As I watched Call the Midwife, I recalled my own personal memories and relationship with the National Health System (NHS). I trained as a midwife in the late 1980s in one of the busiest (if not the busiest) inner-city maternity hospitals in Britain. We delivered 8,000 babies a year. Midwifery training was highly competitive. The school admitted twelve students who had a minimum of one year experience as a registered nurse, three times a year. We trained in the school, the maternity hospital, and the community. By the 1980s, all midwives in Britain went through similar eighteen month training and took national exams that included an oral examination in London in front of a Board of Examiners.
It was a challenging training and one that was particularly difficult after running my own ward as a night nurse. I remember one slow Sunday afternoon in particular when Sister ordered me to refold the linen in the linen cupboard. Astounded, I reminded her that I was in fact receiving double-pay for a Sunday afternoon shift, as it was considered “unsocial hours” by the NHS. Was there something else I could do? Her answer was that I should fold everything in the linen cupboard.
The training could appear extremely petty at times. But there were also some eye-opening moments too, especially when visiting the homes of some of our clients. Midwives were required to do home visits at 36 weeks to make sure that fires had guards, and to deliver home delivery packs if needed. The hospital catchment area included the largest low-income housing (council estate) in Europe. Leigh Park was built after the WWII to house those families who had lost their homes during the war. By the 1980s, these postwar homes had become slums with torn and threadbare rugs, greasy sofas and cigarette butts littering the smokey rooms. Call the Midwife reminded me of the slums I visited and the poverty I witnessed in the late 1980s at the end of the Thatcher years. I also remembered that most of the poor women wanted to deliver their babies at the hospital. They wanted to stay as long as they could in a comfortable bed with meals made for them and away from the squalor of their daily lives. This was so different from the women in Call the Midwife who preferred to deliver at home because of a fear and dread of hospitals.
Call the Midwife reminded me of the antenatal wards in the maternity hospital. We had an open door policy. Women could present themselves at the hospital for admission at any time during the pregnancy. Many took advantage of this policy thinking they might be in labor, or having seen vaginal bleeding, or witnessing a decrease in fetal movements. The philosophy of the midwives who worked at the hospital was that no woman came without a good reason. It might be the need to escape an abusive partner, or the need for a rest, or increasingly in the 1980s, because of hunger. Every woman was taken seriously and examined carefully. All were required to stay for at least 24 hours if they came to the hospital. Many stayed longer. I remember one woman, who insisted she had fallen into a doorframe and received a black-eye, two broken ribs, and bruising to both armsm ended up staying for two weeks. Domestic abuse was common, but the police rarely intervened and the women rarely complained. Our maternity hospital, with its locked doors and limited visiting time, provided a refuge for women like this as they thought through the reality of leaving the fathers of their unborn babies.
The Flying Squad
My older sister was delivered at home by a midwife in the 1950s. My mother hemorrhaged after delivery and the midwife called the “Flying Squad,” which was an ambulance with a doctor, another midwife, ergometrine, and blood supplies.1 Usually coming from the nearest hospital, the flying squad was the emergency response service in case of an unexpected problem during a home birth such as post-partum hemorrhage, an undelivered placenta, or an infant needing extra attention. The first episodes of Call the Midwife illustrated the way the “flying squad” was an essential aspect of maternal-child healthcare when the squad responded to the midwife’s call after the delivery of a preterm infant.2 Calling the flying squad wasn’t that easy. Most homes in 1950s Britain did not have telephones. In a particular episode, a child in the family went out to find a telephone box. Today, public telephone boxes in Britain are practically non-existent, as most individuals carry a cell phone. In the 1950s though, the presence of a working public phone could mean the difference between life and death. In one episode however, the unexpected happened. The newly delivered mother, a Spanish-speaking patient, refused to have her premature infant taken to the hospital and placed in an incubator. Instead, the mother instinctively kept her infant son in her arms and fed him drops of breast-milk every hour. The child thrived and the family was kept intact (I can’t help wondering if a woman would have the same right today to refuse medical intervention for her premature infant, especially a woman who could not speak English…).
Set up in 1948, the NHS trained nurses and midwives from all social backgrounds. Faced with a shortage of labor after WWII, many women chose to train as nurses and midwives. Call the Midwife, in many ways, sets out to demonstrate this with some of the characters. “Chummy,” Camilla Fortescue — Cholmeley-Browne, was just one of the more eccentric elite women who trained as a midwife and found herself at Nonnatus Hosue.3 She had never learned to ride a bicycle, a requirement for community nursing in the 1950s. Sister Monica Joan, probably suffering from a form of dementia, is another woman with an elite background who devoted her life to the religious order and to delivering the babies of the poor in London’s Docklands. Sister Evangelina, on the other hand, is from the East End and the same social class as her patients. She makes it quite clear that she knows all the tricks and won’t be outsmarted. The protagonist, Jennifer Worth, is young, lower middle-class, and treats the East End like a tourist. These characters pale in comparison to some of the more colorful individuals that make Call the Midwife appealing to viewers.
