Call the Midwife
The front line: then and now
Health Minister and Conservative MP, Nadine Dorries, was the first member of parliament to be diagnosed with Covid-19. This was back in early March … at a time when there were only 382 reported cases in UK, only 6 people had died. Halcyon days, huh? Less than two months later, we’ve already exceeded 26,000 deaths!
The news about Ms Dorries triggered a memory: I’d read somewhere that she was a trained nurse, and intrigued, I’d bought two of her ‘nursey’ novels in a coffee shop on my way to Wigtown, Scotland’s National Book Town a couple of years ago, stuck them on my shelves, and promptly forgotten about them – The Angels of Lovely Lane and Christmas Angels. Time, methinks, to dig them out and read them … a kind of tribute to the nurses today working so hard to care for people with the virus in a very different world.
I must confess neither the genre, nor the style of writing, are ones I’d normally go for, but there were aspects of these books that gave me pause for thought and sober reflection. These nurses were practising not long before I trained; their experiences resonated with me. Rather like BBC1’s drama, Call the Midwife.
Reading about and recalling those days made me so grateful for all that modern medicine and social care can offer today. How far we have come from those days when
– the NHS was in its infancy
– antibiotics were wonder-drugs
– women had limited career options
– smoking was the norm
– lecture notes were written on typewriters using carbon paper
– rubber tubing was boiled before being inserted into various orifices
– patients were lifted manually
– doctors were revered and all powerful
– women died or were imprisoned following illegal abortions
– ten days bedrest was de rigeur after a simple D&C; three weeks after childbirth
– nurses wore starched collars and frilly caps, always kept their hair off their face tucked inside their caps, lived in hostels with rigid rules, and were all known by their surnames
– silver buckles on petersham belts denoted qualifications
– the Irish were openly discriminated against …
Compare all that with communication, technology, medical expertise, opportunities, science, in 2020. What would have happened if the dreaded coronavirus has struck then?
In her fiction centring on Liverpool in the 1950s, Nadine Dorries has captured a world I knew, and for a few days took me away from the uncertainties and restrictions and anxieties of our present situation, to a bygone era. Memories both happy and sad. But overwhelmingly reasons to be devoutly grateful for what’s available to us today, and the amazing work our front-line staff are doing – and are able to do – to beat Covid-19.
‘Calm down, dear!’
In a former life I used to be a midwife working in an extremely busy labour ward (I’m third from the right in this photograph). In spite of the fast turn-over, we spent long hours with the couples in our care, and often developed warm relationships. We were, after all, sharing one of the most special, intimate and precious experiences in their lives. And for me certainly, it was always a privilege and a thrill as well as a relief to see the infants safely in their mothers’ arms. Indeed, I always said that, if it ever ceased to be a miracle, I would quit the job. It never did; I left for other reasons – good ones.
However, it wasn’t all a bed of roses. One day a mother registered a complaint against me with my boss. Why? Because apparently, I had exhorted her to ‘push into your tail end.’ It demeaned her apparently, reducing her to the status of an animal! Now this was fifty years ago, at a time when we’d never even heard the term ‘political correctness’, never mind become obsessed with the notion, but even so, I confess I felt mildly irritated. When you’re spending a good chunk of a day/night with a woman, encouraging, supporting, reassuring; working through official breaks and long past your shift-hours to deliver continuity of care, you don’t tend to doctor every word that comes out of your mouth. You’ve got more important priorities, I’d suggest. Especially if the woman hasn’t a clue what she’s supposed to be doing and has no knowledge whatsoever of the anatomical names for the parts of the body she’s employing for the mysterious but monumental effort of giving birth. But hey ho! I could only apologise and try to learn from the experience. Fortunately the Superintendent of the Labour ward was a no-nonsense, straight-speaking, hugely experienced woman who fully shared my values, and she generously let me know (without words) that I had her sympathy and confidence.
