Call the Midwife: why the NHS used sock puppets to teach breastfeeding

The strange history of knitted nipples in 1960s Britain

BBC, TL

The British have a thing about breasts. We’re happy to expose them, inflate them or fetishise them, but when it comes to their primary purpose – feeding infants – squeamishness sets in.

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“Being very northern European about this, we still don’t tend to breastfeed in front of each other all that easily,” says Terri Coates, the midwifery adviser on Call the Midwife. And while medical advances over the past 60 years have transformed many aspects of giving birth, the knitted breasts and sock-puppet babies used to teach 1960s mums about breastfeeding today remain an oddly retro feature of antenatal teaching.

“There’s a lot to be said for the knitted body part,” laughs Coates. “Sock puppets are actually very good for showing how the baby latches on to the breast, and the knitted uterus is great for demonstrating how the neck of the womb opens when a baby is being born – just think of pulling a very tight polo neck over your head!”

Coates has worked on Call the Midwife since the first series in 2012; indeed, it was an article she wrote in the Royal College of Midwives’ Journal in 1998, calling for “the James Herriot of midwives” to step forward, that inspired retired midwife Jennifer Worth to write the bestselling memoirs on which the series was based (Coates also advised on the books).

A practising midwife, lecturer and author, Coates started her own clinical training in 1975. “The people who were training me were the girls in Call the Midwife, ten years on.”

Social and political factors have complicated women’s response to feeding their babies, says Coates. “Midwives, though, have always been required to promote and support breastfeeding. In the 1950s and 60s, if someone was bottlefeeding, we actually had to notify the authorities, because it was seen as a risk to the baby. But around the same time, Page Three topless models were a big deal, and breasts weren’t primarily seen as something for nurturing an infant. Then, in the 70s, Women’s Lib played its part – if the baby was being fed by bottle, the mother could get back to work.

“But more recently, in some circles, breastfeeding has been promoted with such zeal that women felt guilty if they’re bottlefeeding – which is sad, because breastfeeding isn’t right for everybody. Personally, I feel it doesn’t really matter how you feed your baby as long as mother and baby are well and happy. That’s possibly not the line everyone would like a midwife to take, but being pragmatic, I think it’s probably the best.” In the era that Call the Midwife is set, Coates says that becoming a mother was sociable.

“Until well into the 80s, pregnant women were offered training in what was called ‘mothercraft’ and later became ‘parentcraft’ – a series of classes, paid for by the NHS, where they made great friendships that lasted beyond their baby’s birth.

“If dads attended those early antenatal classes, it was mostly to tell them what to expect after delivery – and if they were present at the birth, it was generally because they hadn’t left the room quickly enough! In our antenatal sessions we used to shoo the dads off to the pub. The mums then had a whole different level of intimate conversation. The camaraderie was wonderful.

“Nowadays, because there is so much information at the touch of a button, I don’t think people feel the same need for midwives’ professional advice – and the way the NHS is funded now, we couldn’t afford to run classes like that anyway. But the problem with Google or Siri is that, if you don’t know which questions to ask, you’re not going to get the right answers. Technology has isolated mothers enormously.”

Birthing scenes in Call the Midwife are so realistic that they’re used as a teaching resource for trainee midwives. “I help the director choreograph what is clinically plausible within a given scenario,” says Coates, who is studying for a PhD in the portrayal of childbirth in TV drama.

“We practise with dolls and prosthetics, so you can spend five or six hours doing a birth, but the baby is only on set for a minute or two. I’m always there, crouching, dangling or leaning just out of shot, to make sure the baby is safe.”

The filming of newborns is strictly regulated and all babies appearing are licensed, with initial paperwork sometimes being completed while they’re still in the womb.

“We have babies just a few days old, others a week or so, but we prefer it when they’re born slightly before their due date so they’re still sleepy and curled up,” she says. For “first birth” scenes, the babies are massaged with oil warmed to body temperature “to make them look wet,” Coates explains.

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“If we used water, the baby would chill very quickly. We also maintain a very, very warm environment – it’s uncomfortable for the cast and crew, but we’re keen on making sure that everything is 100 per cent right for the babies.”