Beacon Broadside

A Midwife's Review of Call the Midwife

Patricia Harman is a nurse midwife and a Beacon author of two acclaimed memoirs, The Blue Cotton Gown and Arms Wide Open: A Midwife’s Journey. Her first work of historical fiction, The Midwife of Hope River, is a Southern Independent Book Seller’s First Pick. 

The final episode of Call the Midwife can be seen on most PBS channels tonight. The series can be viewed in its entirety or purchased on DVD at PBS.org.  

The PBS premiere of the widely popular British mini series, Call The Midwife, was something that, as a nurse-midwife, I was determined not to miss. I rushed back home to West Virginia from Washington, DC—where I was attending an independent book sellers convention to promote my Beacon Press memoirs and my new novel—and plunked down in front of the TV just as the show started. I wasn’t disappointed.
Based on the best selling memoir of Jennifer Worth, a district nurse in the East End of London in the 1950s, the first episode of the six-part series rang with authenticity. Having delivered thousands of babies here in West Virginia, having visited the homes of the rural poor, none of the poverty, misery and squalor of the East End docks seemed strange to me. Even the births were surprisingly realistic.

The second episode offered a scene that markedly echoed my own experiences. One of the new midwives, Chummy Brown, is called to her first home birth. It’s a busy night in the East End, no one is available to come with her, and when she gets to the three-story walk up, she finds the baby is breech. The same thing happened to me—only this was in rural West Virginia back when I did home births in the 1980s.
I remember it as if it was yesterday… the dilapidated farmhouse, the brave mother in labor having her first child. I had checked her just that morning and thought the baby was head down, but when called to her house 12 hours later I found a baby’s bottom presenting.

Breech births are difficult. The cord can be trapped and slow the heart beat or the head can get stuck after the rest of the body is already born. My patient was ready to push. We were an hour from the hospital on gravel roads. Did I really want to deliver my first breech baby in the front seat of a pick-up truck by flashlight? No—I did what Chummy did. I delivered the baby in the mother’s bed, and everything went fine.

Now I’m an author of books about women’s health and midwifery, and part of the job of being an author is promoting your books. The interesting thing about traveling from bookstore to book convention is that, invariably, I end up talking more about midwifery than about my writing.

“Do all midwives deliver in the home?” a man, in the back row of an independent bookstore, asks. 

“No,” I explain, “They can if they want to, but most of the 13,000 certified nurse-midwives, (who are RNs with graduate degrees), work in hospitals or in free standing birth centers. There’s also another kind of midwife, the direct entry midwife, who’s not a nurse. They do apprenticeships and are called CPMs or Certified Professional Midwives. These midwives only do out of hospital deliveries and cannot do gyn care or write scripts for medication, like nurse-midwives can.”

The fellow nods as if he understands, but I think he’s still confused. I don’t blame him. That’s one of the problems in the U.S.; laws vary state by state, and all these titles—CNMs, CPMs, Direct Entry Midwives—how can the ordinary person keep them straight?

“My daughter is pregnant and told me she wants to go to a midwife. That’s why I came here tonight,” a grandmotherly type admits. “I hate to say it, but I was shocked. I always assumed she’d go to an OB/Gyn. Don’t you think they’re the experts? It’s her first baby. Anything could happen. I’m afraid for her.”

“You know, 80% of babies in the world are delivered into the hands of midwives. Pregnant women are doing their research. They know that the Cesarean Section rate in the US is 33%. That means that one in three mothers have their baby by major surgery! If the women want to avoid a C- Section, they look for a provider who has the lowest rate. Because midwives aren’t surgeons, we get very good at getting babies out the regular way.”

“So why, then, do people like me think there’s something wrong about midwifery?” another woman asks. 

I have to explain the history of modern midwifery in the United States, which dates back to the 1930s when the first schools for midwives were established (in Europe and Great Britain training programs began over 100 years earlier). Before that, in the early part of the twentieth century, our country was still very rural, and 95% of deliveries were in the home with midwives who were self-taught. Then a campaign began by the medical establishment to present midwives as dirty and unclean—a real marketing blitz. Hospitals were put forward as modern, sanitary and safe, with supposedly better-trained professionals. What makes this ironic is that doctors in those days received no hands-on training in obstetrics at all.

The attacks against midwives continued for 30 years, despite the statistical proof that midwife-assisted births were safer than those conducted in hospitals. By 1955 only 1% of babies were delivered by midwives, and it’s taken all these years for the profession to recover. Now midwives are back up to doing 10% of the births in the United States, and guess what? We now have our own publicity campaign… not to show that midwives are better, but that we are a safe alternative and that we believe in the strength of women and their ability to give birth naturally.  

