Embracing change plays an important role in Episode 7 as many of Poplar's residents remain resistant to contraception and new ways of birthing. Andrea Altomaro explores this issue.

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 7

“Nothing stays the same. We don’t stay the same, ourselves. And all the time, the world keeps on spinning faster.” – Sister Evangelina

So much has changed between the 1950s when we first met the midwives of Nonnatus House and our current season in the 1960s. One of the most exciting (and controversial) developments of the time was the contraceptive pill. Dr. Turner and Shelagh were thrilled with what the contraceptive pill could offer, especially to unmarried women.

Prior to the arrival of “the pill,” women needed to visit a family planning clinic for any contraception, and only married women could be referred to a family planning clinic. However, Sister Julienne struggled with the moral implications of the pill and cautioned the midwives about promoting “recreational intercourse.”

Most of the Nonnatus midwives seemed to feel that taking contraception and putting it in complete control of the woman was exactly what was needed. Prior to this, women had to try and convince their husbands or partners to wear a condom, or they had to rely on less reliable methods of contraception, like we (quite surprisingly!) learned that Nurse Crane had done back in her younger days.

Dr. Turner told the midwives that the contraceptive pill boasted a 100 percent success rate when taken as directed. Today, we are hesitant to say that anything is 100 percent effective, but we do know that with perfect use, combined estrogen and progesterone contraceptive pills are 99.9 percent effective. With typical use — which means that women might occasionally take a pill late or miss a pill, or sometimes forget to start a new pack when the old one is done — the failure rate is around 8 percent.

Dr. Turner had mentioned that 10 percent of babies born in Poplar were born to unmarried mothers. Even with a typical-use failure rate of 8 percent, the pill could prevent a great deal of unplanned pregnancies, and with that, avoid the stigma that came with being an unmarried mother in the 1960s. What an exciting prospect at the time!

Today, we not only have the contraceptive pill, but we have many forms of safe, reliable birth control. These range from the daily pill (similar to those that first came out, however it was soon realized that we could use much lower hormone doses and still remain effective, thus decreasing some of the risks and side effects).

Thankfully, anyone is able to visit a family planning clinic, doctor or nurse midwife and discuss their contraceptive options and work toward finding a method that will work best for them.

This week, we also met Daisy Blacker, a bargee. This meant that Daisy and her family lived on a barge and traveled frequently. Daisy was very independent and delivered all of her children on the barge without any help. After a scare where she fainted during this pregnancy, she agreed to a stay in the maternity home for rest and monitoring.

Right away when Daisy arrived to the maternity home, I started to cringe. Shelagh brought Daisy a hospital gown, robe and slippers, and written on the gown in big bold letters was PROPERTY OF THE MATERNITY HOME. What a horrible thing to have stamped on your back! Daisy was already feeling hesitant about being away from her family, and she became even more upset when her children came to visit her and they had all been given new clothes, new haircuts and washed with de-lousing shampoo.

She wailed that her children didn’t even look like themselves! Patsy tried to tell Daisy that they were just trying to help the children feel like they were fitting in at school. She didn’t realize that this interference seemed to Daisy that everyone was trying to change her and her children, that somehow being themselves wasn’t good enough.

When people come into the hospital today, whether it be for a prolonged stay prenatally or in labor, we often encourage them to bring and wear their own clothes, along with any amenities they might like to help their hospital room feel more like home. It can be very hard to feel comfortable in labor if you’re wearing a hospital gown that flies open in the back, leaving your rear end exposed.

In labor and birth, we really need oxytocin, the love hormone, to be front and center to allow things to progress. Adrenaline, our stress hormone, will take over if we feel defensive, anxious or unsafe, and this hinders progress.

Something as simple as having someone remain in their own clothes can help someone feel not only more comfortable, but more human. You are not property of a hospital or a midwife or a doctor — you are an individual who has chosen a hospital and a care provider to help you and be present while you labor and birth your baby.

This wasn’t always the way of thinking (and still might not be for some hospitals and providers), but the central theme of our most recent episode is embracing change. It’s hard for everyone to embrace change.

With the triumphant arrival of Sister Evangelina, we also received her wise words: “When things change, we have to find a different way.” We get set in our ways and the thought of having someone labor in a tank top and a skirt isn’t the way we’ve always done it.

We also used to immediately clamp and cut the umbilical cord and pass the baby over to a warmer to be cleaned off and wrapped in blankets before the mother could hold her own baby. Now we know that immediate skin to skin contact and delayed cord clamping are evidence-based care, and we strive to provide that to everyone.

Kudos to Daisy for knowing instinctively to leave the cord connected! As she said, “There’s worse things than being completely part of someone, being part of something bigger.”

Andrea Altomaro (MS, RN, CNM) has been nurse-midwife for the past three years and is currently working for the Henry Ford Health System. Before becoming a midwife, she worked as a nurse in the emergency department and also in labor and delivery.
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