One-to-one with Terri Coates

By Terri Coates on 07 March 2018 Midwives Magazine

Call the midwife is one of the BBC’s most popular and award-winning series and has given the profession a great boost, thanks to the programme’s midwifery advisor Terri Coates. 

Had it not been for an article in the first issue of the RCM Midwives Journal, the award-winning BBC series Call the midwife might never have come about.

Photo credit: Sophie Mutevelian

The series is one of BBC TV’s most popular dramas, regularly achieving viewing figures of 10 million, and is enjoyed in many countries, including the US, Australia, Greece, Finland and Spain. In the UK, it has been credited with boosting the profile of the midwifery profession, with student applications rising alongside the popularity of the series.  

In 1998, midwife Terri Coates, now midwifery advisor on the series, turned an essay for her MSc into an article on the role of midwives in literature, arguing that the profession was under-represented in books.

‘My call was for someone to write about midwives and give them a story in the same way that James Herriot did for vets,’ says Terri.

The article struck a chord with midwives, many of them writing to Terri. One was Jennifer Worth, who told Terri she felt inspired to write about her time as a midwife in east London in the late 1950s.

‘I thought little more of it, but 18 months later she sent me a handwritten manuscript. The stories leapt off the page, but she had only been a midwife for a short time so had misremembered her midwifery to quite a large extent,’ says Terri. ‘For example, she would say “the normal posterior position”, but midwives know that she means anterior.’

Terri offered to edit the midwifery elements in the manuscript, and Jennifer agreed. Jennifer went on to write three books about her time as a midwife: Call the midwife, Shadows of the workhouse and Farewell to the East End. Terri worked with Jennifer for no payment, but that changed when the BBC turned the first book into a drama. 

‘As Jennifer didn’t really have much midwifery experience, when the books became a programme, she could not advise on the script or on set. So she suggested me,’ says Terri.

It was the start of a journey that took Terri’s career in an unexpected direction, even as she continued to work in education and clinical practice.

Making it real

Terri is involved in each series from the treatment stage, when there is discussion about the content of each episode. She will work with the producers and writers on storylines to ensure the professional language is appropriate and that the content is accurate.

‘If they want to portray a breech birth, I would ensure that the clinical side is right,’ says Terri.

On set, she works with the director to ensure that the depiction of pregnancy and birth is accurate.  

‘That might be making sure there is no dialogue during a contraction – women don’t talk through a contraction. It’s almost choreographing birth. The actor needs to be in an appropriate position to make the scene clinically plausible,’ explains Terri.

Terri manages details only a midwife would spot, such as ensuring the actor portraying the labouring woman is not sitting forward on her perineum, which would prevent the baby coming out. 

Working on set involves long hours, with the crew filming for six months. A 12-hour day will result in four to five minutes of an episode. Filming a single birth scene can be the same length of time as some real-life births – six or seven hours. 

‘On set, there’s intense concentration. Everyone works very efficiently. If it’s a woman giving birth, they try to have a small crew. The actress is in a very compromising position, just as she would be if she is really giving birth,’ says Terri. ‘And hair and make-up will come in and out as needed – it takes a lot of effort to get people looking dishevelled.’

Ensuring births are true-to-life means that Terri will often be lying out of shot to ‘deliver’ the baby to the actor playing the midwife. If the woman is filmed kneeling on the floor or lying on a bed, then Terri will be underneath the actor or the bed. On other occasions, Terri’s hands might be filmed rather than an actor’s.

The welfare of the newborns on set is another part of the job. The babies are found by an agency, but the actors don’t touch them until Terri believes they are ready. For the scenes where manoeuvring is depicted, lifelike prosthetic babies are used. Because scenes are shot out of chronological order, sometimes two or three babies are used to portray one newborn in the show.

Popularising the profession

Such is the popularity of the show that interest in midwifery as a career soared – as did sales of old-fashioned bicycles. Terri says that clearly midwifery has changed from the 1960s: ‘The programme shows midwifery with a rosy glow, in the same way James Herriot did with vets. But the show is not scared of difficult storylines and it shows birth, life and death.’

Some differences are obvious – midwives are seen cycling past bombsites in London from the war, and the show depicts differences in the way that people lived in the 1960s, without the mod cons, such as central heating. ‘Most houses didn’t have phones so someone would be sent out with coins to the phone box,’ says Terri.   

Terri’s first NHS job was in 1974, and she began her midwifery course in 1980, so the nurses and midwives who trained her would have been the same age as those portrayed on Call the midwife.  

‘Things were not that different in 1974. There was not the enormous change that we’ve seen between 1980 and 2000. Now, even five years sees a big change because of technology,’ says Terri.

Putting midwifery practices from the 1960s side by side with those of 2018 highlights the huge changes in society and technological advancement. Maternity care has evolved to include antenatal tests and scans, giving midwives greater knowledge about a baby’s health and, generally, the population is healthier, says Terri. Women and families today are much more knowledgeable and demanding, and midwives serve a larger population. Home births are now less likely, and Terri thinks that midwives then may have had greater confidence in the human body. 

‘The level of autonomy in 1960 was much greater because backup was more difficult to access,’ she says.

Terri is unsurprised that midwives enjoy Call the midwife: ‘It’s a professional narcissism. You enjoy it when it’s well done.’ For ensuring that midwifery is well done and well represented, midwives have Terri to thank.

Special effects on Call the Midwife 

• If cords are shown attached to babies in a scene, it’s computer-generated imagery.   
• Warmed oil is used on babies so that they don’t get cold on set.
• The fake blood, which Terri describes as ‘sugary and sticky’, is similar to glycerine.
• There have been more than 100 births portrayed on the programme.