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'Call The Midwife': An Interview With Consultant Midwife Terri Coates

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CALL THE MIDWIFE
This image provided by Neal Street Productions shows, from left, Bryony Hannah, Jessica Raine and Helen George in "Call The Midwife." (AP Photo/Neal Street Productions, Laurence Cendrowicz) | Neal Street Productions/AP

"Call The Midwife," PBS's newest Sunday-night British drama series, has already been hailed as a successor to the smooth and stately smash hit "Downton Abbey."

But while "Downton," the enthralling saga of a wealthy, well-dressed aristocratic clan, excels in a field well known to fans of British TV, its new ratings rival lends the spotlight to a less familiar breed of heroine: the (eponymous) postwar London midwife. And as Terri Coates will tell you, that's quite an innovation.

Coates, who is an experienced midwife, is the show's technical advisor and part of its very DNA. Her 1998 essay on the dearth of midwives in literature inspired another real-life midwife, Jennifer Worth, to write her memoirs. The TV series grew out of those memoirs -- and although Worth passed away in the summer of 2011 without seeing any of the shows, Coates now works hard to ensure authenticity on set (with help from a few £5,000 prosthetic babies and other skillfully engineered props).

HuffPost Parents spoke to Coates about how the show was born, and found out that while uniforms and standards may have changed since the 1950s, childbirth itself -- in all its trials, traumas and triumphs -- has always been composed of the same highly emotional parts.

You’ve been a part of this project since the very beginning, when you inspired Jennifer Worth to write her memoirs. Can you talk about how the concept for “Call The Midwife” came about?

In 1997 I was completing a master’s degree, and for one part of it I decided that I would like to look at how the midwife was perceived in English literature. After reading an awful lot and writing an 8,000 word essay, I came to the conclusion that the midwife was almost completely absent from literature -- and that I would really have liked somebody to have written some form of a story about what a midwife did, so that the general population would know how we worked and what we did.

Around the same time, the journal of the Royal College of Midwives was being relaunched. The new editor asked me if I could do an article for him with a very quick turnaround. So that’s what I did -- I wrote 1,500 words and came to the conclusion that somebody needed to write a story that did for midwifery what James Herriot did for vets.

What kind of response did you get?

The article was very well received, and I got a lot of letters through the Royal College saying that people really appreciated my point. One of the letters was from Jennifer Worth, who was a newly retired music teacher and said that it had made her remember her time as a nurse and a midwife in the late ‘50s and early ‘60s and that I’d inspired her to tell her story. A lot of the people who wrote to me said that they’d like to write, or that they had written [something], and I didn’t really think much more of it.

About 18 months after that, Jennifer wrote back to me; she said she’d written her memoirs and asked me if I wanted to read them. I said of course -- and she sent me her hand-written manuscript. The stories just leapt off the page, but there were a lot of things that she’d misremembered about midwifery practice. So I got in touch with her and asked her if she’d like me to correct the midwifery for her. And that started about 12 years’ worth of collaboration.

Can you describe the hands-on involvement that you have in the production of the show? What you do on a given day of shooting?

It starts before the shooting -- it starts with the script, because if the first time I got it was on the set, we might get into all sorts of difficulties. I correct midwifery errors in the script and then on the set I work with makeup, costume and props to make sure that the equipment they’re using is correct, and that the setup we have is appropriate (so if it’s a clinic setup, I make sure that the clinic beds look right and the equipment they have around them is correct). And then on the set itself and in rehearsals I teach the actresses how to undertake basic midwifery procedures, such as taking blood pressure and doing abdominal examinations. It’s all on prosthetic bumps -- nobody’s put at any risk.

And are there elements of midwifery that have actually changed in the time since Jennifer was practicing? How much research have you had to do into older practices that just aren’t used anymore?

Practice changes quite subtly and slowly over time. Childbirth really is pretty much the same, and has been for millennia. Taking blood pressure hasn’t changed really since we had a stethoscope and a blood pressure cuff -- so there are a lot of things that are exactly the same. ...

But professional education has improved; hygiene has improved; the uniform has definitely improved, thank heavens -- much easier to work in now! Contraception has improved, so women don’t have to have baby after baby after baby [anymore]. They now know what causes it and they know how to stop it. So we don’t have women like Conchita, in the first episode, [having] 24 –- they’re more likely to have two or three or maybe four, but certainly not 24 pregnancies. Women are better educated, and because they’re better educated they know what to ask for.

What about the role of midwives in their communities?

We don’t walk or cycle around quite so much as we used to. We don’t live on the corner anymore. Instead of living in small communities or little groups of midwives -- as they do on the set, in Nonnatus House -- midwives live in their own homes with their own families.

But the clinic setup is pretty much the same; women still come to a clinic to see their midwife -- although the midwife that they see may not be the same one all the way through.

Back in the late ‘50s and early ‘60s there were lots of small maternity units where people gave birth still within their community, but now there are not so many small, cottage hospitals. There are far more large centers of excellence -- just like in the States. You go to a hospital or to a larger clinic to have your antenatal care. In that way progress has moved on.

The series has a large pop culture following in the U.K. now. How has it been received by the professional midwifery community?

Midwives have been very complimentary about the show. They are just delighted that midwifery and childbirth are being portrayed accurately. There’s an awful lot of childbirth on films and in soap operas where you just see a woman screaming, and that doesn’t really portray the reality of birth. Birth and labor are very hard work, but it’s a teamwork between the mother and her midwife. And I think that the relationship between the mother and the midwife is portrayed very nicely in “Call the Midwife” and it reflects the wonderful stories that Jennifer wrote. There have even been obstetricians who have been very complimentary about it. It’s been very gratifying. People who practiced in the ‘50s and ‘60s have also been complimentary about how the work has been shown. Some have said, “Oh, we didn’t do it quite that way” -- but I think in the ‘50s, ‘60s and ‘70s there was a greater variation in what was thought to be correct and normal. We didn’t have the national guidelines for things and I think practice was slightly more varied; they did what they believed was right at the time because there weren’t any other guidelines.

What does the success of the series mean to you personally?

I’m absolutely delighted to see that it’s doing well. Jennifer wrote so vividly about life in the East End in the 1950s that I think if she’d excluded midwifery and just written about life in the East End, the stories would have leapt off the page anyway. She wrote very unsentimentally, and she wrote an amazing piece of social history. And the popularity of the books has just grown and grown. It has been a vindication. It’s lovely.

Watch the Call the Midwife series premiere:

Watch Call the Midwife - Episode 1 on PBS. See more from Call the Midwife.

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