How are we already at the end of Season 8?! The season finale gave us two exciting occasions to look forward to: Nancy’s wedding and Sister Catherine’s first vows! 

Even though Nonnatus House was busy preparing for these upcoming events, a fire at the mother-baby home (which was used for young, unwed mothers, often planning to place their babies for adoption after birth) nearby forced them to switch up their plans. Some of the young mothers needed to stay at Nonnatus House while they awaited placement in one of the other area homes. 

Although these unexpected guests threw a wrench in some of the wedding plans, it ended up benefitting all involved. Nancy and Collette pivoted to stay with Ms. Higgins, and Rosalind was able to reconnect with her former patient, Paula. 

You might recall that Paula was the young 14-year-old girl found to be pregnant in Episode 1 of this season. Her devoutly religious parents initially considered that her pregnancy had to either be the result of immaculate conception or the work of the devil. Paula’s parents eventually realized that the “care” being provided by the church (an exorcism-like procedure) was highly traumatizing, and sent her to the nearby mother and baby home for the remainder of her pregnancy. After the baby is born and placed for adoption, her parents stated they will accept her to come back home. During her pregnancy, however, they did turn her over to the foster care system, so Cyril became Paula’s social worker. 

Sister Veronica tried to connect with Paula’s mother to see if they would accept Paula to come home for the remainder of the pregnancy when she ended up displaced because of the fire. Unfortunately, Paula’s mother felt strongly that Paula could only come home “once she is a child again.” 

This was heartbreaking to hear; Paula is a child, regardless of her pregnancy status. She needs her parents’ love and support now more than ever. It’s also very clear that Paula is terrified of giving birth. Being moved to Poplar’s maternity home was less than helpful, as Paula was extremely frightened by hearing other women give birth. The only upside to her proximity to home now was that her father was secretly visiting her behind her mother’s back, offering what support he could during this time. 

Fear of birth can unfortunately be very common. If you ask most people to describe labor, they often describe labor as involving the sensation of pain. Fear and anxiety can physically affect the body during labor, too. Fear causes muscle tension, which can make labor more uncomfortable. 

Fear and anxiety also increase adrenaline, our “fight or flight” hormone. Adrenaline inhibits oxytocin, our lovey-dovey hormone that is responsible for uterine contractions in labor, as well as bonding with our babies after birth. Having higher levels of adrenaline, and therefore lower levels of oxytocin, can lead to longer labors. Someone who experiences high levels of fear and anxiety during labor can result in trauma, which leads to an increase in postpartum depression and anxiety, or even post-traumatic stress disorder. Fear can rob a woman of the joy and empowerment of birth.

In Paula’s case, she wasn’t even aware of how women became pregnant or that she even had sexual contact with the boy who got her pregnant. She was so naïve about the situation that suddenly having to learn not only about her body but also about the birthing process was very overwhelming. I thought it was beautiful that Rosalind stayed by her side because the familiar face and continuity of care was probably extremely beneficial for Paula, but being pregnant and having to give birth at that young age was clearly traumatic for her, and I wished her mother would have been by her side.

There were so many things running through my head during this episode. Would Paula’s life have been better if abortion had been available to her in early pregnancy? Would her parents even have consented given their religious beliefs? 

In modern times, we would have also been able to offer Paula an epidural for pain management during labor. I can imagine that would have reduced the trauma of her forceps-assisted birth. In the practice I work for, we would have created a special multidisciplinary care plan for someone like Paula. This means that the whole OB team gets together (midwives, physicians, the high-risk OB team if needed, nursing, and anesthesia) with the patient and we come up with a birth plan together. 

Paula had wished to be put to sleep during her birth and wake up when it was over. Although a cesarean section under general anesthesia is not our first choice for someone so young, having their first baby, it would be something we would all discuss in one of our multidisciplinary meetings if someone requested it. Knowing your care team and being able to voice your concerns and preferences can make a huge difference for someone going through a traumatic pregnancy. 

While I was grateful that Paula and her baby came through the birth physically healthy, I worry a lot about Paula’s mental health in the weeks to come.

Finally, I would be remiss if I didn’t mention the arrival of Nancy and Roger’s beautiful baby girl, albeit a few weeks earlier than expected. I loved how Ms. Higgins and Phyllis immediately reacted with joy upon learning that Nancy was pregnant. Nancy had been so nervous to tell anyone because she already had Collette “out of wedlock.” She didn’t want the nuns at Nonnatus House to be disappointed in her. 

I think we all know the Nonnatus House Sisters well enough by now to realize that they care for all of their patients without judgment, and of course, extended that to Nancy as well. 

When Nancy started experiencing contractions before the wedding, knowing she was likely only about eight months (32 weeks) pregnant, she was terrified. Phyllis stayed with her, providing a calming presence and support. She kept Nancy as calm as possible and prepared her for what to expect. She knew to put the baby on Nancy’s stomach right away and leave the umbilical cord intact, which is ideal for a preterm baby being born outside the hospital setting. The skin-to-skin contact will help keep the baby warm, which is especially crucial for preterm babies. Leaving the cord intact also helps the baby continue to receive oxygenated blood from the placenta, which can help their transition to the outside world. 

It was Phyllis’ combination of skilled midwifery care and gentle kindness that made so much impact on Nancy’s second birth.

So much has changed in Poplar in the 1970s, both in and around Nonnatus House, but Call the Midwife continues to show us how empathy and compassionate care will always remain the cornerstones of midwifery care. Midwives will continue to care for the most vulnerable populations, and our care changes lives. 

It might be hard for Paula to think back about her pregnancy, labor, and birth, but I hope she remembers Rosalind’s kindness and steadfast presence. Nancy had a preterm labor and birth, probably made a little scarier because as a midwife herself, she knows too well what can go wrong. I do believe that being around midwives that she knew and trusted made that experience exponentially easier. 

I can’t wait to see what adventures await the midwives in 1971! Although new evidence will emerge and new technology will continue to evolve around maternity care, the midwives of Nonnatus House will continue to provide the same comprehensive and compassionate care they are known for.