Editor’s Note: The opinions expressed in this blog post are solely those of the author.

“Sometimes in life you get the chance to start again. We breathe deep, stand tall, we prepare to make our way. The future waits, night has ended, and the light is flooding in. This is the morning that we dreamed of when we struggled. This is the dawn, the new day, the road back. This is everything we wanted, everything we thought was lost and our journey begins…… steps so few that a child could count them—forged by the force of life itself.”

Hello Season 10—what a fabulous journey we have had so far and here is to many more seasons ahead! We begin this Season with Sister Monica Joan’s look of determination and trepidation for the challenges that lie ahead. I felt as if there were physical, emotional, spiritual points of support as we saw the bible, the cross, the cane, and her colleagues, friends and cheerleaders there to support her. Sister Monica Joan’s journey begins with these small steps surrounded by those who love her. We step into Season 10 with new storylines, births and challenges, joys and heartaches, laughter and tears, pain and the salve of togetherness as we walk forward into this journey…this journey called life.

I want to focus my blog post on the storyline of Audrey and Derek Fleming. They experience the highs of a long awaited pregnancy due to years of infertility and then the beauty of her working hard during her labor and birth. There are the two neighbors/best friends laboring in unison; however, one was joyful while Audrey experiences sorrow and the loss of baby Christopher. Christopher is born without limbs below the knee and dies shortly after birth. Derek had been experiencing gastrointestinal issues and after exploration it is identified that he, along with his fellow National Service colleagues, had been involved in Operation Grapple. Prior to the show I had never heard of “Christmas Island” or Operation Grapple. I commend the show for highlighting a public health issue and the underlying scandal of this environmental disaster and resulting impacts that this disaster had on human health and reproduction.

“Christmas Island” was a British colony in the South Pacific Islands—it is now called Kiritimati. This island had served as a stop-over for those during WWII on their way to Japan. After the war they conducted nuclear testing and the first British hydrogen bomb on “Christmas Island” along with “Independence Island” (now called Malden Island). The testing occurred on May 15, 1957, and was code-named “Operation Grapple”. These remote islands were part of the British colonies until 1979. From 1957-1958, there were 9 nuclear testing’s/ explosions. Servicemen from the UK, New Zealand, Fiji, the USA, along with indigenous people were exposed to elevated levels of radioactivity. There was a lack of protective clothing or gear along with exposure from the nuclear fallout and consumption of local water, fruits, and exposures from bathing and inhaling the radioactive dust. Even after a 4 year halt to testing in 1962 the UK joined with the USA on Operation Dominic and carried out another 31 detonations in this region.

There are short term and long term impacts from the radiation exposures. In the episode Derek felt they experienced food poisoning from eating bad fish; however, they were experiencing radiation sickness/ poisoning. While his fellow servicemen gave emotional support to Derek after the loss of his son they shared stories of health implications both for themselves and their children.

The Ministry of Defense in the UK has maintained that there was not an excessive or unsafe level of exposure to the servicemen or local residents. However, military secrecy in the 1950s-1960s, just as the Call the Midwife episode alludes to, did not continue to follow or research those exposed.

The interaction between the environment and human health raise ethical questions related to environmental regulations and health policy decisions. Things get very complex and entail cooperation, transparency and communication with many agencies and varied disciplines. The issues are ever changing and can really go beyond local and regional ramifications but can be global in scope. There has to be exploration and balancing of benefits and risks as many factors can intersect. As well, social justice concerns arise from these issues. Public health strategies can impact human rights in varied ways: individual as compared to the good of society; human rights issues; and even at times property rights.

The midwives in the show were sensitive and very human in their response and made me proud of their professionalism and individualized, respectful care and attention. They gave time to ‘hold space’ and for the couple to be with their baby –even to the extent of putting the baby on ice so that they could have time to absorb the totality of their experience. Bathing the baby with the soap from Derek again showed sensitivity and respect for the couple.

Midwives are in a unique position to provide anticipatory guidance to all their clients/families either through pre-conception visits or during annual primary healthcare visits. It is so important to target conversations to evaluate and identify social, behavioral, biomedical and environmental risks to their fertility as these factors impact their health and their pregnancy outcomes. Hopefully with evaluation, identification, education, counseling and at times intervention – risks can be minimized or reduced. So many people experience unplanned pregnancies so it is essential ANY time you have the opportunity to explore these varied elements of care that you take advantage of that time. As well, all women of childbearing age should take folic acid supplementation as when they arrive for prenatal care it may be beyond the primary period of organogenesis (between 3-10 weeks gestation). Environmental exposures are essential to explore and, when possible, to avoid toxic exposures at home, at work, and in the community.

Below are some resources that I have found helpful and have used during pre-conception, annual visits, and prenatal appointments to open discussion around environmental health-based messaging, exposure-reduction techniques, and resources to suggest for further information. When you are concerned about excessive environmental or occupational exposures or toxicants then involving the local poison control center or even referring a family to a medical toxicologist may be needed.

Looking forward to Episode #2—welcome back CTM – I missed you!

“Nonatus House was far from doomed…. instead it was changing, keeping pace with a dance of time itself. Spring of 1966 was full of new beginnings. Some were evident as daffodils and sunshine others barely stirred beneath the earth…. they would be revealed when their season came. Nonnatus would not give less, or strive less, and it would not falter as it tried to find its way because those who lived and worked there knew what it was to love and why love mattered. Love is all, regardless of its source. With love all things were possible….only without it could anyone be lost.”

RESOURCES

CDC’s National Center for Environmental Health: CDC’s National Center for Environmental Health (NCEH) plans, directs, and coordinates a program to protect the American people from environmental hazards. 

Environment & Human Health Inc. Check out varied pamphlets for pregnancy and things to avoid. 

National Institute of Health (NIH) National Institute of Environmental Health Sciences (NIEHS)

Organization of Teratology Information Specialist (OTIS): Provides factsheets for patients on a variety of common exposures. Or Call 866-626-6847

Pediatric Environmental Health Specialty Units (PEHSU)

Pregnancy Exposure Registries on Reproductive Health and the Environment

Teratogen Information System (TERIS) and Shepard's Catalog of Teratogenic Agents in Seattle, Washington. (Or call 206-543-2465)

United States Environmental Protection Agency

World Health Organization-Environment, Climate Change and Health: WHO pursue a healthier environment by strengthening health sector leadership, building mechanisms for political and social support and monitoring progress towards the Sustainable Development Goals regarding environmental threats to health.