When I watch Call the Midwife on BBC1, I’m often reminded of those days, since the programme’s set shortly before the time I’m talking about. The Nonnatus midwives even use terms of endearment when encouraging the mothers in their care – ‘sweetie’, ‘love’, ‘pet’, ‘darlin’!! Ppphhhwww!!! It’s some years now since real-life carers were told to eschew such expressions, lest patients/residents/clients, felt patronised, although I’m quite sure they were used in all innocence as terms of affection and engagement, not slights.
Nevertheless, all these decades later, I’m feeling a sense of disbelief. The Royal College of Nursing has just issued a document for its practitioners in which it advises against addressing women as ‘ladies’ to avoid causing unwitting offence … hello?! Other terms now off-limits include ‘pensioners’, ‘alcoholic’, ‘mankind’, ‘manning a ward’, ‘gays’ … Oh, and don’t forget to be scrupulous about selecting the preferred pronouns for people who don’t subscribe to the usual binary classifications, and … You get the idea. Nor is the RCN alone in this; it’s about three years now since the British Medical Association deemed the term ‘expectant mother’ to be taboo, lest it offend transgender people …!!!
Really? Seriously? Has the world gone completely mad?
In the security of my own blog, I think I might be allowed to voice a personal opinion and declare that I honestly think the powers that dictate these things would be well advised to concentrate on gaining more time for clinicians to do their jobs, without the colossal pressures currently hedging them about with stress and restrictions. Time for them to save lives, to ensure safety and the best care, in the first instance. Giving them breathing space – time to attend to those niceties and refinements without burning out themselves. Easing the chronic under-staffing and over-working they labour under, instead of putting even more pressure on them to examine every word before uttering it. Pphshaw!
It appears I got off lightly all those years ago!!
Future possibilities
There will never be a shortage of subjects for me to write about! I lose tracks of scientific breakthroughs and medical marvels. And today, given the breadth and range of material available, I’m not going to even attempt to link everything I mention to scientific papers – Google the key words and you’ll get the information if you’re interested.
When HIV/AIDS first came to our attention in the 80s there were doomsday predictions of biblical plague proportions and real-life devastating statistics. I was a researcher at the time and saw it, wrote about it, first hand. 
Then came huge public awareness campaigns … followed by the development of anti-retroviral wonder drugs … then combination therapies, that could hold the disease at bay. Now here we are, with stories of stem cell donations from people with ‘natural immunity’ rendering patients free from the virus. You could weave a pretty complex plot with that one! And in 2019 my file marked HIV/AIDS looks completely different from the slim wallet of 30 years ago.
Then there’s the transgender issue. Wow! So many dimensions. About young children wanting to transition. About people wanting to reverse the process; the irreversibility of some therapies. About misleading statistics. Eebie jeebie – how crazily tortuous a plot could you construct in that area. The imagination goes into overdrive. Makes my little sally into that world in Inside of Me, pale into banality.
It’s 41 years since the first test-tube baby, Louise Brown, was created, and infertility was very much top of my pile when it came to choosing subjects for my set of novels. Now despite widespread opposition, criticism, vilification, stigma, as many as 8 million babies have been born by IVF. And the endless thirst for knowledge and understanding, coupled with a bottomless pit of compassion, drives researchers and clinicians in this area to seek more and more solutions to the problems couples have in conceiving, or avoiding perpetuating deadly genetic diseases. There’s mileage for several more books to follow on from Paternity, Double Trouble and Saving Sebastian. 
Did you know, for example, that the success rate for assisted fertility is way way higher (50%) than for natural conception (25%) … plenty of scope to work up a story-line there, huh? Imagine a gang of 35-year-old career girls going to the freezer to select artificially-created sperm … or genetically screened/modified embryos … ticking selection boxes along the way for green eyes, athletic ability, fiery temperament …? Endless possibilities!
The statistics on abortion reflect changes in society’s mores and values; programmes like Call the Midwife have increased public awareness of how things have developed in a generation. Add in dating apps, modern career paths, cohabitation, social expectation, fertility statistics … I feel an historical reflective story coming on! I well remember, in the 70s/80s soon after the 1967 Abortion Act was introduced, women coming in for a second, perhaps even third, abortion were looked upon askance. Recent Government figures have highlighted that of almost 68000 abortions carried out in 2017, 1049 were undergoing their fifth abortion and 72 their ninth! And there’s a story behind every one.
