Medical dramas on television have always been popular, but rarely do medical professionals think they get it right. Call the Midwife always seems to find a way to master this, and episode 2 this season was right on the mark yet again.

Trixie is assigned to care for Arlene, a pregnant woman who was just released from the Linchmere Hospital, a psychiatric facility. Arlene has “manic depression,” or what we would call bipolar disorder today.

I absolutely love how Trixie really embodied the essence of midwifery care during her interactions with Arlene. She was patient, kind, and nonjudgmental. She studied up on lithium use for bipolar disorder because this was a new treatment at the time, and she wasn’t familiar with this medication or its possible side effects.

Midwives are known for being experts in the care of low-risk women. But depending on where you practice, you may actually be involved in the care of moderate- to high-risk women and will co-manage their care with a physician. This is what we do in my current practice.

Since the Nonnatus House team, plus Dr. Turner, are the only maternity care providers within Poplar, the midwives often continue to see women with additional risk factors during their pregnancies. When someone “risks out” of their care, they will be cared for at St. Cuthbert’s Hospital.

Unfortunately with Arlene, we do see another example of poor patient communication and education from her psychiatric care providers. It seems they take the approach (apparently quite popular with hospital staff at the time) where “they know best,” “please don’t question their care plan,” and “just do as they say.”

They also failed to see that an offhand comment about not wanting Arlene to breastfeed while taking lithium frightened her from continuing to take the medication during her pregnancy. Arlene wanted her baby to be healthy; she loved her baby so much that she couldn’t bear the thought of the lithium being potentially harmful.

We know so much more about how medications affect unborn babies today, as well as understanding that risk/benefit ratios exist; sometimes, taking a medication that might carry some risks to a pregnancy is worth it if it greatly improves the health of the mother.

Today, we feel strongly that continuing on many psychiatric medications through pregnancy is beneficial if it keeps the mother’s mental health stable. We know what medications are definitely harmful to a baby versus what medications carry a potential risk.

If one of the psychiatric doctors had taken a few extra minutes to have explained the importance of maternal mental and physical health on having a healthy pregnancy versus the very small risk of lithium use, it may have helped to keep Arlene safe and healthy and taking her medication.

Arlene went into labor during a manic episode, but thankfully Trixie and Dr. Turner were right by her side. Though, we did see a birth emergency occur – something called a shoulder dystocia.

A shoulder dystocia is when the baby’s head is born, but the shoulders become stuck behind the mother’s pubic bone. The shoulders do not deliver with the mom’s pushing efforts and routine obstetric care. This is an emergency because once the head is delivered, the baby is not getting oxygen until its entire body is born. We only have minutes to get the rest of the baby out before brain damage can occur.

Trixie and Dr. Turner did almost everything right. Trixie verbalized out loud that the head had been born but the shoulders weren’t coming, so Dr. Turner would be aware. They tried two different position changes that can often help the shoulders be born. Finally, Dr. Turner said he was going to “help the baby out.”

That was where I started cringing.

He did a maneuver called “fundal pressure,” which is not used anymore because it was found to be much more harmful than helpful. However, in the 1970s, I’m sure this was the standard of care! As with everything in medicine, when you know better, you do better.

Today, we realize that fundal pressure can actually make a shoulder dystocia occur, or, if it is already present, can worsen things. We have several different evidence-based interventions we would use instead.

In the end, Arlene had a healthy, beautiful baby girl. Due to her unstable mental health at the time, her baby would be placed into foster care. I am so glad that Trixie was able to continue to care for Arlene and her baby, even while in the hospital, and was able to facilitate some bonding between them before they had to be separated.

The way that Call the Midwife showcases the spirit of midwifery is probably what keeps most of us so engaged season after season. Midwives aren’t perfect. Our jobs are stressful and tough and sometimes devastating, but also beautiful, magical, and could even be described as sacred.

Patient-centered care is a cornerstone of midwifery, and treating all patients with respect is of utmost importance. We saw this in the way that Trixie cared for Arlene as well as how Shelagh and Miss Higgins cared for everyone involved in the gonorrhea outbreak.

The kindness they showed Ada Rowntree when they discovered she was working at the brothel was exactly the way I hope to show up for my patients. Although Miss Higgins was surprised to see her there, she quickly let Ada know that this didn’t change the way she saw her. Ada said that she wished she didn’t work in the brothel, but she had to make ends meet and continue to provide for her family.

Ada was a good mother, and working in sex work didn’t change that. Miss Higgins was even able to shift her plans to allow all of the women at the brothel to be tested and treated on site, instead of hoping they would come to Dr. Turner’s office. This removed barriers to care (possible struggle to get time off, transportation issues, fear or shame in seeking treatment) and also helped to stop the spread of gonorrhea within Poplar.

I’m certainly not suggesting that every midwife is kind, patient, and nonjudgmental. However, providing compassionate and respectful care to every patient is ingrained in us from nursing school and all the way up through our midwifery education. Trixie, Shelagh, and Miss Higgins all displayed these abilities in this week’s episode.

The episode reminded us of the impact of diligent and compassionate healthcare. As always, the midwives of Nonnatus House are a beacon of hope, reminding us that even in challenging cases, the power of human connection and unwavering support can make all the difference.