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