Call the Midwife… then, now and in the future

We might think that a book about midwifery in London in the 1950s would be of little relevance today; but how wrong could we be?

The true tales which Jennifer Worth (1935- 2011) relates in her Call the Midwife trilogy, now being televised by the BBC, are not as some suppose stories removed from the realities of the present day. They connect in core ways with our current lives for at least two reasons.

First, Jennifer Worth’s accounts of the grim realities of family life in London’s war-torn East End in the 1950s are critical to our present understanding of why the UK National Health Service was one of the greatest achievements ever for the wellbeing of the mass of ‘ordinary’ people. Let no one imagine it wasn’t a big deal. It was (and remains) a history-changing collective leap towards a fundamentally different mode of constructing public service.

Second, the experiences of 1950s London which Jennifer Worth relates are still sometimes with us. Mercifully there have been no wars on British soil since then further to destroy the physical fabric of our communities. But awful things do still happen to young families and babies, and the circumstances under which some British children grow up remain unforgivable, in one of the wealthiest nations on earth.

Perhaps poverty and basic human survival needs are now often less acknowledged than they were in the immediate post-WWII years.  Jennifer Worth tells us that few knew about the East End of London of the 1950s, but nonetheless almost everyone understood then that money was tight. The most basic human requirements were not always available, regardless of one’s bank balance; food rationing – which at least in theory applied to everyone – didn’t go until 1955. In that sense at least we probably really were All In It Together.

There has been a shift towards conflating ‘need’ and ‘would like to have’. While we can debate the desirability or otherwise of this shift – materialistic, yes; but maybe also a vehicle for raising valid ambitions – the clear downside is that most in mainstream society now genuinely don’t perceive the desperation of those without enough simply to survive.

That basic lack of the essentials for a decent life is at the core of what Jennifer Worth recounts. And for some, hidden away from public view except when there is ‘trouble’, this is still their unremitting experience, every day. There remain enclaves of abject material poverty and almost zero visibility, perhaps most often in the ‘donuts’ of inner cities or in isolated rural locations, where for the women especially empowerment in civil society is beyond comprehension.

Yet these same disenfranchised women turn willingly to the midwife when her services are required. Anyone who has worked in early years or Sure Start will be aware of clients who without hesitation admit the local midwife but absolutely no-one else into their homes.

This most intimate of public services is accepted trustingly by almost every woman who requires it, regardless of chasms between client and provider of culture, language and whatever else. And by very definition these clients are all prime carers of tiny British future citizens for whom we as a society have enduring responsibility.

Interviewing midwives in the course of my work, I have been struck by the clarity with which they see their role as mediators and advocates for the women in their care. More than once I’ve been told by a midwife that ‘we’re the only people who speak for [some of] these women’.

In defining midwifery as women’s work of no wider relevance, conducted in a silently conspiratorial bubble away from the public eye, we take that same eye way off the ball.

Midwives report that in the absence of integrated support they are asked to deliver many other tasks as well as babies; they tell of being asked for help with housing, benefits, school problems and other issues which confront struggling families. But it doesn’t have to be like that.

There is currently a critical nation-wide shortage of midwives. Their core expertise, caring for expectant mothers and delivering and nurturing their infants, is enough to ask of them. Beyond that, the public service challenge is to find ways to secure seamless client progress from the privacy of maternity care to the wider remit of child and family care; and from there onwards towards responsible civic engagement.

Midwifery demonstrates that virtually everyone will accept public services if these are tailored to need. It’s time to take heed of those midwives, and to blend their intuition and understandings about so-called ‘hard-to-reach’ clients (is it them; or is it us?) into the canon of generic public service.

At the very least, Jennifer Worth’s work offers a chance for practitioners in every part of provision, from education and health providers to housing and town planning professionals, to consider afresh what the world looks like from the vantage point of the most vulnerable, whether in the 1950s or now.

What starts in the delivery room must move on through the home, school and community into the place of work. Any public service which loses the trust of some clients before their children even reach nursery class is one which also fundamentally breaches the trust for long thereafter of its smallest future citizens.