Call the Midwife: real nursing then and now

How has the job changed from the 1950s to today?

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Call the Midwife: real nursing then and now
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That was then...

Jennifer Worth describes a heartbreaking visit in the East End of the 1950s in this extract from Call the Midwife (Orion):

I had another visit to make, to Molly Pearce, a girl of 19 who was expecting her third baby and who had not turned up at the antenatal clinic for the last three months. As she was very near to full term, we needed to assess her.

There was noise coming from inside the door as I approached. It sounded like a row. I’ve always hated any sort of row or scene, and instinctively shrank away. But I had a job to do, so I knocked. Instantly there was silence, and the silence seemed more menacing than the noise. I knocked again. Still silence, then a bolt pulled back, and a key turned. The unshaven face of a surly-looking man stared suspiciously at me through a crack in the door. Then he swore obscenely, and spat on the floor at my feet, and made off down the balcony.

The girl looked flushed, and was panting slightly. “Good riddance,” she shouted down the balcony, and kicked the doorpost.

She looked about nine months pregnant, and it occurred to me that rows of that sort could put her into labour, especially if violence was involved. But I had no evidence of that, as yet.

I asked if I could examine her. She reluctantly agreed, and let me into the flat.

The stench was overpowering. It was a foul mixture of sweat, urine, faeces, cigarettes, alcohol, paraffin, stale food, sour milk and unwashed clothes. She led me into the bedroom, which was dark.

The bed was filthy. There was no bed linen, just the bare mattress and pillows. Some grey army surplus blankets lay on the bed and a wooden cot stood in the corner. I asked Molly to loosen her clothes and lie down. As she did so, I noticed a great black bruise on her chest. I enquired how it had happened. She tossed her head. “’Im,” she said, and spat on the floor.

I examined her. The baby’s head was well down and I could feel movement. I listened for the foetal heart, which was a steady 126 per minute. She and the baby seemed healthy, in spite of everything.

It was only then I noticed the children. I heard something in the corner of the dark room, and nearly jumped out of my skin. I thought it was a rat. I focused my eyes, and saw two little faces peering round from behind a chair. Molly heard my gasp, and said, “It’s all right. Tom, come ’ere.”

...this is now

It’s less personal, but modern drugs save lives, says Gail Wright, team leader of the delivery suite at Leeds General Infirmary, the maternity unit featured in One Born Every Minute (Wednesdays C4):

Midwifery today is very different. The majority of midwives now have specialised roles in big teaching hospitals. You still get very small, stand-alone units where midwives do it all — the antenatal care, the inter-partum care and the postnatal care — but it’s happening less and less because it’s a more expensive system.

Most babies now are born in hospital — only about two per cent of deliveries are home births. Mortality rates are much, much lower for mothers and for babies than they were in the 1950s. We have women coming though our doors now who would never have had babies back then — women with heart conditions, for example, who years ago would never have survived pregnancy and delivery.

Antenatal foetal monitoring — ultrasound scans and screening — has made an enormous difference. In the 50s, you hadn’t the same opportunity to screen for physical abnormalities. Even a multiple birth could come as a shock — often a woman wouldn’t know she was having twins or triplets until the first one was out.

Another big difference is the widespread use of drugs; epidurals for pain relief, for example, or the oxytocic drugs used to stimulate the delivery of the placenta quickly and safely. In the 1950s, you had to wait for nature to take its course and a massive bleed could be fatal.

There is an awful lot more administrative work attached to the job these days. It’s there for a reason, but I think that if more resources were made available for support staff, midwives could spend more time on relationships with patients.

I think that a lot of the time, the Government just sees us as as the ones who “catch” babies. But it’s so much more than that. We get to share with families in that very special moment that no one else gets to see. It’s a very powerful position and we have to be respectful of that.

Call the Midwife continues on Sunday nights at 8:00pm on BBC1

This is an edited version of an article in the issue of Radio Times magazine published 9 January 2012

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