By Steven Clark
“Call the Midwife” rings true to Jacqueline Biggs because, in part, she lived it.
The popular PBS and Neflix series, based on the best-selling memoir of the same name, features the midwives and nuns of Nonnatus House in the gritty town of Poplar in East London from the late 1950s to mid-1960s. Although it was a decade later that Biggs spent her coming-of-age years as a midwife in the industrial English city of Manchester, she notes the similarities.
“The focus was always on the community. We knew the community, we knew the police,” says the long-time, much beloved midwife, who came to the U.S. in the 1990 after two decades working in England and Jamaica, and now works primarily out of SBH’s Bronx Park office. “We also had the husband who was drunk and got thrown out of the delivery room.”
Biggs is one of a team of nine midwives at SBH, six of whom spent a recent morning discussing their work, their backgrounds, and their love of a profession that even some of those in their personal lives may not have fully appreciated until viewing the British TV series.
Between them, Biggs and Julie Crocco, director of the midwifery program at SBH, estimate they’ve delivered 5,000 babies. Crocco teases the “girls” on the team – Carly Wilson, Kaitlyn Greenough and Su Thet – “you have no idea what it was like to be a midwife, working around the clock, in the old days.” Today, most of the midwives work 9 to 5, with pre- and post-natal clinic and birthing responsibilities, in addition to gynecological care. They feel they have earned the respect of the community of women they serve and their fellow professionals.
“I never hear, ‘Oh, why isn’t the doctor here?’” says Lynn Fisher, an SBH midwife who spends three overnights a week at the hospital, and at times is pulled into the ER to deal with issues that can range from teenage girls giving birth surreptitiously in apartment stairwells to mothers rushing in with dying newborns in their arms. “They seem to understand. They show respect.”
“Not all of our patients understand everything we do as midwives, but they all seem to appreciate that we go the extra mile, that we are always available to them and will answer all their questions,” says Greenough.
Department leadership concurs.
“In many ways our midwives are our inspiration,” says Dr. Mark Rosing, chair of the Department of Obstetrics and Gynecology at SBH. “They keep the entire team focused on the patients’ experience in both our maternity unit and our ambulatory sites and they assure we are all providing the highest levels of quality and safety. The relationship between our physicians and midwives is a symbiotic exchange of equals and our collaboration makes all of us the best clinicians we can be.”
Education is at the heart of what the midwives do, in addition to performing normal deliveries (they do the first assist on C-sections). They educate their pregnant patients – which includes teaching them the importance of preand post-natal care and of breastfeeding, the last of which was underscored by the leadership role they played in the hospital recently earning the prestigious Baby Friendly designation after a five year journey. They instruct medical and midwifery students. Midwives also take the lead in the hospital’s Centering Pregnancy program, which provides women in the community with prenatal support groups from weeks 16 through 40 of pregnancy.
Even her friends and family, says Greenough, may be confused about the differences between a doula and a midwife. While doulas provide physical, emotional, and informational support to expectant mothers before, during, and after childbirth, perhaps offering relaxation, massage and breathing support, a midwife is a healthcare professional who, in New York State, is a nurse with a post-graduate degree in midwifery.
”Some still think that midwives only perform home births and are surprised to hear that I work in a hospital,”Greenough says.
In addition to delivering babies and offering pre- and post-natal care, the midwives also perform Pap smears, pelvic and breast exams, write prescriptions, perform fetal monitoring, and provide information about contraception.
“Patients understand what a midwife does when they’re pregnant, but I’ll
see them in gyn, and they’ll say, ‘I’m not pregnant, Carly. Right, am I?’” says Wilson. “We are involved in the whole lives of our patients. We have conversations that are not just about birth. We talk to the whole person. We listen to them. There is a senseof partnership.”
The History of Midwifery in the U.S.
The history of midwifery begins in the early 1700s in America. According to Midwifery Today, the licensing of midwives in New York City first occurred in 1716. Since physicians were not formally educated about childbirth, midwives took on the primary responsibility. In the early 1800s, middle-class families started using doctors for childbirth. As anesthesia became widely available in the late 1800s and early 1900s, deliveries began shifting to hospitals. Midwives were only used for those who could not afford a doctor. During the economic boom in the early 1920s, upper and middle-class women preferred doctors, looking down on midwives they perceived as the bastion of the lower class.
By the 1960s, more than 90 percent of births were performed in hospitals. During this time schools introduced formal education for nurse midwives and the concept of family-centered maternity care grew.
A resurgence in midwifery sprung up in the 1970s, hand-in-hand with the feminist movement. Yet, today, midwifery flourishes only in a relative handful of hospitals in New York City, at least partially because there are only four graduate midwifery programs in the city. According to the College of Nurse-Midwives, the profession’s governing body, there are only 12,000 certified nurse midwives in the U.S. (not all of whom work in hospital settings).
The SBH team of midwives came to their profession from very different places. Crocco had three children and didn’t return to school to become a midwife until she was 39. Biggs, meanwhile, started working as one when she was 17. Fisher was an elementary school teacher for years before changing careers in midstream. Greenough spent a year as a waitress after college before starting her journey. Thet was an L+D nurse in California for nine years and became a midwife because she admired a colleague who worked as one. And Wilson, an art history major in college, at one time owned an art gallery and worked as a school photographer. (Two SBH midwives who couldn’t attend the round table discussion were Emilie Fitzmaurice Rosnor, a Harvard graduate who worked in clinical research before going to Columbia University for her midwifery degree, and Jeanelle Chaperon, who just gave birth to her second child, and worked as a pediatric nurse.) “I thought it would be cool to be a midwife, but I always saw it as a fantasy job, not something you could actually do,” says Wilson. “I thought midwives were rock stars.”
All said they wanted to do something that would make a difference, primarily for women in an underserved community. “Education and continuity of care is a big component,” says Thet. “It’s really essential to a community like this.” Adds Crocco, “I wanted to be a voice for those women who didn’t have much of a voice.”
Call the Midwife first appeared in the U.S. in 2012, around the time Greenough began her career as a midwife. “I saw myself then as Jenny, the young, naive midwife,” she says. Biggs, meanwhile, says she eventually began to see herself as more like one of the stern, authoritarian nuns. Regardless, like their celluloid counterparts – who saw their patients through everything from genital mutilation to sickle cell anemia to thalidomide – they see themselves playing an essential role in the community they serve.
“I like the combination of science and technical side,” says Greenough, who now occasionally runs across children she delivered nearly a decade ago. “I have relationships with these women. It’s allowed me to do something tangible. To do something good in the world.”