First, Do No Harm

Posted by Andrea Altomaro on April 24, 2019
Spoiler Alert: This post discusses events in Season 8 Episode 4.
Ctm s8 ep 04 007
Credit: Neal Street Productions
Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Many people have heard of the Hippocratic Oath, which is a pledge that states the obligations and proper conduct of doctors, which many doctors even today will recite in medical school. Perhaps one of the most well-known parts of the Oath is the statement of, “First, Do No Harm.”

Nurses don’t recite the Hippocratic Oath in nursing school, but there is a version that was created in 1893 by a nurse named Lystra Gretter, and named after Florence Nightingale.

“I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully.
I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.
I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.
I shall be loyal to my work and devoted towards the welfare of those committed to my care.” 
Florence Nightingale Pledge

Two parts of the Nightingale Pledge stand out to me today. Pledging to do all in your power to maintain and elevate nursing practice is so important. The last line, though, being “devoted towards the welfare of those committed to my care,” is what is resonating with me this week after watching this episode of Call the Midwife.

When we first saw Jeannie Tennant at Trixie’s Keep Fit class, my initial concern was that she may have an eating disorder. For so many years, and of course today, our society has equated thinness with beauty and health, and there is an extreme amount of pressure for mothers to “snap back” to their pre-baby bodies. Don’t even get me started about how medical professionals are often the most fat-phobic of all, discrediting women’s complaints if they are overweight, or oversimplifying that losing weight will solve whatever complaint they may have. I could probably go off on a tangent and write an entire blog post about this topic, but I’m going to switch gears to what Jeannie’s actual problem was: an undesired pregnancy.

Jeannie had two young boys. She and her husband had a plan, were buying a house, and she was set on giving her children a life she never had. Jeannie mentions that her mother had seven children, and suffered from mental breakdowns that led to Jeannie and her siblings being placed in foster care. Jeannie’s biggest fear is that her life could turn out like her mother’s. With the news that she was expecting another baby, Jeannie could see the life that she had worked so hard for slipping away.

Jeannie tried to go about getting a termination as safely as possible. She asked Dr. Turner for help. She expressed her concerns about how her mental health might suffer because of this unplanned pregnancy. Because of the law at the time, and probably also because women’s health concerns are often downplayed or dismissed, Dr. Turner states that because abortion is illegal, he cannot help her arrange a termination. Both Trixie and Dr. Turner had tried to convince Jeannie that with time, she would become happy about the pregnancy and new baby, and the midwives could support her through the pregnancy.

That’s the thing though. Midwives can offer support during a pregnancy, but we’re not therapists. We’re certainly not au pairs, and we’re not going to show up at the mother’s house at 3am when she hasn’t slept in 2 days and hold the baby for her so she can get rest. We’re not going to help her pay her rent that month, or get money for groceries. Continuing a pregnancy is not just about the fetus and the pregnancy, there’s a baby, who grows into a child, and you’re responsible for that child and their well-being for the rest of your life. There are many people who may be ambivalent about a pregnancy in the beginning, and sometimes supportive care from a health care provider can make a difference in that woman’s life and experience, but there are also women, like Jeannie, who immediately feel very strongly that this pregnancy would be detrimental to their mental health or their life.

Continuing a pregnancy is not just about the fetus and the pregnancy, there’s a baby, who grows into a child, and you’re responsible for that child and their well-being for the rest of your life.

I’m so glad that Call the Midwife is willing to go deep into this controversial topic, because this remains a hot news topic today, and the amount of harmful misinformation about abortion laws that has been circulating creates a lot of panic. As a medical professional, I’ve said it before and I’ll say it again, I will support my patients in their decisions regarding their own health care.

Dr. Turner was struggling after doing everything he could to save Jeannie (although, I did panic about the terribly slow chest compressions—I wanted to scream at the television “100 BEATS PER MINUTE!”). He felt responsible. I’m certain that when Dr. Turner became a physician, he took the Hippocratic Oath, and also made the pledge to “Do No Harm.” Sometimes, in the case of abortion, that can be a personal struggle for a health care provider. Who is the patient—the pregnant person only, or the fetus? Both? Especially in a time where all abortion was illegal, Dr. Turner felt like Jeannie’s concern over being pregnant would resolve with time, and I’m sure he felt he was doing the right thing by denying her a medical termination of pregnancy. He, and many health care providers, will often only consider one’s physical health when it comes to treatment recommendations. I can’t imagine the guilt Dr. Turner felt when Jeannie’s husband said, “She came to you, and you sent her away!”

I believe Dr. Turner’s character is a good man, and thought he was doing the right thing. I believe that he truly meant no harm by refusing to refer Jeannie Tennant for a medical abortion. If we can take anything away from this episode, I hope it is that we understand that we really cannot assume we know better than any of our patients. We are not living their life, or living in their bodies, and no one knows their bodies and minds better than they do. We must take the time to listen to our clients, and provide care that is in their best interests, whether or not it is the choice we would make for ourselves if presented with the same circumstances.

About the Author

Andrea Altomaro MS, CNM, IBCLC has been nurse-midwife since 2012 and is currently working for the Henry Ford Health System. Andrea knew from a young age that she was interested in pregnancy and birth, and decided to become a nurse. When she learned about the role of certified nurse midwives when she was in nursing school, she knew she had found her path.