“In the July of 1969, the world was looking upward – far beyond the small round of mankind. Our planet felt tiny but our dreams were gigantic. The universe was swirling and it was in our grasp. We were voyagers, adventurers. We had started something new the power was ours, the potential was ours. We were all astronauts - one way or another.

In Episode 4, two storylines caught my attention: the Apollo 11 mission and the “near-miss” event with Mrs. Prudence Stanton’s birth and postpartum hemorrhage. As such, I wanted to focus on both storylines in this blog post. I was in Grade 2 when the moon landing occurred. On July 16, 1969, we witnessed the launch that took place from Cape Kennedy on television. That year, our family relocated from Windsor, Ontario Canada so that my father could complete his PhD in Columbus, Ohio at The Ohio State University.

I will never forget my parents gathering up the entire family to witness the moment Apollo 11 landed. We had our television, but my parents wanted us to recognize and remember this for the momentous historical event that it was. They brought us to the student center to watch with so many other excited individuals. We saw the images and then heard the famous words, “Houston, Tranquility Base here: the Eagle has landed.” I will always remember the subsequent cheers and excitement I heard on that OSU campus. It is incredible to think that we watched along with an estimated 650 million people as Neil Armstrong said “… that’s one small step for man, one giant leap for mankind” on July 20th, 1969. It took such teamwork for Neil Armstrong, Buzz Aldrin, and Michael Collins to accomplish this feat. So, in total, 24 Apollo astronauts got to visit the moon and 12 of them walked on its surface! The Artemis space program will see a return to the moon — hopefully in 2025.

It seems that when you are younger, you are often asked what you want to be when you grow up. Well, watching that moment in 1969 had an impact on me. For many years, I remember I would lie on the ground next to the couch with my legs bent on the cushions and dream about being an astronaut. This may be crazy, but to this day, if I was asked to go into space, I would jump at the opportunity. And maybe I could dream of catching the first baby in orbit! I was awestruck when I witnessed the moon landing; however, I am always awestruck when I attend to a woman as she gives birth. In that flash of a moment, the world changes a little on its axis— the room stands still as you wait for that first breath. There is nothing but potential in front of you!

To accomplish that unbelievable moon landing it took many years of education and unbelievable preparation, along with following many protocols and processes …. And it got me thinking how becoming a midwife takes many years in the making as well. There are many behind-the-scenes actors from our parents, teachers, professors, preceptors, mentors, and most importantly, the women and families that we have served. They all helped us during our journey and in fulfilling our dreams. In the episode, we saw the student midwives handing in their casebooks for review to be evaluated and given feedback on areas for improvement. We could see their nerves as they knew that not everyone would be successful.

As providers, we are always striving to examine and assure quality as well as aiming for improvement with processes and systems that can aid in that goal. The Health Resources and Services Administration (HRSA) has definitions for both Quality Assurance (QA) and Quality Improvement (QI). Quality assurance (QA) measures compliance against certain necessary standards, typically focusing on individuals, whereas quality improvement (QI) is a continuous improvement process focused on processes and systems. Both of these are essential as we strive to give optimum maternal care. In the United States, the latest report from the National Center for Health Statistics states that 1,205 women died of maternal causes in 2021. The maternal mortality rate had jumped more than 60% over two years, from about 20 deaths per 100,000 live births in 2019 to about 33 deaths per 100,000 live births in 2021. Black women are also three times more likely to die from pregnancy-related causes than white women. The U.S. also continues to be an outlier among other industrialized nations when it comes to mortality rates. While the estimated rates of Australia, Austria, Israel, Japan, and Spain all have a rate between 2-3 deaths per 100,000 in 2020, the U.S.’s number is roughly ten times that.

Despite having one of the most advanced health systems in the world, the U.S. currently has the highest pregnancy-related death rate among developed nations. So what is a “near-miss” event? The World Health Organization (WHO) defines a maternal near-miss case as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” That is what we witnessed with Pru Stanton in our storyline — a near-miss event.

I really felt for Trixie with the woman that she attended — her mind and focus were being pulled in another direction in addition to having a pupil midwife that she was responsible for overseeing. Globally, we note that obstetric hemorrhage is the number one cause of maternal deaths. But, the fact of the matter is we are human. Trixie was not having her best that day and had a horrible reminder that we need to be alert, mindful, and focused. It is hard to believe that it was not until 2008 that the World Health Organization (WHO) even adopted a maternal near-miss definition. The WHO also established standard criteria for the identification of women presenting with pregnancy-related life-threatening conditions. This really was essential so that we could have a common footing across countries and could implement common assessments and comparisons.

As a midwife, I have true compassion for Trixie. Everyone must also be honest that we cannot be 100% every single day. I also think that Trixie was experiencing gender role pressure — this is something that a Modern Day Midwife may not experience. We may not be asked to choose between being a wife or a midwife; however, the guilt and pull that she was experiencing with the multiple roles she wants to fulfill would be similar! If I could talk to her I would want to make sure she has self-compassion for this situation. At times we can all feel inadequate, angry, confused, or struggle with being hard on ourselves. We need to show self-compassion. Self-compassion involves responding with kindness, sympathy, and understanding. When we are hurting we often need to comfort ourselves.

Recently, two colleagues and I gave a webinar on “Mindfulness and Self-Care of the Provider.” One topic we focused on was self-compassion. It is not always easy as we need to remember to motivate ourselves with encouragement rather than criticism. We can at times really fight ourselves with self-criticism, and then flee from others trying to isolate ourselves, or we can just get frozen and think and think and ruminate about what happened. With self-compassion, we can work on self-kindness, common humanity, and mindfulness.

I will be anxious to see the next episode and how the relationship between Trixie and Matthew unfolds. There will be some growing pains with navigating the push and pull of responsibilities. Thank you, Call the Midwife, for making me stop and think about how I can work with my students to remind them that resilience is your ability to recover quickly from problems or difficulties and to enhance coping with life. Students can learn resilience and practice will only enhance it. Self-compassion is one element and it is something they will hopefully embrace.

“Man had reached the moon. Not every star is mapped. Earth remained a place where people could be lost and need a human hand to guide them home. Home is our center of gravity. No scientist can calculate the pull that draws us back or hurls us out into the dark beyond fragile and petrified and brave. But, still, we travel along one small step at a time.”