Dr. Clarkson arrives at Downton Abbey to check on Sybil, who is having early labor pains. He declares that all is well, only to be told that Robert is calling in a society obstetrician, Sir Philip Tapsell. When Sir Philip appears, he seems more at home with the rituals of dinner and the drawing room than with the obstetrics case upstairs. At Cora’s insistence, Dr. Clarkson returns. He expresses concern over Sybil’s sudden swollen ankles and muddled mental state. Offended by Dr. Clarkson’s interference, Sir Philip dismisses these warning signs.
Matthew takes advantage of a moment alone with Sir Philip to ask a delicate question about his fertility, in view of his war injury. His worry is that Mary is not yet pregnant after much trying. Sir Philip assures him that anxiety is their only problem.
Meanwhile, Anna has hit on a detail that may prove Bates’s innocence: Vera (whom Bates has been convicted of murdering) was last seen by her best friend scrubbing pastry from under her nails. She had apparently baked a poison pie to make her subsequent suicide look like Bates’s doing, and she didn’t want evidence that would turn suspicion on her.
Scandal rocks the servant class. It seems that Isobel has hired Ethel as an act of charity to the former prostitute and Downton maid. Isobel’s cook, Mrs. Bird, immediately resigns in protest. At Downton, Carson rules that no maids or footmen are to be allowed in Isobel’s house.
In other action, Thomas is taking a keen interest in Jimmy, the new footman, giving him pointers on winding clocks and other chores. Jimmy begins to suspect that his colleague’s friendship is not as innocent as it appears.
Back in the delivery room, Dr. Clarkson is certain that Sybil has eclampsia, a life-threatening complication of pregnancy. He insists that she be taken at once to the local hospital for a cesarean section, which is the only hope of saving her. But Sir Philip is adamant that she is perfectly safe at Downton. Robert agrees with Sir Philip, although he leaves the final decision to the father-to-be, Branson. But time has already run out, since Sybil is about to give birth … to a girl, as it turns out.
Mother and baby are fine, until that night when Sybil goes into seizures, which grow steadily worse. It’s eclampsia, just as Dr. Clarkson feared. With the family standing by helplessly, Sybil departs Downton forever. All are devastated, but Cora is also angry, blaming her youngest daughter’s death on Robert’s obstinacy and Sir Philip’s incompetence.
Robert knows she is right and begins to feel the weight of a decision that has deprived him of a daughter and may destroy his marriage.
Editor's Note: Between 5-8% of pregnant women - 300,000 women each year in the U.S. - are affected by hypertensive disorders of pregnancy such as preeclampsia (formerly known as toxemia), eclampsia and HELLP syndrome. For more information, please contact the Preeclampsia Foundation. http://www.preeclampsia.org.