The extraordinary real-life impact of ‘Call the Midwife’
How did a period drama come to shape 21st-century healthcare across the world?
Since ‘Call the Midwife’ aired, the United States has gone from having two clinics offering gas and air to over 1,000
On Christmas Day, Call the Midwife will return for its now-customary festive special, with the ninth series following next month. Its success is well documented. On its launch in 2012, the series overtook Downton Abbey’s record for the largest first season audience on British TV for a drama this millennium. Today, it is regularly watched by 10 million viewers.
The appeal of Heidi Thomas’s series, originally based on the memoirs of Jennifer Worth, a nurse practising in the poverty-stricken East End of London in the Fifties, is clear. Call the Midwife harks back to seemingly kinder times, with the nostalgia factor amped up by its crooner-heavy soundtrack and retro fashions, often sported by Helen George’s modish Trixie.
Yet Call the Midwife is not simply comfort TV. This paper praised its ability to “tickle the middle of the brow while touching the most anguished parts of the human condition”.
Not only does it punch surprisingly hard emotionally, it also tackles the big health issues. Female genital mutilation, cleft palates and sickle cell disease have all found their way into Thomas’s scripts, and the next series will cover fistula and tuberculosis.
Thomas began researching medical history once she ran out of source material (Worth’s memoirs only run to three short books, totalling 1,000 pages). She explains: “Once we started addressing issues of disability or broader health practice, we started to hear from the audience, including members of the nursing profession.
“It was a rare day when I didn’t receive a letter or message from a member of the public saying that an episode had touched or helped them.”
But perhaps the most extraordinary thing about Call the Midwife is its influence in practical terms. In the UK, there has been a surge in interest for midwifery courses. For example, in 2013, Anglia Ruskin University saw an 11.6 per cent rise in applicants.
This year, an episode aired in which a patient died following an illegal backstreet abortion. Prof Louise Kenny, of the Faculty of Health and Life Sciences at the University of Liverpool and a consultant obstetrician at Liverpool Women’s Hospital, spearheaded the campaign to overturn Ireland’s ban on abortion in the 2018 referendum, emphasising how the law prevented women with cancer from getting terminations they might not want but desperately needed.
Kenny credits Call the Midwife with influencing public opinion about the dangers of illegal abortion. “When I was knocking on doors prior to the vote, I would often open the conversation by asking: ‘Do you watch Call the Midwife?’” she says.
Even more surprising is the show’s global reach. For example, when the series started to air in the States (on public service channel PBS), the perception of midwifery started to change. There, midwives are present at only 10 per cent of births (compared to more than half in the UK), since the majority of expecting mothers in America opt for an obstetrician instead.
Prof Michelle Collins, a midwife who teaches at Rush University in Chicago and is former director of the nurse-midwifery course at Nashville’s Vanderbilt University, says: “I think people in the US are more and more curious about how universal healthcare works, as we see the dissolution of our own healthcare system.
“Seeing the midwives doing home visits, sitting down to have a cup of tea with a patient, going out of their way to assist a family with some social situation – these are experiences that endear the midwives to US viewers.”
This has had a practical knock-on effect as the high rates of risky Caesarean-section surgery have led to an increased interest in the midwifery model, which is less reliant on technology, less invasive and less inclined toward intervention unless there is a clear medical need.
Another point of influence can be traced back to Call the Midwife’s second series, when nitrous oxide was used in childbirth. The show’s Facebook page was inundated with messages from American women, asking: “What is that gas and how can I get it?”
Nitrous oxide was used until the Fifties in America but declined in popularity because of epidurals and general anaesthetic. However, Collins introduced the use of nitrous oxide in childbirth at Vanderbilt at around the same time as the series aired. Then, it was only one of two places in the United States where you could receive the treatment during labour. Now, in 2019, there are over 1,000 such clinics.
Call the Midwife has had a similarly profound effect in South Asia. Deep in the jungle in west-central India, at a hospital surrounded by tigers and snakes, former British community midwife Tanya Burchell is using episodes of the drama to demonstrate compassionate care to her students.
Every year, 32,000 women in India die as a result of pregnancy or childbirth. To reduce that number, the Indian government announced, in December 2018, that it would be offering an official course of training for midwives.
Traditionally, the term “midwife” is used in India to refer to all women who help deliver children, in particular the traditional “dais” whose knowledge is passed down through generations, but who are unable to provide emergency care if needed.
Dinesh Baswal, deputy commissioner for maternal health at the Indian Health Ministry, has described the new official midwife course as “an effective intervention” to maternal and infant mortality.
TVS, films and telephones are not permitted in the jungle nursing school, but permission has been given to screen one episode of
Call the Midwife a week for educational purposes. For many of the future nurse-midwives, it is their first experience of “birth” and their response is already effecting change.
One student, Priscilla, said that after watching Jenny (played by Jessica Raine) sit down to talk to a dying soldier in episode three of the first series, she too sat down with a patient – an act that, in India, is not considered part of a nurse’s task-orientated role – and held his hand.
“The majority of the practices in
Call the Midwife are what we should be aiming for today,” explains Burchell. “It reminds us that the core of caring is made up of many things; compassion, rapport, using humour and continuity of care, support and encouragement.
Meanwhile, in Bangladesh, a country where 20 women die in childbirth every day and 300 babies die in the first month of life, a soap opera called Ujan Ganger Naiya
(“Sailing Against the Tide”) has launched. It uses a similar premise to
Call the Midwife’s to spread the word about the value of midwives to rural communities where seeking medical support during childbirth is not the norm.
Terri Coates, a professional midwife who advises on the British show, helped to direct the labour scenes and showed the actors how to portray giving birth convincingly.
“I was intrigued,” Coates has said. “Bangladesh is a conservative country and child bearing is not discussed very much. Bangladeshi TV had never shown a woman in labour and the crew were all men and, unlike their UK counterparts, not one had experienced childbirth.”
Of course, there is a strange irony to all of this – a period drama effecting change in the 21st century.
“The more complex the Sixties become, the more the Call the Midwife world seems to reflect life in the present day,” says Thomas. “Maybe the show has more to say than ever before.”
Call the Midwife Christmas Special is on BBC One at 7pm on Christmas Day; Call the Midwife series 9 starts on Sunday Jan 5 at 8pm