“Show, don’t tell,” a writing teacher once instructed me. “Show, don’t tell.”

That’s what’s great about the mini-series, Call the Midwife. It shows us why a midwife makes a difference. And that’s what my books are meant to accomplish, show what midwives do, show their courage and their love for their patients.

“So do you want to hear about my new book?” I finally get around to asking the audience. Heads nod, yes. 

“Patience Murphy, is the Midwife of Hope River” I explain. “She’s a transplant from Pittsburgh during the Great Depression, hiding out in the mountains of West Virginia, and she tells you in the first chapter that she’s 36, too old and too obstinate for courting, and besides that…” (Here I pause for dramatic effect) “…she’s wanted in two states!” Eyebrows shoot up. The man in back laughs out loud and I laugh with him.

“Now you have to read the book… to find out why.”

Photo: BBC

Breast Cancer Doesn't Play Politics

Today's post is by Patricia Harman, a certified nurse midwife and author who lives and works near Morgantown, West Viriginia. Her first book, The Blue Cotton Gown, was called “luminescent, ruthlessly authentic, humane, and brilliantly written” by author Samuel Shem. Her second book, Arms Wide Open, was described by Tina Cassidy, author of Birth: The Surprising History of How We Are Born, as "A sparkling, vivid story of how a midwife is born-and survives." 

Recent events involving Susan G. Komen for the Cure, the nation’s leading breast cancer advocacy group, illustrate how vulnerable women’s health care options are. Last Tuesday the organization announced they were cutting their funding to Planned Parenthood, which amounted to about $680,000 in 2011. By Thursday, under tremendous pressure internally and externally, the charitable foundation reversed its decision.

As a nurse-midwife and women’s health care provider, I see the issue from the front-line when my patients who don’t have insurance come to me with breast problems. Follow me into my exam room and you’ll see what I mean.

Forty-five-year-old Gail Wilson lies on the table with her left breast exposed. I don’t even have to touch her to see there’s a mass. A lump the size of a quail’s egg shows in the upper right quadrant and I inwardly cringe.

“It’s bad isn’t it?” Gail asks me.

“Well, it’s not good, but not all lumps are cancer. How long have you had it?”

“About a year.”

“A year! Weren’t you worried?"

“Not at first, but finally my husband insisted I get an exam. He was laid off at the shirt factory three years ago and we don’t have health insurance…” Her voice trails off apologetically. “There isn’t a Planned Parenthood in my area and it took a few months to find a provider that would see me.” I let out my air wondering how and where I will get this woman a mammogram. I can do her visit for free, but it’s $350, at the hospital, for the scan.

It takes me four days and I’m getting worried, when I finally find a program through the health department that will fund Mrs. Wilson’s mammogram. Unfortunately the news isn’t good; the test shows breast cancer, stage 4, with metastasis into the lymph nodes. Gail waited too long. She won’t last the year.

Approximately 1 in 8 U.S. women will develop breast cancer during their life time, that’s around 300,000 new cases each year and 20% of those women don’t have health insurance.

In a nation as rich as the United States, it is a travesty that people like Gail and her family cannot get diagnostic tests when they need them, cannot get an examination when they’re ill, cannot get medication when it’s prescribed.

The Susan Komen incident should be a wake up call. There are those on the religious right who are willing to sacrifice important health care services to the poor in order to advance their pro-life agenda. Until everyone has access to care, no matter what our personal beliefs about pregnancy termination, we must support Planned Parenthood and other women’s health organizations like it. That’s Pro-life too.

Arms Wide Open: Lighting Candles for Winter Solstice

Today's post is an excerpt from Arms Wide Open: A Midwife's Journey by Patricia Harman, Certified Nurse Midwife. Harman has published in the Journal of Midwifery and Women's Health and the Journal of Nursing Scholarship, as well as in alternative publications. She is a regular presenter at national midwifery conferences. Her first book, The Blue Cotton Gown, was published to acclaim in 2008. Harman lives and works near Morgantown, West Virginia, and has three sons.

Today is Winter Solstice, The longest night of the year.  We will light candles here in West Virginia and pray for the cold, the hungry, the frightened and for our endangered earth. -- Patsy Harman 

Winter has locked around us for sure, now. As I leave from work, the storm begins. Snow coming in from the West. By the time I get to the freeway, the tops of the mountains are covered with white. 

