“Call the Midwife – A Memoir of Birth, Joy, and Hard Times” by Jennifer Worth

This well written memoir was published in 2002, the first of three books about practicing as a midwife in the poverty stricken East End area of London (the Docklands) in the 1950s. The BBC produced a television series based on these books, broadcast beginning in 2012. Having seen just one episode, I was expecting Call the Midwife to be humorous and exciting. Instead I found it to be gritty and very sad. I actually skipped one chapter (about the workhouse), not feeling up to it.

The first surprise for me was how BAD conditions were in postwar London. Wartime damage to buildings had not been repaired. Housing was limited, so poor people lived in overcrowded and unsanitary conditions. Not every apartment had a bathroom or hot water. Men readily found employment on the docks, but the work was hard and poorly paid. Women married young and had many children. If they worked, they were poorly paid.

Nonetheless, there were positive aspects to life in the Docklands. People knew their neighbors well, and extended families were very supportive. Nurses and doctors were so respected that they were safe even in violent neighborhoods, where the police worked in pairs. Worth also mentions in passing the richly expressive Cockney dialect, almost a distinct language. She understood it most of the time, but certainly never spoke it.

Having just read  Empty Planet – the Shock of Global Population Decline by Bricker and Ibbitson (see blog entry dated August 15, 2019), I found myself pondering the “demographic transition”, the shift of a community from high birthrate with high death rate to (eventually) low birthrate with low death rate. Sometimes countries at these two extremes are described as “third world” and “developed”.  East End London in the 1950s was in a transitional state, with high birthrate and low death rate. It was challenging and (inherently?) unstable. The conditions described were so bad, I had trouble remembering that I was NOT reading about, say, the year 1900.

The quality of obstetrical care provided in this teeming slum was amazingly high. Midwives and nurses were well trained. Doctors and hospitals could deal with a wide range of emergencies. Most babies were born at home, attended by a midwife. Follow up as extensive as three nursing visits PER DAY might continue for several weeks. Doctors also made home visits, and extreme emergencies were handled by an Obstetric Flying Squad which could transport mother and baby to a hospital quickly if necessary. The maternal and infant survival rates were high. Little was available by way of contraception, so families with more than 10 children were common.

Death rates also fell because antibiotics became available and communicable diseases were increasingly controlled.

In the introduction to Call the Midwife, Worth attributes the disappearance of the Docklands community to “the closure of the docks, slum clearance. and the Pill”. When oral contraception became available, women chose to have much smaller families. The midwifery practice in which Worth was employed saw births fall (over a few years) from 80-100 per month to four or five per month! One can only speculate about how things would have changed if this reproductive revolution had NOT been accompanied by job loss and the wholesale destruction of old (but potentially useful) housing.

This book should be read by urban planners. Some experts think that the most sustainable human future will arise from high density urbanization.

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