As I reflect on this week’s episode of Call the Midwife, I can’t help but focus on the hostility that Nurse Joyce Highland experienced from Bernie Midgely, a patient at the maternity home.

In healthcare today, we talk a lot about checking our implicit biases and realizing our own microaggressions, but how do we react when it’s the patient treating the nurse or midwife poorly? What about when someone’s behavior is openly racist? Unfortunately, this is exactly what Joyce went through this week.

We often think of racism or implicit biases in healthcare from the perspective of providers caring for patients, but it is true that it can happen in the other direction. Fellow healthcare providers: how often have you heard someone say, “I really just want a doctor that I can understand, you know? Not someone with an accent.”

Really, I think if you’ve worked in healthcare long enough, you’ve heard that one. Or, what’s currently floating around all of my social media pages is a video from a popular TikTok account slamming nurses who have long nails, lashes, and “elaborate makeup” as being “ghetto” and unprofessional.

Now, I could probably write an entire blog post about why using the term “ghetto” to describe something negative is inherently racist and harmful, but you would end up being here for several pages. I’ll give the condensed version instead: people have used the term frequently to describe characteristics stereotypically associated with Black culture. When you say something is “ghetto,” even if you’re describing something unrelated to race, you’re drawing on negative stereotypes about Black people.

I can’t pretend to fully understand what Joyce went through when Bernie Midgely turned from the happy-go-lucky baker, bringing treats for the maternity home staff, to rudely refusing her care because of the color of her skin. Bernie was so staunch in her hatred of Joyce, for no other reason than for the color of her skin, that she even refused assessment in the middle of a medical crisis.

However, I have been in the position of Sister Catherine many times. People have made prejudiced comments in my presence, either thinking I will agree with them because I look like them, or because they don’t care who they say it in front of.

I sincerely wish in my younger days, that I had the backbone to speak up and call out this behavior as unacceptable. Instead, I did behave a lot like Sister Catherine. I convinced myself I was imagining it; that must not be what they meant. Or, I didn’t want to bring it up afterward to my colleague and make them feel uncomfortable. I probably was also a little embarrassed that I hadn’t spoken up at the moment, so to bring it up again would be calling attention to my own failure.

I can see now that those reactions are so “me” centered. I would worry more about how I would be affected or how I would feel instead of standing up for what is right. Thankfully, I’ve become a lot more confident and direct as I’ve grown older, and unfortunately, as overt racism has somewhat become “normalized” behavior.

Midwives and nurses spend a good amount of time during their education learning how to provide culturally competent care and also about healthcare disparities and implicit bias. Modern midwifery emphasizes anti-racist practices with a goal of equitable care for all individuals.

This doesn’t mean that modern day midwives are perfect, or even that every midwife is culturally competent and aware of their biases. However, it is refreshing to see that so much of midwifery education today does focus on this as well as trauma-informed care, even more than it did 13 years ago when I was in midwifery school. This is truly one of the biggest interventions that can improve health disparities (outside of things like universal healthcare, working to improve public transit, quality public schooling, and increasing fresh food availability in “food deserts”).

I’d also like to touch on the importance of Trixie’s “Early Ambulation” seminar. Pregnancy puts women in a hypercoagulable state, meaning that they are more prone to blood clots during pregnancy and postpartum. When we encourage people to be sedentary after birth, it greatly increases their risk of a deep vein thrombosis, or DVT. Part of a clot from a DVT can dislodge and can cause a pulmonary embolism or stroke, which can be life-threatening.

While we do want women to be taking it easy after birth so their bodies can heal, there is a big difference between low levels of regular activity and complete bed rest. I always tell my postpartum patients, “I do want you resting after birth!” Don’t plan any big outings or even long walks in the first couple of weeks postpartum. The discharge paperwork we supply everyone even says, “No cooking, no cleaning, and no housework for two weeks.”

But I do want you to move gently around the house; use the restroom frequently; get up to get yourself a snack or a drink; and encourage short, slow, steady walks.

Even our patients who have c-sections are encouraged to get up and walk by 6-8 hours after surgery. This not only helps get their bowel function returning to normal, as Joyce mentioned during Trixie’s seminar, but also helps with improving circulation, decreasing the risk of blood clots but also offering increased circulation at the surgical site, which improves healing.

Finally, I'm struck by how Call the Midwife so beautifully captures the enduring power of support among its characters. Even though my daily work life as a midwife doesn't involve living in a nunnery or cycling around the city with my colleagues, that deep sense of camaraderie is something I experience every day.

I’ve been with my current practice for 11 years, largely due to the incredible support of my fellow midwives. This profession, with its intense emotional and physical demands and its mix of both beautiful and difficult moments, truly requires the ability to lean on one another to prevent burnout.

As we watch Joyce face her disciplinary hearing, I have no doubt that the Nonnatus House midwives will offer her the unwavering support she deserves, recognizing the careful, caring, knowledgeable, and skilled midwife that shines through.