Welcome to 1971, with the Women’s Liberation Movement in full swing in Great Britain. The Nonnatus House midwives are front and center in the movement, doing what midwives have done throughout history — pressing for social change. We were shaking things up back in the days of being burned at the stake as witches, but that’s a story for another day. Change is occurring at a rapid pace, as we watch the midwives of Nonnatus House attempt to navigate the choppy waters of the National Health Service (NHS) reorganization.

The National Health Service (NHS) is a foreign concept to us in the US. It is the publicly funded system of healthcare in the UK which has been in existence since 1948. The mission of the NHS has always been to provide universal comprehensive healthcare to every citizen of the UK, regardless of ability to pay. A misnomer is that the care is “free” because payment is not required at the time of service. It is, however, funded by public taxes, so citizens pay for it, just not at the time of service. The reorganization of the NHS will play a central theme this season. 

There were several storylines in this episode, but the one that struck a particular chord with me was the secondary trauma (also called vicarious trauma) experienced by the newest midwife at Nonnatus House, Sister Catherine (played by Molly Vevers) upon the extremely premature birth of a patient she was seeing for a home visit. Unfortunately, secondary trauma is a common form of distress experienced by anyone who is witness to the trauma another person experiences, but those who work in the healthcare profession are particularly vulnerable.

Bernice (played by Carla Freeman), the woman with the premature birth, had hyperemesis gravidarum (HG) which is a severe and unrelenting form of nausea and vomiting in pregnancy. Far beyond the expected normal nausea and vomiting of pregnancy, women affected by HG often physically suffer from dehydration and exhaustion, unable to work or care for their families, and it can last the entire pregnancy sometimes. 

Women in labor can also experience nausea and vomiting, and it can be a symptom of preterm labor (PTL). The presenting signs and symptoms of PTL can also be “silent,” meaning that the woman experiencing PTL may not feel the same painful contractions and other labor signs as a woman at term with her pregnancy. 

Sister Catherine, on her visit with the pregnant Bernice, noted her to be having the same nausea and vomiting of HG with which she had been struggling. There was little reason for Sister Catherine to suspect that Bernice’s nausea and vomiting was a sign of premature labor. Preterm labor is often faster than term labor, as well, as a much smaller baby takes less time to progress from intrauterine to extrauterine life. In typical fashion, the cascade of events of her preterm birth progressed quickly from Bernice vomiting, to giving birth on the toilet.

I can promise you that every midwife, from the day we “catch” out first babies to the day we catch our several thousandth baby, carries the weight of any untoward experience like that which Sister Catherine experienced. We second guess, we lie awake at night repeatedly reviewing every detail of the event, we question our skill, our decision making — did we miss something? Did we make the right decision? If we made the right decision, did it come soon enough? 

Compassion fatigue can be the result of the repeated psychological and physical exhaustion that accompanies secondary trauma, and droves of caregivers leave the healthcare profession every day as a result. I have personally seen excellent midwife colleagues leave the profession because of a traumatic incident in which they were involved. While everyone assumes that working in the birth realm is filled with joyous and happy events, that is certainly not always the case. Unexpected events occur, babies and mammas don’t always survive, and outcomes are not always happy and joyful. 

After every uncomplicated birth I attend, I say a silent prayer of gratitude, as those are the birth experiences that carry us forward, giving us the strength to wade through the experiences that leave us questioning this calling.