“Some pleasures are simpler than others. The high bright sky; the brand new day; the affection of friends; serving others; giving to others; the longing of others; and knowing, at last – that a prize may be within our grasp."

In Episode 5, we witness a seaside excursion that ends in near tragedy; Matthew is still privately dealing with mounting stresses and financial issues; Trixie passes her driver’s exam. The storyline I want to focus on is of the young couple and their two children who are diagnosed with a malignancy. The young mother, Lindy Webster, and her boyfriend, Melvin, were raised in foster care with challenging upbringings. Early on in the episode, Lindy admits to Nurse Crane that she still does not feel like a “proper adult” but rather “a big sister” to her eldest daughter. I really appreciated that the midwives recognized her vulnerability and were on heightened alert to observe her to offer extra assistance if and as needed.

As a Modern Day Midwife, I am envious of the community involvement and engagement that the Nonnatus House team is able to experience. Today, healthcare in the United States is very fragmented with many patients unfortunately falling between the cracks. I find that an individual can have multiple providers, but the providers do not always work in a coordinated fashion. Additionally, many providers have less and less time to engage with their clients. Beyond their work hours, the Nonnatus House nuns and midwives go to the seaside and also organize play time with the local children. Obviously, the nuns have a vocation and they are living and breathing within that; but, we also see the midwives living and sharing their lives within that community as well. As a midwife today, I note the commonality of love for our communities, advocating for their needs, and being empathetic and compassionate in our work. However, to find the people who have fallen between the cracks, you need to go that extra mile by listening to their stories and observing unspoken things. It is important to have continuity of care or consistency of providers that are caring for an individual and family, along with coordination with those that are on the team to optimize health. It’s possible we see more folks falling between the cracks due to multiple issues such as shortages, burnout, and changing workforce with this next generation of providers.

The Association of American Medical Colleges has reported that half of American counties do not even have one OB/GYN provider. In a 2021 report by the Department of Health and Human Services, it states there were 50,800 practicing providers in the year 2018 and that there will be 3,000 fewer by the year 2030. An article by The Hill also cites an aging workforce, an aging population, high rates of burnout, and abortion restrictions as contributing to the medical shortage. According to the American Medical Association, almost half of the country’s physicians are 55 years old and older and approximately 35% will be at retirement age in the next five years.

We are also seeing similar issues with the midwifery workforce. Many new midwives who are joining the workforce are stepping away – sometimes fairly quickly into their careers. The American College of Nurse Midwives (ACNM) reports that 30% of midwives leave clinical practice before their five-year certification cycle and 50% of all midwives report leaving clinical practice within 10 years after their initial certification. There are a myriad of reasons for this, with some being the level of stress, long hours, increasing documentation and paperwork, reimbursement issues, cost of malpractice, and other factors. There are also issues with having enough educators or professors along with limited clinical sites and preceptors once we have our students. The Royal College of Midwives (RCM) in the UK is warning of a ‘midwife exodus’. The results from their annual member experiences of work survey reported that over half of midwives surveyed said they were considering leaving their job as a midwife with 57% saying they would leave the National Health Service (NHS) in the next year. The rationale for 8 out of 10 of those surveyed was their concern about staffing levels and two-thirds were not satisfied with the quality of care they are currently able to deliver. With these stresses, many can fall between the cracks – our characters in Call the Midwife may not have had the same outcome of discovering their children’s health issues expediently.

In our episode, Lindy and Melvin struggle as they find out that Danielle and Michelle are both diagnosed with a rare eye cancer – retinoblastoma – that begins in the back of the eye. As the cancer first appears, there are few symptoms, although it can be identified when a light shines in the eye. Phyllis eventually caught the symptom after developing photos from the seaside excursion; a photo with flash was taken of Danielle where her pupil showed up white in the image. After bringing up the observation to Dr. Turner, both Danielle and Michelle were brought to an eye specialist. Their final diagnosis was met with diligence, follow-up, and coordination with all involved specialists. They listened, encouraged the parents that they were not alone, and offered care that was tangible. They gave the support that this vulnerable couple needed and strengthened them with their actions and behaviors.

As a result of the diagnosis, Danielle has to have a surgical procedure to remove the eye, followed by an ocular prosthesis. Lindy and Melvin’s newborn, Michelle, also has to receive radiation therapy. The family’s predicament does feel tragic; however, the young couple seems resilient, and because of their support system, are able to step up to the plate and transition from feeling like the big sister to responsible parents.

“Is any pleasure simple in the end? A smile can be the foot of terror and of courage. Our happiness is often rooted in its opposite -- the threats that rocked us but did not come to pass. The loss of urgent; the tears we did not cry. But if our shadows fall behind us – they can also lie ahead --watching, waiting for their turn … undercover of the sunshine.”

RESOURCES

American Academy of Medical Colleges. (2024). Labor pains: The Ob-Gyn shortage. 

American College of Nurse-Midwives (2022). What is the rate over time that midwives leave clinical practice? 

O’Connel-Domenech, A. (2024). The United States is experiencing a growing OB-GYN shortage. Here’s why. The Hill.com. 

Royal College of Midwives (2021). RCM warns of midwife exodus as maternity staffing crisis grows.