Call the Midwife by Jennifer Worth looks back on her years in a tough part of London, when home births were the norm and bed rest the cure-all for any problem pregnancy.
Hannah Patterson went to meet her, and talk about midwifery past and present.
Life was tough in London’s docklands in the 1950s… the age of the Kray twins, gang warfare, slum conditions; an era when contraception largely wasn’t used, so women were having many babies – often more than ten – and living in seriously overcrowded conditions. Pre- and post-natal care was limited. Women who were overdue were just left until the baby arrived. Most women breastfed, even if they seemed too weak or ill to do so. Many wouldn’t have had a clue how to sterilise a bottle or make up formula milk. Jennifer Worth discovered just how hard docklands life was for men and women alike, when she joined the East End community as a midwife at the age of 22.
Worth, now 73, and living in Hemel Hempstead, recalls that people were doing well then if they had running cold water and a flushing outside toilet, while many lived in tenements due for demolition. The majority of men worked in the docks. Women generally didn’t go out of the home to work – the washing, drying and ironing took up the biggest part of their day, and washing machines were conspicuous by their absence.
Early marriage was the norm, and unmarried partners virtually unknown. Children were brought up among a widely extended family, all of whom were close by. While violent family rows were commonplace, husband and wife usually stuck together.
Jennifer Worth’s Call The Midwife, an account of life with the nuns of Nonnatus House (the fictional name she gives to her midwifery training hospital in the heart of the 1950s docklands) is currently riding high in the non-fiction bestseller charts. It’s a powerful read. Most compelling are the characters she encountered, whom she brings back to life in these pages – a downtrodden mother beaten by her thug of a husband; an aged pauper driven half-mad by her children’s death in the poorhouse years earlier; a Spanish mother of 25 children; a 14-year-old girl, forced into prostitution after running away from her abusive family.
Despite the hardships, though, which were much greater than they are today, life was in many ways better, says Worth: “Life was just as happy as it is in this more affluent age. After the war, people were just thankful to be alive. In those areas of London you could never be sure that you were going to live to see the morning.” Worth rates highly the sense of community, the extended families and the fact that everybody knew everybody.
“Family and social life has completely broken down,” she says of contemporary society, “and three things occurring together, within a decade, ended centuries of tradition – the closure of the docks, slum clearance and the Pill.”
Worth’s recollections and experience put her in an excellent position to comment on the current state of affairs. Contentious as the situation is, it is undoubtedly an improvement from the mid-19th century, when maternal mortality among the poorest classes in the area stood at around 35-40% and infant mortality was around 60%. Anything like eclampsia, haemorrhage, or mal-presentation would mean the inevitable death of the mother. There was no training in midwifery and no control over the ‘handywomen’ who took on the task.
It wasn’t until the passing of the Midwives Act in 1902, when it became compulsory for a trained midwife to deliver a baby, that mortality started to drop. Today, infant mortality is at five per 1,000 live births, less than half the rate of the 1950s. Improved sanitation, nutrition and medical advances have also considerably lowered figures throughout much of the world.
Yet all is not well. A recent Health Commission report found that one in four women reported being left alone during labour or shortly after giving birth at a time that worried them. Some 43 per cent of women said they were not given a choice of having their baby at home, as national guidelines suggest.
“Modern midwifery now seems very much more hospital based,” says Worth. “In the 1950s in the East End, approximately 60% were home deliveries. The more affluent people went into hospital. Now almost everyone goes into hospital.”
She doesn’t believe that’s necessary, drawing a comparison with the 1950s, when the extended family was often at the home to support the expectant mother: “It was a calming influence. She felt secure. Today you are surrounded by strangers at the time of birth and it leads to insecurity and fear. Giving birth has been made into a clinical process.”
Worth thinks, though, that home births will become fashionable again because of the possibility of infection in hospitals. “You don’t get infection in the home because the mother is already immune to the germs in her own environment. A home birth is definitely more relaxed, and relaxation aids birth.”
The Royal College of Midwives is now campaigning for 5,000 more trained midwives, while ministers are being forced to pay retired midwives to come back to work amid a growing crisis in maternity services. The government says it will recruit 4,000 extra midwives in England by 2012 to relieve pressure on overstretched maternity services.
Jennifer Worth observes, that, irrespective of their numbers, midwives are under very different pressures to their predecessors of the 1950s – because of litigation.
“I have the greatest admiration for midwives today. They work under very difficult circumstances. They have to be continuously looking over their shoulder to see who is checking up on them.”
She’s not convinced it’s a good system. “If we are developing a medical service based on defensive medicine, with any decision being based on the idea that you might be sued, that’s bad medicine.”
Call The Midwife, by Jennifer Worth, is published by Phoenix, priced £6.99