Katie Moriarty explores the changes between the '60s and today, touching on unplanned pregnancy, child deformities and a shift from home births to hospitals.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 5 Episode 4

“The world was shifting on its axis in 1961. Strides were being made, decisions taken, questions asked. It was as true at Nonnatus House as it was anywhere. The world was turning faster, burning brighter. It was all we could do to keep pace, keep time, keep abreast of so much change.”

This episode dealt with unplanned pregnancy and the extremes of pain when hopes and dreams of a brighter future start to slip through our fingers. There was a focus on the tide of change with birth shifting to the hospital setting; growing awareness (within the small circle of the medical community) that more babies are being born with deformities; and, a growing romance between Barbara and Tom as Trixie steps to the side to let what the heart wants begin to unfold.

I noted things that are still similar and things that have shifted with time within this episode. We will always deal with unplanned pregnancies. However, there are more contraceptive options today, less stigma for pursuing reproductive choices and less pressure to marry with an unplanned pregnancy.

However, just like this episode, an unplanned pregnancy can alter your dreams, shift your future and increase the obstacles to what you think are your hearts desires. This episode also had an attempted suicide. In this era it would be faced with more openness and supports would be offered.

Some of the differences (or myths of promises) between home and hospital were blatantly shown in Episode 4. There were voiced hopes with the hospital as a place for increased safety, options for pain control and the ability to get some rest away from the demands of large families. I have supported women and families in all birth sites which are home, freestanding birth centers (FBC), in hospital birth centers (called alternative birthing centers – ABC), and hospital labor and delivery units.

I felt somewhat akin to Sister Julienne as she was struck by the hospital rules –most times without an evidence base. See the resource section for an American College of Nurse-Midwives (ACNM) link to read about normal, healthy childbirth and things that can disrupt this process along with the link from Childbirth Connections to assist someone with their choice of birth place.

Examples of things that can disrupt the normal birth process are an environment that lacks privacy and home like comforts; lack of desired people to lend continuous support; restrictions on food and drink; separation of mother and baby (those first moments should not be spent with the labor nurse in the corner under warming lights filling out paper work); the ability to move around freely; the ability to give birth in any position desired; and the ability to go into labor spontaneously as well as not speeding up labor unless there is a medical indication.

We often witness an environment that lacks shared decision making and true informed consent. Rules and options are still present and at times only benefit the hospitals and staff that work there over the families we serve. Sister Julienne was a patient advocate and as a Modern Day Midwife I still struggle with these same advocacy issues.

Did you know you can look up your hospital and see how it rated for certain outcomes? You must be an advocate for yourself! See the Consumer Report link below to check out your local environment.

One final thing I did want to note is that there is a large difference in that Baby Cottingham would have been held by her parents in this era. Sister Julienne, thankfully found her and made those last moments one that enveloped love and comforting words.

“We knew so little then in a world that seemed so full of opening doors and bright horizons. We thought only of what was new and better because it was new and better and it would take us to places we had never been before. We couldn’t see what was coming or understand yet what had already come to pass. We had so much still to learn.”

RESOURCES

American College of Nurse-Midwives (nd). Normal, heathy childbirth for women and families: What you need to know.

Childbirth Connection: Choosing a place of birth. Best evidence for choosing a place of birth.

Consumer Report: The biggest CS rate may be your hospital.

Katie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
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