How many times have you said you were fine, when really, you were screaming for help on the inside? How many times have you turned down offers of help because you felt like you really should be able to do it all yourself? How many times did you turn someone away out of fear or shame? 

I think for many women, including myself, this has happened more frequently than we care to admit.

This week, while Sister Veronica is on a visit to discuss the truancy of two little girls, we meet the Baldwin family. When she realizes that Eva Baldwin has another baby on the way – and appears to be quite far along in her pregnancy – she offers to put Eva on the books for prenatal care and delivery at the maternity home. Eva quickly declines, with an excuse that they will be moving soon. Something about it doesn’t sit right with Sister Veronica, and she reports back to Nurse Crane and Sister Julienne that it would be worthwhile to drop in again and offer their services.

Sister Julienne takes it upon herself to drop by the abandoned warehouse where Eva, Vincent, and their two daughters have been squatting. She is met with a rather cold and abrupt response as the Baldwins decline any assistance from Nonnatus House when it comes to delivering their very soon-to-be-born baby.

Just as she is leaving, Sister Julienne notices significant bruising around Eva’s wrist, and the defensive response from Eva about being “clumsy” during her pregnancy is one that Sister Julienne has heard in the past far too many times. She is nearly certain that Vincent has been abusing Eva, and Sister Julienne realizes that Eva needs her help now more than ever.

For many women, domestic abuse can either begin or worsen during a pregnancy. We know pregnancy is a stressful time, and if you add in a potentially unplanned pregnancy, increased financial stress, or for some people, even a feeling of jealousy as the pregnant woman shifts her attention and priorities to the coming baby, this can all be a trigger for abusive behaviors.

Globally, it is estimated that 25% of mothers may experience some form of intimate partner violence during their pregnancies. This can be even more common than other pregnancy complications, such as gestational diabetes or preeclampsia.

When Sister Julienne is harshly rejected by the Baldwins, she can’t let it go. I understand her preoccupation with the family; when you’re in a “caring” profession, it’s hard to accept that someone doesn’t want your help. It’s even harder to accept it when you think the person might be coerced into rejecting your help but may want or need it.

Sister Julienne kept reaching out to Eva, even when she was met with hostility. It was starting to affect her moods, and her colleagues could see that something was wrong. Sister Julienne wondered something that I’ve thought many times through my 12 years of midwifery practice – what is the point? You can help one “Eva Baldwin,” but then you turn around and there are six more women just like her.

In midwifery, we see some of the best, most beautiful moments in people’s lives. We also see a lot of heartbreak, a lot of hardship, significant relationship issues, and rocky family dynamics.

Sister Julienne was deeply feeling the stress of knowing she needed to help Eva, but unsure what good it would do in the long run. The other Sisters and midwives at Nonnatus House could see how this was eating up Sister Julienne, and they continued to offer their support and encouragement. Even though it was hard, they encouraged Sister Julienne to keep reaching out to Eva and make it known that, no matter what, they would be there to help if she wanted it.

Eventually, it pays off when Eva and the girls attend a Tuesday clinic, where Sister Julienne can give her a proper check-up. However, during this check-up, it becomes apparent that Eva is actually in early labor.

Sister Julienne follows Eva back to the warehouse they have been living in, because Eva panics thinking that Vincent will be angry if he finds out she went to the clinic for help. By the time they make it back to Eva’s home, labor is underway. Much like she suspected, Vincent is furious that Sister Julienne is there. 

I was so proud of the way that Sister Julienne seamlessly fibbed that she “ran into Eva on the street and could tell she was in labor,” so she followed her home, in order to take any blame off of Eva for requesting assistance. She also stood her ground and firmly asked Vincent to leave, allowing her to work safely with Eva in peace.

After realizing that Eva was actually pregnant with undiagnosed twins, Sister Julienne is able to use her quick thinking, midwifery knowledge and skills, and sends the Baldwin girls to fetch help while she helps deliver the second baby, who was malpositioned.

I can’t imagine the fear that must have been going through Sister Julienne when she realized first that there was a second baby, and then that it was transverse! We know a baby cannot be born when they are presenting sideways, and if someone is not able to successfully turn the baby or perform a timely cesarean section, the baby, and possibly the mother, will die.

Sister Julienne was able to stay calm and give off a quiet confidence despite the chaos I’m sure was going on in her head! One of the best compliments I have received as a midwife is that when I’ve been in emergencies, I’ve been able to remain outwardly calm and confident while taking steps to care for a patient. It’s always so great to hear that feedback, because the fear or panic might be present inside my head, but it’s so important to stay calm so those around you can also stay calm.

Panic doesn’t help anyone in emergent healthcare situations. I used to work with a physician who would hum during emergency c-sections. His seemingly nonchalant attitude in situations that were very high stakes really helped keep everyone involved calm. You had to think, “Well, if the doctor isn’t panicking, in fact, he’s so calm that he’s nearly singing a tune, there is no need for me to panic. He knows exactly what he is doing, and everything is fine.”

Can you imagine what would have happened to Eva Baldwin if Sister Julienne hadn’t kept reaching out her hand? The outcome would have been very different. My biggest takeaways from this episode are that kind and compassionate care can mean the difference between life and death for some women. If someone had shamed Eva for not receiving prenatal care, or they hadn’t looked beyond her initially rude attitude to see that she actually needed help, it could be very easy for someone like her to slip through the cracks.

This episode highlighted the vulnerability of pregnant women, and that healthcare providers need to be diligent about screening for abuse and intimate partner violence. Finally, it reminded me that when I’m feeling burnt out and wondering if what I do is making a difference, the answer is yes. I can make a difference for every single person I provide care to. Even when it feels challenging to connect with patients who seem unwilling to accept help, the continued offer of care and support can be truly lifesaving.