Lessons in Nursing Care from the Early Years of the NHS

20/02/2012 by Emma Jolly.

The first series of Call The Midwife ended last night on BBC 1. The show was a huge ratings success, with its final episode being watched by 9 million viewers. Much of its appeal lies in the fairly accurate recreation of 1950s Poplar and of its realistic scenes of childbirth.

Today, with UK healthcare under threat from the NHS bill, this portrayal of the Service’s successful early years may hold some clues as to how it could more simply be reformed. There have already been calls for the NHS to go ‘back to basics’, with the return of matrons and a focus on patients’ essential needs. Could a return to 1950s methods of nursing care, whilst retaining 21^st century scientific and technological advancements, be the answer?

Decades before the NHS was created the founder of modern nursing, Florence Nightingale, regarded open windows as the hallmark of a healthy hospital ward. Open windows were much in evidence on Call The Midwife, both in the hospital wards and in houses of the East End.

This basic policy is supported by an article in today’s Independent, which reports on a microbiologist who believes air conditioning and an ultra-sterile environment are harming patients by contributing to infections. Jack Gilbert of Argonne National Laboratory in Chicago and head of the Earth Microbiome Project, explained the science behind his theory:

“Open windows let bacteria in from outside and you will either dilute out the pathogens, or you are not allowing the pathogens to establish themselves because there is too much competition for the nutrients and energy that the bacteria need to survive. . . There’s a good bacterial community living in hospitals and if you try to wipe out that good bacterial community with sterilisation agents and excessive antibiotic use, you actually lay waste to this green field of protective layer and these bad bacteria can just jump in and start causing hospital-borne infections.”

Contemporary scientists are not alone in their praise of basic practice, as seen on Call The Midwife. My godmother, a retired chief midwife, was impressed by the authenticity of the breech birth scene in episode two. Mothers on the babycentre.co.uk webchat, agree. They believe that the 1950s method of covering the baby’s head with a towel, in order to keep it warm and prevent it taking a breath in the birth canal, was preferable to their experiences, which had resulted in lung pumps and incubators.

Having been through childbirth twice, I agree that the birth scenes in this programme are the most realistic I’ve seen on any television drama. Happily, like mine, most of the births shown in the series ended successfully. However, one of the most tragic scenes was that in episode 4 where middle-aged headmaster David loses his beloved wife Margaret after she suffers eclampsia. Eclampsia and pre-eclampsia remain dangerous conditions. As now, good ante-natal care is key to identifying present and prospective complications. Sadly, Margaret was shown to have left her ante-natal appointment before being seen by the midwives.

In the early 1970s, my mother saved the life of a farmer’s wife from a remote area who was admitted with pre-eclampsia:

“We had to take her into a single room with the blinds down and keep her sedated. Suddenly she began fitting and her heart stopped. With no second to spare, I had to give heart massage until we felt a pulse. After this, she was given an emergency caesarean section, and both she and her premature baby survived.”

My mother, who began her training in 1963, warmly remembers the camaraderie of the early years:

“There was much more of a family feel than there is in today’s nursing. There were many people aged 18, mostly young women, with very very few men in general nursing. We were all enthusiastic, really loved the patients and all the young ones felt we were in it together.”

Like the midwives who lived together at Nonnatus House, my mother and her colleagues lived in a nurses’ home where hierarchy was much in evidence:

“We were awe of the sisters, and the matron could sometimes be quite terrifying! We were issued with so many dresses, so many hats and so many aprons. There were the hospital laundries which did all the laundry and starched your hats. This helped keep infections down. The matron and sisters were very strict about hair being kept back, and absolutely no wearing of jewellery.”

Community and personal relationships are seen as central to nursing care in the television series, and were very much key values for nurses of my mother’s generation:

“Everything was about caring for people, the care of the person. Especially as young nurses, we got to know the patients and their families. Great emphasis was put on nutrition - also the going out. The fluids in and the fluids out, as it were. Anyone who wasn’t up and about, we had their charts and went around making egg and milk drinks, making sure they were all well-nourished.

I trained in a big hospital where we rarely saw the matron, but the assistant matrons did daily rounds. We had to make sure that we knew everything about our patients. The senior staff would walk round and ask any question at all. We had to be particularly alert with one, who asked the blood results of each patient, which we had to know without looking. Also, we looked after the whole ward so we knew every patient there.”

This later changed, with nurses only being assigned a small number of patients on each ward.

Some viewers have expressed relief that they do not have to give birth, drug-free, in a bug-infested slum in the bomb-shattered East End of post-war London. But many more are attracted to the positive experiences shown on Call The Midwife: the strong community, inexhaustible humour, and, above all, the patient-centred nursing care. On a day when so many are criticizing and heckling the Prime Minister and the Health Minister for their planned reforms, it seems appropriate to remember the value of high quality nursing in those early years of our National Health Service.

The Guardian’s obituary of Jennifer Worth (Jenny Lee), who died shortly before the series was filmed, can be read at http://www.guardian.co.uk/books/2011/jul/06/jennifer-worth-obituary

For more on the local history aspect of Call The Midwife, see the The Sugar Girls’ blog: http://www.thesugargirls.com/call-the-midwife/ 

Posted in NHS Bill, NHS, Nun, David Cameron, Andrew Lansley, matron, back to basics, Midwives, Nurses, London, Emma Jolly, Genealogy, social history, History, Poplar, Call The Midwife, Family History | No Comments »