“We did not come to earth to live our lives alone. We all need each other from the moment we are born. Our hearts beat side by side, in tandem with the ticking of the clock we all must follow. Life. Love. Work. Hand in hand in hand. This is the rhythm of the world and, if we are to thrive, we must dance to it together. If we are forced to dance alone, we may stumble and then fall.”

Season 14, Episode 3 dealt with several storylines, but I wanted to focus my blog post on Mr. and Mrs. Norma Lasley and the birth of their baby. The baby was born with spina bifida. 

The episode started with several scenes of Norma preparing for her birth and baby. She had three weeks of meals all prepped and in the freezer. She attended the Pregnancy Relaxation Classes and recited the objectives of the course as assisting them to be “serene and prepared.” When her husband woke up and found her laboring beside him, she stated that she, “would not panic – I am serene and prepared.” 

She was incredible throughout her labor and put those skills she learned into amazing use. She was coping with her breathing and was incredible as she birthed (I loved the upright position ). 

As a midwife, I loved watching Rosalind. She was calm, encouraging, and skilled with the birth. Norma had been so unbelievably prepared, yet life often has other plans for us. We cannot prepare for everything, and there are unexpected twists and turns. We can face difficulty with unbelievably challenging outcomes. They can feel like insurmountable obstacles. Life can feel very unfair at times. 

As soon as Rosalind saw the baby’s back, we could see the caution and concern on her face. She abruptly hit the emergency call bell. Dr. Turner arrived and confirmed what she already knew …. that the baby had spina bifida. They were empathetic and explained what was happening and that the baby needed to go to St. Cuthbert’s Hospital for evaluation and surgery. 

You may wonder what causes this disorder and that answer is not completely known; however, it is believed that genetics, nutrition, and the environment may play a role. 

Spina bifida is a birth disorder whereby the spine does not completely develop. Spina bifida is a neural tube defect. The neural tube is an embryonic structure that forms early – it is a precursor to the brain and spinal cord (which is known as the central nervous system or CNS). The upper part forms the brain and the lower part forms the spinal cord. Spina bifida is when the neural tube does not completely close. 

There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. In our storyline, the baby had a meningocele, which means the meninges (which are the three layers of membranes that cover and protect your brain and spinal cord) stick out through the spine and expose a sac of spinal fluid on the back. This sac may or may not be covered by a layer of skin.

There are varying symptoms that people can experience with this disorder based on the type and the severity of the problems in the brain and spinal cord development. I put a couple resources for those who may want to learn more about spina bifida in the resources below. 

Folate is essential for the proper development of the neural tube and this relationship between folate and neural tube defects was noted as early as 1965. The British Medical Research Council actually conducted the first randomized control trial (it was published in 1991) investigating the effectiveness of folic acid as a supplement in the prevention of its recurrence. 

As a modern-day midwife, we recommend that every woman in their childbearing years take a multivitamin that has folic acid. The reason that we recommend all women take this during their childbearing years is that 50% of pregnancies are unplanned and the neural tube closes around 28 days after conception. The dosage we recommend is 400 micrograms (0.4 mg). 

However, some women are at higher risk for having a baby with a neural tube defect, and we advise a higher daily dose of 4,000 micrograms (4 mg). These individuals include a woman who has previously had a pregnancy – or a family member – with a neural tube defect, or women with certain medical disorders, such as diabetes, malabsorption disorders, or obesity. As well, women taking certain medications can also benefit from the increased dose, especially those for epilepsy or antifolate medications. 

Even though we had educational programs endorsing for all women to take this supplement and to eat foods high in folic acid, there were studies that demonstrated these campaigns still did not work. Behavior did not change or alter. So, we then saw mandatory food fortification programs enacted in countries. In the United States, that was authorized in 1996, and then fully implemented in 1998. I found an article that reviews this history and goes over varying countries which I found interesting and placed the reference below in the resources if you want to read it. It is older (2011), but it is reviewing history.

As a modern-day midwife, we can offer some prenatal options to test for neural tube defects. In our storyline, Norma would not have had that opportunity as testing for this disorder in the blood – by detecting elevated levels of maternal serum alpha-fetoprotein (MSAFP) – was not discovered until the mid-1970s. As well, routine ultrasounds were not always performed, but their use gained momentum both in Europe and the US in the 1970s. In 2003, the American College of Obstetrics and Gynecology (ACOG) began recommending routine testing of maternal serum alpha-fetoprotein. 

It was hard not to feel saddened by the parents’ response to the diagnosis in our episode. When we face lifelong challenges or the unknown, we often need to let things settle in and absorb the enormity of things. We can wonder what our true capacity is for adapting. Sister Veronica was eloquent when she noted that people can underestimate their ability to cope. 

The entire team lovingly cared for the baby, from the wound care and naming her June after the month she was born to Rosalind registering her birth since the family declined to take custody of her. They spent loving time with her and the truly simple but touching act of Rosalind sending her off to the orphanage with the stuffed bunny. I kept hoping the family would see that they could open their lives to envelop this little one….  

It was hard for the Nonnatus House team to accept that social services would not step in to give the family time to accommodate. The team was a bridge and now the Mother House orphanage will need to hold space or just move forward for June as her caretakers. 

The show does such a good job of showing simple acts of kindness during times of incredible stress, unbelievable challenges, instability, and fragility. We witnessed simple acts of Nurse Joyce Hyland getting the Daily Gazette, Chamberlain cigarettes, and mints for her patient, and Fred coming to fix things around his apartment. We witnessed a heroic act with Fred going into the building after the explosion to save Mrs. Williams’ children. I was proud of Trixie as she stood before the Board of Health with evidence, statistics, and facts to show the need for the Nonnatus House nuns and their entire team to fulfill the essential work within their community of servicing Poplar residents from the cradle to the grave. 

I found the injured bird such a strong visual. Birds are often symbolic for love, family, devotion, freedom, hope, new beginnings, courage, vulnerability, and of compassion and kindness. This sweet bird was injured at the beginning of the show, but Fred lovingly restores its health and vitality. 

Each character in our story was dealing with issues and needed some love, care, and support to help them face another day. When Fred released the pigeon at the end of the episode, we saw the embodiment of this new beginning along with the Nonnatus House being able to move on and continue to serve another day.    

“Everything we do, we do together. Whether we choose it or not. Whether we know it or not. If we lack the power to change another’s life, we can still care. That counts as action. If we cannot stop the wound from bleeding, we can try to help it heal. For that is love. And everyone knows that love is beautiful, strongest when given to fragile things. Love is the chain that links us, the armor that shields us. Love is the arrow that pierces the heavens, and it sets us free.”

RESOURCES 

Crider, K.S., Baily, L.B., and Berry, R.J. (2011). Folic acid food fortification - Its history, effect, concerns and future directions. Nutrients, 3(3), 370-384. 

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): https://www.nichd.nih.gov/ 
Phone: 800-370-2943 

March of Dimes: https://www.marchofdimes.org/ 
Phone: 888-663-4637 (888-MODIMES) 

National Institute of Neurologic Disorders and Strokes (NINDS): https://www.ninds.nih.gov/health-information/disorders/spina-bifida 

Spina Bifida Association: https://www.spinabifidaassociation.org/ 
Phone: 800-621-3141 
Email: sbaa@sbaa.org