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Downton: why let science get in the way of a good story line?

Posted by Dr Mortons 4 Comments

Written by Karen Morton, Consultant Gynaecologist and Obstetrician and founder of Dr Morton’s – the medical helpline

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Poor Mrs Bates. Every woman who has ever had a miscarriage, let alone several, will have experienced a flashback when they heard Mrs Bates tell Lady Mary:

“I can’t have children, m’Lady” clarifying it with: “I can’t hold on to them.”

These words will resonate heartbreakingly with any woman who has felt the bleeding or looked at the ultrasound scan picture and seen just an empty space and the sympathetic face of the sonographer, indicating another miscarriage.

In 1912 there would have been very little known about why women have recurrent early miscarriages.

However, cervical incompetence, as suggested by the Harley Street gynaecologist to whom Lady Mary took Mrs Bates, would be highly unlikely. The storyline suggested that Mrs Bates’ miscarriages had been early, in other words before 14 weeks.

Cervical incompetence is one cause of late miscarriage or premature delivery. It is a weakening of the ability of the cervix to stay closed like a valve until it should let the baby out.

Typically women with cervical incompetence come to hospital with a blood-stained discharge and a bit of discomfort. An examination reveals a bag of membranes in the vagina with a baby kicking around in it. It is such a tragic sight. As an obstetrician I have seen it many times, and breaking the news that the little baby, often at a ‘so close and yet so far’ gestation such as 21 weeks, is literally falling out, is very sad indeed.

Back to Downton. Mrs Bates is in bloom and Lady Mary is ready to whisk her back to London for a ‘cervical cerclage’. Now, the producers of Downton have again made an historical scientific mistake. The operation of Cervical cerclage was not actually described until the 1950s!

But would it solve her problem anyway? A cervical cerclage (a stitch put around the cervix in the vagina) does not work even for late miscarriage and certainly would have no bearing on early miscarriage. for late miscarriage, it must be put much higher up through an abdominal incision and the baby delivered by caesarean section.

So, I wonder how the story at Downton Abbey will unfold this weekend? I suspect a stitch will be ‘successful’ and we will be treated to that unmistakable look of fatherly pride on Mr Bates’ face as he cradles his new-born baby.

I hope so… because reality doesn’t make for such a good storyline.

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Tags: caesarean, cervical cerclage, cervical stitch, Downton Abbey, miscarriage

4 Responses

  • Marcia says:
    February 1, 2016 at 12:53 AM

    I just had to look this up. I had this procedure done for two pregnancies after losing my first. I couldn’t imagine that it was being done in the 1920s. Shhh don’t tell anyone. It does add an interesting twist to the story.

    Reply
  • Judy says:
    October 11, 2015 at 1:23 PM

    hOpe it is a happily ever after situation!!

    Reply
  • julian says:
    October 11, 2015 at 9:40 AM

    very interesting but I hope all goes well at Downton

    Reply
  • julian says:
    October 10, 2015 at 9:30 PM

    medically interesting but why allow facts to get in the way of a good story?

    Reply

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