“Perhaps it is always best to start things in the spring. Matching our rhythm to the earth’s clean beat…moving in synchrony with nature’s good intentions: small beginnings, time to grow, sunshine to feed the farm, and drink.”

Welcome back Call the Midwife—I have missed you! It is amazing that it is Season 13. I felt excited knowing that we would meet the new students to join the Nonnatus House team. As an educator, I do know that preparation with getting all your ducks in a row with requirements, and the anticipation of that new and unbridled energy with your incoming students. For students and teachers a year is not January to December; but, it is always the beginning of each term that marks a new start to life!

As a Modern Day Midwife, I did note some things from this episode that made me smile. In some instances, the Season 13 premiere depicted some changes or advances in obstetric practices, while in other cases, showed many outdated ones. I wanted to blog about some of these things that I noted in Episode 1.

At the beginning of the show, we saw the students witnessing a forceps birth, with the woman in stirrups and the entire student team (midwifery and doctors) all watching as she gave birth to her son. Everyone was in a stark white. When the woman was "delivered" of her child, her baby was handed off to the waiting nurse. The midwifery students were asked to vacate the room while the residents stayed to learn suturing. Thankfully, I do not feel we still have that type of witnessing of birth. However, I am sure it does depend on the district you live in. I actually remember when I was in school there was a “theatre” type setting whereby students could sit and watch from above! It is crazy to reflect on that now.

As a Modern Day Midwife, there would now be a shared decision-making process of having a student participate; there would also just be one student, not a whole group. If we did need more medical assistance at a birth, we would “protect” our client from unneeded individuals in the birthing room. Additionally, today, we no longer have the stark white teams — birth has perhaps gone "technicolor." We have also seen a large decrease in the use of forceps. When I entered obstetrics in the 1990s, the rate of forceps use in the USA was over 5%, however, the most recent data reports a rate of 0.5% (Statistica, 2023). The last part of this specific scene shows the baby being shown to the mother wrapped up in a blanket and taken away. Today, that baby goes right to the mother’s body for skin-to-skin contact.

In this episode, we also saw the new team of student midwives — Joyce, Kathy, Norelle, and Rosalind — move away from their hospital experience toward that of the community. In one scene, Trixie and Shelagh instruct them on their delivery bags. I smiled when they noted the use of enemas and razors that were common practice in the hospital setting but were not welcomed by their clients in the community setting. When I started my career as a labor nurse in 1988, it was still common to give enemas, shave women, and use stirrups when physicians attended births. Yet, these practices were not common for midwifery births. Thankfully, we have now seen this practice altered for obstetrician practices as well!

Later on in the episode, when Trixie was evaluating her client for potential labor, she used a Pinard to listen to the fetal heart tones. A Pinard horn is a type of stethoscope that allows you to auscultate or listen to the fetal heart rate. It is typically made of wood or metal, and its hollow center amplifies the sound. You put the wide end on the abdomen and then listen through the other end. It reminds me of a trumpet in some ways. I have a wooden Pinard and we occasionally will have a client that still wants this used; however, we most often use a handheld Doppler to listen. This way mum and the support people can hear the fetal heart rate as well. That said, I loved seeing Trixie use her Pinard! I have a necklace with a charm of one on it and I find only my midwife colleagues know what it is!

There are two ways of monitoring the fetal heart rate — either continuously or intermittently. When we continuously monitor a woman, they are on an electronic fetal monitor. There is one belt recording the uterine activity, or uterine contractions, and one recording the fetal heart rate. When we intermittently monitor, we can use a Pinard or a handheld Doppler. In the hospital setting, most women who go to an obstetrician, whether they are low risk or higher risk with health complications, are put on a continuous external or internal monitor.

Interestingly, researchers have found that when mothers are monitored continuously, there is a significant increase in cesarean surgeries, forceps births, and interventions. When the technology was developed, it was touted as being able to reduce cerebral palsy; however, there has been no reduction in cerebral palsy or neonatal deaths when it is compared to intermittent auscultation. I have put an article reference at the end for those who wish to read more about fetal heart monitoring and its recommended frequency in labor. The article is by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). There is also a nice article by Lisa Heelan which gives some historical information along with discussion points regarding informed choice. 

Thank you, Call the Midwife, for bringing me down memory lane with some things that I have not reflected on in a while. The next time I am with my students I will ask if they have ever used a Pinard or seen one — and I will report back.

“In the spring of 1969 no one at Nonnatus House knew what the future held. They only knew that the future had begun. Seeds had been sown and sap was rising. There would be growth there would be opportunity. There was so much hope. They knew spring would turn to summer and to autumn. That leaves would brighten and fade to brown and then snow would fall and everything would change. But at Easter—everyone was flying. The sky shone with promise and they could see forever.”

REFERENCES

Association of Women’s Health, Obstetric and Neonatal Nurses (2018). Fetal Heart Monitoring. Nurs Womens Health, 22(6), 506-509. doi: 10.1016/S1751-4851(18)30227-7. PMID: 30501908.

Heelan L. (2013). Fetal monitoring: Creating a culture of safety with informed choice. Journal of Perinatal Education, 22(3), 156-65. doi: 10.1891/1058-1243.22.3.156. PMID: 24868127; PMCID: PMC4010242.

Statistica (2023). Percentage of births delivered by forceps or vacuum extraction in the United States from 1990 to 2021.