Then there’s the horrific topic of female genital mutation … don’t get me started! The recent story of the first person to be convicted in Britain briefly reported in the national press was shocking enough – the little girl was three years old; the mother cut the child herself in her London home; indecent images and animal pornography were involved. I absolutely couldn’t go there with fiction. But … should our collective conscience be prodded?
Resources, caps on the cost of medical and social care … I’m somewhat allergic to numbers, but reading about the human consequences of budgetary restrictions brings out the indignant in me. And might just compel me to write about it if I’m around long enough to get to that file.
Even the topic of assisted dying – a recurring hot potato – has subtly changed since I published my novel on the subject, Right to Die, eleven years ago. The issue’s been described by lawyers for the Royal College of Physicians as ‘one of the most controversial and morally contentious issues in medicine’, but ongoing polls of both medical and public opinion show a definite move towards accepting the need for some change. This might be simply taking a neutral professional stand as against opposing it; or a swing towards legalising some form of assisted suicide in the UK. A novel today could look very different.
Yep, I’m endlessly adding to the possibilities in my files as medicine and science reveal more and more, and society’s tolerances and expectations change. This is just a superficial skim. Anyone out there keen to pick up the gauntlet?
Call the Midwife
Looks like I missed a trick! In 1998 a nurse/midwife/midwifery lecturer, Terri Coates, pointed out that midwives are virtually non-existent in literature. Doctors and nurses yes, – in abundance – but not midwives. Given that they’re at the centre of one of the most spectacular experiences common to all human beings, why is this so?
‘The responsibility they carry is immeasurable. their skill and knowledge are matchless, yet they are completely taken for granted, and usually overlooked … Why aren’t midwives the heroines of society that they should be?’
Jennifer Worth, reading about this in the Midwives Journal, picked up the gauntlet and in 2002 the book, Call the Midwife, was born. It reads rather like a novel in places, but it’s actually based on the true story of life in the East End of London in the 1950s. And of course it rose to fame when Heidi Thomas serialised Worth’s books on BBC TV, series 1 beginning in 2012, and series 7 recently ending on a tragic note which suggests it’ll be back to heal the wounds. And yes, Thomas has indeed signed up for another two series.
The experiences Worth relates rang very true to me. I trained as a midwife myself in the 60s (third from the right in the photo below, taken outside the world’s most famous maternity hospital) and remember vividly that era. Abortion was illegal, premarital sex and illegitimate children were stigmatised, the Pill wasn’t available, racial prejudice was rife, soap and water enemas and pubic shaving were common practice. I too worked in homes where the kiddies ran around in vests and nothing else, free to urinate anywhere without making washing. I learned to take newspapers with me to provide a sanitary base for my bag and coat. Young women did die of eclampsia, infections, undiagnosed complications, back-street abortions. Naive and relatively inexperienced, we accepted the responsibility of being alone in houses with no telephones, few mod cons, but the legendary lashings of boiling water on standby! We too worked long unsocial hours and attended lectures on Saturdays. We too sallied forth anywhere at all hours confidently, wearing our uniforms with pride, and turned our cloaks inside out to parade through the wards in festive red, singing carols at Christmas time.
But Jennifer Worth worked in post-war London; I in Edinburgh and Paisley. She saw a level of poverty and degradation below that I encountered. Prostitution, meths drinkers, homeless immigrants, drug addicts, huge families living in condemned buildings. Mothers desperately trying to keep their families together with no regular income, no benefits, selling hair and teeth as a last resort before being taken in by the workhouse. This was her world.
My own mother regaled me with plenty of stories of those same years and i could only admire the strength and courage of these families who took adversity in their stride and showed such fine examples of parental love and integrity.
It’s a fascinating read, and the success of the BBC show indicates that the topic has widespread appeal. The book includes a potted history of the professionalisation of midwives for those unfamiliar with developments, but the real meat is in the characters and experiences Worth grew to love and appreciate. And the enormous privilege it is to share this most miraculous experience of new birth.