Despite a recent bout of melancholy, I’m excited. I always love the first good snow and it’s winter solstice night. “Hello Snow!” I greet the lacy clumps that whirl from the low grey clouds. It’s going to be a good one! They’re predicting eight inches.

“Oh, the weather outside is frightful…” I sing along with the radio.

On Turkey Run, the short cut behind the University Agricultural Farm, the traffic slows and I find myself thinking of Ruby. I saw her in the clinic this afternoon for her first OB visit. Six weeks is early to start prenatal care, but that’s fine with me. I like to see the women as soon as they call, talk to them about how to have a healthy pregnancy, answer their questions, get lab work and go over their history for risk factors. Despite her spotting, on the early ultrasound we could see the fetal heart flicker. 

I hand Ruby a thick green folder with our Women’s Health Center logo printed on the front, a pine tree with the slogan, Take care of yourself. Your health is valuable resource.

“What’s this?” Ruby asks.

“These are your OB handouts. You don’t have to read them all tonight,” I make a little joke of it.

There are hundreds of books on childbirth, but in our practice, the patient’s educational and socio-economic levels vary so much… some women have their PhDs…others never finished high school. Some have read Spiritual Midwifery and The Working Woman’s Pregnancy Book, before they come for their first visit and others don’t read at all. For this reason, I like to start the educational process early.

I take the flyer called What to Eat When For a Health Pregnancy out of the packet and place it in Ruby’s Lap. “So what did you have for breakfast this morning?”

“I don’t usually eat breakfast. No appetite.”  She shrugs as if that’s the end of it. But I don’t give up easy.

“I know what you mean. Me neither. But when you’re pregnant that has to change. So what could you eat? Do you like milk?”

Ruby and I problem-solve together on healthy food choices, things that are handy and not hard to cook. I have to be careful in my suggestions, because Ruby is on a medical card and doesn’t have much money. I tell her how to get signed up for WIC, the women’s, children’s and infant’s federal program that gives pregnant and nursing mothers coupons for free healthy food.

Ruby still smokes a half-pack of cigarettes a day, has limited understanding of nutrition, is underweight, doesn’t exercise because of her chronic pain, is unmarried with a lot of family problems and is still on narcotics. This will be a challenge, but I like challenges and I like Ruby.

Once I’m on the freeway the traffic thins out but at the top of our steep drive, I stop singing. If the snow gets too deep, I won't be able to get my Civic back up. I take a deep breath and drive down, anyway. “Let it snow. Let it snow. Let it…”  

Since returning from a recent trip to Moscow, I’ve been lonely for my boys and have had a hard time getting into the holiday spirit. I managed to get a tree up, a wreath on the door and the manager scene laid out, but that was the end of it.

Inside, I toss my briefcase in my office and shake off the blues. Soon it will be Christmas and Zen will be home…we haven’t seen him for six months…and Orion and Ari and Lissie and baby Abraham will be here.

Though it’s still afternoon, I put on an album of seasonal music and scurry around the house collecting candles for our solstice ceremony. This year, as last, it will be just the two of us. I glance out the window where snow now blows in at an angle, thankful that I made it home early. The gazebo is already covered. Six inches of fluff coats the porch rail. If the roads get too bad, it might be just me.  

A blast of wind jolts the house and the lights go off. The microwave beeps. The stereo goes off. When I check the telephone there’s no service. When I flip open my cell to call Tom, there’s no connection. No refrigerator sound, no fan from the heater. No heat, I remember. Even though we have a gas furnace and gas fireplace, electricity controls the pilot.

It’s nearly dark now and from the corner windows I can no longer see the oaks twenty feet in front of the house. I light one of our old kerosene lamps we brought from the farm. The wind slams the other side of the house and the whole building shudders. I’ve been in storms like this before, in Minnesota and at the commune. You’d think I’d be afraid, but I’m strangely excited.

“Whoo! Whoo!” Someone calls from out on the porch. I hurry to the front door. When I pull it open, white swirls in.

His arms are full of groceries. His LL Bean jacket and hair are plastered with snow.

“Happy Solstice!” It’s Tom.

In twenty minutes, the two of us are seated at the dining room table. The room is dark except for the circle of yellow from the kerosene lamp. I can almost imagine the fragrance of wood smoke from a cast iron cook stove and can see our little boys, Mica, Orion and Zen sitting with us.

Tom strikes a match to light the first taper. "This yellow one is for the sun, giver of life," Then it's my turn. “This gold candle is for family.” We take turn saying prayers.

