The episode opens with a couple hurrying out of their ice cream truck and into the Maternity home in what turns out to be false labor, or the experiencing of Braxton Hicks contractions. The difference between real labor contractions and Braxton Hicks is that real labor contractions cause cervical change. 

A midwife I know told me that Midwifery School is often like labor — no one knows when it will happen or how long it will take!

When Call the Midwife began, I was in my late 20s, had a career in film and television under my belt, and was looking to return to school. As I eagerly soaked in the episodes, I was inspired to become a nurse. 

Over the last decade, as an obstetrics nurse and a student nurse-midwife, I would try to “diagnose” the conditions in the episode while watching. This episode was no exception. The second that the young father, Tony (Steffan Rizzi), exposed the blood on his shirt, I exclaimed to no one, “Male breast cancer!”

Many people are unaware that breast cancer can affect men. Affected men often feel highly stigmatized. According to the World Health Organization, only about 0.5-1% of breast cancers occur in men. 

As Dr. Turner (Stephen McGann) explained to his patient, we all have breast tissue — just in different amounts. People assigned male at birth have a worse 5-year prognosis than females, primarily because it is often diagnosed at a later stage. 

Tony has an open wound with blood oozing from his nipple, with intense localized pain when touched. He mentions that he had a lump for a while, which he ignored. 

The other storyline in the episode involved a woman who fights in illegal wrestling matches. There were a few clues to her diagnosis. Experiencing multiple concussions can lead to Traumatic Brain Injury (TBI). The rash on her back could simply have been from the unsanitary conditions of the underground wrestling rings. 

Once she mentioned her painful joints, though, coupled with fatigue, I began to suspect something autoimmune, which her blood test results supported. A compromised immune system could also put her more at risk for picking up a contagious rash.

Initially, I thought she had Rheumatoid Arthritis but the moment she turned around and had the butterfly-shaped rash on her face, I hollered aloud, “Lupus!” 

The butterfly rash is a distinctive symptom of systemic lupus erythematosus (SLE), an autoimmune condition most common in women of childbearing age. It is likely genetic, with the affected person experiencing an environmental trigger, like a virus, which activates the condition.

As I prepare to take my certification exam in the last step of becoming a Certified Nurse-Midwife, I struggle with some of these non-obstetric topics. This episode was a great reminder that as Advanced Practice Nurses, we care not just for obstetric and gynecologic conditions, but also a wide variety of afflictions. 

It also gave me a bit of encouragement that my “diagnoses” were correct!