The show is set against the background of austerity and rationing that continued in Britain until 1954. This meant that much of the NHS was cobbled together, and purpose built midwives clinics took years to be built. The midwives and sisters of Nonnatus House used community centers or other spaces to examine outpatients (Later, midwives used the local doctor offices in the afternoons for their clinics, as doctors held surgery in the morning and evenings and their offices were available then. This practice continues today in areas without a community healthcare clinic). Sisters of Nonnatus House were held in high regard by the locals because they stayed during the bombing raids during WWII that killed more civilians than military personnel (the government attempted to order the evacuation of children to the safety of the countryside in 1939 but many returned to their families during the phony war). The presence of the services of Nonnatus House meant that families could stay together and be assured of civilian nursing services at a time when medical services were in short supply. Babies were delivered at home by competent practitioners and the locals did not forget. The lack of running water or the squalor of the tenements did not help the work of Nonnatus House, but they did speak of the unutterable condition of Britain’s working-class homes in postwar Britain before reconstruction.4
Nonnatus House, and the midwives who worked as a team, delivered babies and care to women who had either chosen not to use birth control or who had chosen to continue their pregnancies. It was not uncommon for families to include eight to ten childre. I remember living on a street as a child where the neighbors had eleven children in a three-bedroomed house. It was always crowded in the house and there were always children on the front step.
The poverty and the squalor of the Docklands in the 1950s made me think of the film, Vera Drake.5 Set in 1950s Britain, Vera Drake is a wife, a mother, and a woman who also secretly helped women terminate unwanted pregnancies. At a time when few families could support large families, illegal, back-street abortions were the only option available. The film suggests that Vera Drake is committed to helping women and girls with unwanted pregnancies because she herself had an unwanted pregnancy as a girl. At the end of the film, Vera is in prison because one of her clients, a young middle-class girl coerced into an abortion by her mother, experiences a life-threatening complication after the abortion. The girl recovers after medical assistance but the mother exposes Vera to the police, illustrating the dangers of having an illegal abortion as well as the danger of performing one. After 1967, women could obtain a legal abortion through the NHS.
The shock at discovering an active sexually transmitted disease in one of the patients at a clinic set up in a community center on Call the Midwife tells us a lot about the sensibilities of the midwife but also perhaps something about the state of sex education or knowledge about sexually transmitted disease in Britain after WWII. Jennifer Worth asked the Nonnatus House Sister, “how could she not know” about the state of her own reproductive organs, given the smell and the open chancre? How do we know unless we are taught? This was a teachable moment for a young, educated, middle-class woman but also an indication of the depth of ignorance that could accompany abject poverty and neglect in an area like the East End.6
In many ways, Nonnatus House and the midwives in Call the Midwife, bridged the old order and the new and stood as a testament to the multitude of voluntary and religious welfare organizations that eventually merged to become part of the new National Health Service. Midwifery before the NHS was part of the District Health Service. This continued even with the establishment of the NHS as women in Britain were given choices about birth. Hospitals like St. Mary’s in Portsmouth, where I trained and worked, existed for “high risk” pregnancies. The GP unit (physically attached to the maternity hospital in Portsmouth) offered delivery with a midwife in a low key environment, not unlike a home-birth but with piped oxygen in the case of an emergency. Women could also choose to deliver in a birth center close to their home or at home. During the Thatcher years, the birth centers were considered too costly to stay open and were duly closed. Women in Britain still have the choice to deliver at the hospital, the GP unit, or home births, always attended by a midwife.
In 1975, my sister had her first baby. During this period, the practice of allowing first-time mothers to deliver at home was discouraged because of the “unknown” and potential complications such as my mother experienced during her first delivery. My sister gave birth at St. Mary’s hospital attended by a midwife. After discharge, the local midwife came, on her bicycle, to visit every day for the next two weeks. She was a local heroine to many women, dishing out cures for blistered or cracked and bleeding nipples; swollen episiotomies; engorged breasts and infants failing to thrive. Her job was the lynch-pin in the National Health Service maternal-childcare. When she felt sufficiently happy that mother and infant were stable and healthy, a minimum of fourteen and a maximum of thirty days after birth, the midwife handed her patients to the health visitor. The health visitor administered vaccinations, tabulated infant weights, evaluated infant milestones and looked for signs of postnatal depression or child abuse.
The NHS in Britain has been criticized by many. I would argue that the maternal-child healthcare that was established in the aftermath of WWII has served to support and encourage women and their families to enjoy health as a human right and as an essential aspect of social citizenship. I think, in many ways, that Call the Midwife is a timely reminder of the people who helped establish the foundation of those rights. While the show sugarcoats some of the very real difficulties experienced in the 1950s by healthcare workers and their clients, it does bear witness to the beginnings of a national system of care.
- The British equivalent of Methergine. Return to text.
- Call the Midwife is an adaptation of Jennifer Worth, The Midwife: A Memoir of Birth, Joy, and Hard Times (Penguin, 2002) and Farewell to the East End (Phoenix, 2009). Return to text.
- This was a pseudonym used by Rachel Worth, the author. Return to text.
- The problems associated with the re-housing of the East End were assessed by two sociologists and included a lack of family support, especially with children and the loss of community life. See, Michel Young and Peter Wilmott, Family and Kinship in East London (London: Penguin, 1965). Return to text.
- Vera Drake, (DVD) Mike Leigh, dir. Studio Canal, 125 mins. Return to text.
- For more on working-class birth control in Britain see Kate Fisher, Birth Control, Sex and Marriage in Britain, 1918-1960 (Oxford: Oxford University Press, 2006). Return to text.