“This pink one is for little kids.” I picture Rose, Abraham and Lissie.

“The white one is for love.” I look in Tom’s eyes and am so grateful to be here with him as the blizzard rages around us.

I glance at the candlelight flickering on the ceiling. The wind still howls in the trees out front.  “I love the house like this in this light. Wouldn’t you like to live with kerosene and candlelight always, maybe in a little log cabin?”

“We tried that before, Pats, remember?”

 “Oh, yeah! How could I forget?” I laugh at myself and we keep lighting candles until they’re all gone.

“This one is for change, the only constant.”

“This one’s for the earth.”

“This one is for the yet unborn.” I think of Ruby and her baby.

Photo by Jupiter Firelyte on Flickr. Used under Creative Commons.

A Midwife's Lessons from Her Patients

Patricia Harman, Certified Nurse Midwife, is the author of Arms Wide Open and The Blue Cotton Gown. Harman has published in the Journal of Midwifery and Women's Health and the Journal of Nursing Scholarship, as well as in alternative publications. 

The exam room is like a confessional; I’ve thought this before, so intimate, patients tell me their secrets. 

“So, how you doing?” I ask Verona Jenkins, a 50-year-old high school teacher. Her straight brown gray hair is cut in a bob and she sits on the end of the rose vinyl exam table in her blue cotton gown with two strings in the back, swinging her legs like a girl. She has a few small red varicose veins on her calf, but her ankles are tan and slim.

“Ok, I guess. Better.” This interests me. I have her lie down to check her breasts and her abdomen.

“What’s your stress level lately between 1 and 10?” I smile. “Ten means you are about to check into the psych hospital.”

“It was eleven last year, but I’d say only a seven now,” the patient gives me a short laugh, indicating this is a joke, but not much. That’s when our real conversation begins.

The exam room is also like a classroom, a place where I learn countless lessons, and these women, my teachers.

I study Vernona’s face as I palpate her lower pelvis, “Any pain?” She shakes her head no. Occasionally I find a tender ovary or sore uterus that needs further attention, but more often in these encounters I find pain in the heart.

This time Verona looks right at me. “Remember my exam last year? It was the first time I’d seen you.” I finish her internal, take off my exam gloves and settle myself on the rolling stool. The patient sits up and primly straightens her blue cotton gown. “I was a real mess. My seventeen-year-old daughter was out of control. She’d dropped out of school and moved in with her boyfriend. I was so scared; this was my baby, now out of my reach, running hell-bent toward disaster. She was using drugs, marijuana and ecstasy. She told me right to my face…no birth control. She wanted to get pregnant.”

Verona stops and tucks a strand of her hair behind her ear. “I was so frightened for her. We were fighting all the time, and my husband was no help. He just withdrew into his work, even told me once, if I mellowed out and got off her case, things would be better.”

“And now?”

Verona smiles, lets out her air and wipes the few tears with the back of her hand. I reach over and offer her a tissue. “Better. The boyfriend didn’t last long and she came home. She was treated for an STD at the health department, but never got pregnant, thank God.”

“So, is she back in school and everything alright?” I am waiting for a happy ending.

“No.”

“Home School?”

“No.” Verona tips her head to the side with a little regret. “She doesn’t do much of anything. Sleeps late, watches TV, reads a little; sometimes she cooks.”

I squint. This would be difficult.

“So isn’t that hard for you?”

“At first, it was, but I was just so glad to have her home and safe, I decided to give up on the lectures and just accept her for who she is.” The voice in my head goes quiet. “Just accept her for who she is.”

“And guess what?” the patient goes on. “The other day, the three of us went out to dinner and Kayla said to us, ‘You know Mom and Dad. You are my favorite people. You accept me unconditionally.’ Twelve months ago we were wolverines at each other’s throats.

“Just the way she said it, unconditionally. I knew she had been reading or maybe only watching Oprah, but she was going to be ok.”

Now I have tears in my eyes. Just accept them for who they are. I’ve read of the miracles it brings when you just love someone unconditionally. I do that with my patients, but with my own boys, Zen, Mica and Orion, I must constantly be shepherding, trying, with my wooden crook, to steer them away from cliffs, lead them down into the green valleys. And does it work? No. I just meet resistance.

I write Verona a script for her hormone replacement and give her a hug. The woman can’t know the gift she has given me. Outside the exam room, I place my hand on the cherry wood door, palm open, fingers spread. I look down the carpeted, hall, and seeing no one, bow from the waist.