young nun’s reading materials.

A Returning Patient

While Sister Frances busies herself with homework, Trixie reunites with two familiar faces this week. After coping with severe faintness and fevers at home, Fiona Aylward returns to Lady Emily Clinic with her husband Matthew. Her doctor, Mr. Scarisbrick, initially wonders if a delayed infection from her recent labor could be to blame, but Trixie spots a peculiar rash on Fiona’s arm that raises red flags. When Fiona later collapses at the maternity hospital, Mr. Scarisbrick calls for more testing and brings in a hematologist to conduct a bone marrow aspiration on her. While the couple waits for Fiona’s test results, Trixie does what she can to help them through their stress and convinces Matthew to bring their newborn Jonathan to the hospital to keep Fiona company.

An Awkward Family Reunion

Meanwhile, as Jacinta’s delivery draws near, the reality of her giving her child up for adoption sets in. She deeply regrets her disloyalty to Dessy but feels even worse at the thought of leaving her baby. Sister Frances attempts to provide her emotional support, but Jacinta’s doubts are only emphasized when Dessy returns home from his travels unexpectedly. At nine months pregnant there’s not much she can do to hide, and when Dessy uncovers the shocking truth, he threatens to take her to court for custody of their two daughters. Sister Frances steps up and urges him to consider that Jacinta’s mistake was a result of being left alone for months on end, and argues that despite everything she’s still a good woman and mother to her children. Never a dull day in Poplar!

Sharing is Caring

As Sister Frances plays mediator between husband and wife, Violet joins Fred and Cyril on their food delivery to the Clarkes’. She’s appalled by the squalid conditions of the single room that the entire family is forced to share and immediately recognizes why Fred chose to help them - and that she should too. When the couple offers to pay the Buckles back once they’re able to, she too dismisses this debt and offers them the goods for free. They’re taken by the generosity of their neighbors, and it’s not long after that Mr. Clarke is able to find a part-time job with the help of his church.

A Heartbreaking Diagnosis

Though the outlook of one family has improved, back at Lady Emily Clinic, the Aylwards have received devastating news. Following her tests, Fiona learns that she has acute myeloid leukemia. The hospital attempts a blood transfusion, but to no avail, and she and Matthew soon realize they’ve run out of options with how advanced her cancer is. Knowing her time is limited, Fiona turns to Trixie for her help writing a farewell letter to her husband.

An Illegal Side-Practice

As if losing a patient isn’t traumatic enough, Trixie suspects that something else is amiss at her new job. She asks to shadow Mr. Scarisbrick during surgery as he performs a D&C, or dilation and curettage, but is disturbed when she discovers what this routine procedure is actually code for abortion. Though the doctor begins the operation more discreetly, he goes on to discuss the removal of a mother’s fetus, confirming Trixie’s fears.

Following the abortion, Trixie protests Mr. Scarisbrick’s actions, noting that what he’s doing is illegal and could jeopardize Nonnatus House’s reputation. He tries to argue that his patients could instead be turning to dangerous back alley abortions (something Trixie has seen first hand all-too-recently) and that legalizing the procedure has been discussed in parliament, but even so Trixie is angered that he would let the order walk into a criminal institution. She’s also angered to know that while the wealthy can afford safer medical treatment under the care of practices like Lady Emily, most women in Poplar don’t have the resources and are often maimed or die as a result of their abortions.

Having given Sister Julienne and Mother Mildred her word that she would report all her findings about Lady Emily to them, she tells them in secrecy about the goings-on of the maternity hospital that they hoped would keep them afloat. It’s another discouraging blow in their struggle to survive. 

Moving Forward

Rubbing salt into a gaping wound, Trixie must return to Lady Emily for one more week and face Fiona’s deteriorating health as the cancer progresses. Matthew, Jonathan, Trixie, and Fiona’s parents are by her bedside during her final moments. Following the devastating loss, Trixie delivers Fiona’s letter to her grieving husband. It’s a long road ahead for the new father as he confronts the challenges of raising Jonathan alone.

A New Kind of Family

While the Aylward family deals with the loss of a loved one, the O’Malley family grows. Soon after Dessy’s return home, Jacinta goes into labor and she delivers her baby before Sister Frances and Phyllis arrive. When the newborn isn’t breathing, Dessy jumps into action to save him. In what may have been a happy moment in different circumstances, the birth is emotional for both of them with their marriage hanging by a thread and the future of their family still unknown. Yet with his conversation with Sister Frances still on his mind, and after some bonding time with the new baby, Dessy has a change of heart. Before leaving for his next trip to sea, he bids farewell to Jacinta and his family, promising to return home to all of them, including his new son.

Forgot how we got here? Catch up on “Call the Midwife” with the Season 10, Episode 1 GIF Recap.