As I watched this week’s episode, I couldn’t help but think through all the beautiful themes woven through the storyline. This was a heavy episode, as many have been, but the beauty was not lost on me. “The mother endures because the mother loves. The cord that binds her to her child is never fully severed, even when it is torn and bleeds. Everybody has a mother somewhere, no matter if they can’t be touched or seen, because we are all bound to each other; our stories, interweaved. Our sorrows unite us. We cherish, we share, we survive.”

One of the special, caring mothers on this week’s episode was Florence Wray. Florence’s grown son, Spencer, was having a baby with his girlfriend, Jill. They were not married, but despite this still being taboo in 1968, Florence embraced Jill and welcomed her into their home. Jill’s own mother had chosen to sever ties with her after Jill fell in love with a Black man. Jill was able to find the love and support that she missed from her own mother from Florence. However, shortly after baby Mylene’s birth, both Jill and Florence could not ignore the changes that had been happening with Spencer. He was extraordinarily paranoid. Nurse Nancy Corrigan noticed as well, and immediately put in a call to Dr. Turner for assistance. Soon, Spencer started having hallucinations. He was hearing voices that were not there. They tried so hard, but could not expedite his appointment with a psychiatrist.

Florence was desperate for someone to help her son. She reached out to Cyril, a pastor, and asked if he would come pray over her son. You could see the fear in Florence’s face, and the devastation as Spencer’s behavior grew more and more erratic, which culminated in a violent outburst where Cyril was stabbed with scissors after he successfully removed baby Mylene from harm’s way. I’ve never been through a situation quite like this before, but as a fellow mother, I could feel Florence’s grief and sorrow. She loved her son more than anything, but she was at a loss for how to help him. Mental health was so stigmatized in the 1960s. I’m sure she worried that in the process, she would lose the relationship with her granddaughter and Jill as well.

Annette Barkely was a joyful mother to a young daughter as well as several step-children. Dr. Turner had been notified that she missed her 6-month follow-up appointment at the cardiology clinic at St. Cuthbert’s Hospital. Annette had been keeping a secret; she hadn’t divulged to the midwives or doctors that she was pregnant again. She had rheumatic fever as a child, and this damaged her heart valves. When she was pregnant with her first daughter, she had a terrible experience at the hospital. People had talked down to her, made her feel stupid for being pregnant, for putting herself at risk like that. Annette did have a relatively uncomplicated pregnancy and birth that time, but had been afraid to let them know she was pregnant and go through that medical bullying again. However, when she became symptomatic, having dizzy spells, word quickly got back to Dr. Turner who worked hard to arrange appropriate care for her.

This history between medical staff and Annette really set something off inside me. As a midwife, shared decision making is one of the cornerstones of my practice. It is important to provide informed consent, however this also implies that there is such a thing as informed refusal. We can tell people our recommendations until we are blue in the face. We can back our recommendations with current evidence. However, we cannot make decisions for people. It is unethical to coerce people into choosing the decision we feel most comfortable with.

I do understand how difficult this can be as a healthcare provider. We don’t often have the option to not provide care for someone, especially if we work for a hospital or health system (some private practices in the US can “discharge” a patient from their practice for being “noncompliant”). Everyone is entitled to care in an emergency or when in labor, no matter whether they have insurance, can pay, or whether they agree with the doctor or midwife’s recommendations. This is the law. Many doctors, midwives and nurses have witnessed poor outcomes, which makes us on edge when a similar situation presents itself to us. We draw on our previous experiences, the patient’s history, the current course of the pregnancy, and the evidence-based standards of care to help us make recommendations to patients and their families. The best we can do is counsel someone, try to be sure they understand the risks and benefits of both sides of the decision, and then the rest is up to them.

In Annette’s case, her medical team is worried about the effect that a pregnancy will have on her heart. Women die from complications that can arise in pregnancy when they have certain heart problems. Her medical team wants her to be safe, and wants her to be alive and well for the children she does have. I understand where their worry comes from, but I also can’t help but think that maybe if they had approached her care in a different way during her first pregnancy, with kindness and understanding, they may have been better able to connect and convey this information to her. Annette is so full of love for all of her children and her husband, that she viewed this pregnancy as an expansion of that love.

I left this episode hopeful. I was hopeful for Annette’s future, for her to have many, many more years with her loving family. I was hopeful for Florence and Jill, two mothers who had each other for support, who shared a love for Spencer, and who would be sure that baby Mylene grew up surrounded by unconditional love. The ties we have to our children are so strong. I know I would move heaven and earth if one of my children were in trouble. Like Shelagh said, it doesn’t get any easier just because our children grow up. Worries change and evolve, but in our hearts, they are always our babies. Our love endures.