Eclampsia Highlighted in PBS Drama "Downton Abbey"

Spoiler alert: This blog discusses plot twists from the latest Downton Abbey episode.

This week’s episode of Downton Abbey, the popular Edwardian period drama that airs on PBS, had a significant plot twist that deviated from the usual quibbling over what to wear for dinner, romantic escapades, and impending changes to the decorum at Downton. Instead, the show tackled the very difficult topic of maternal death.

Along with postpartum hemorrhage, sepsis, and unsafe abortion, preeclampsia is among the leading causes of maternal death in the world.First, for those of you who may be unfamiliar the show, here’s a quick recap of this week’s episode: Lord Robert Grantham’s youngest daughter, Lady Sybil Branson, is about to give birth and her father has called in respected physician Sir Phillip Tapsell. While Sir Phillip has a pedigree that his Lordship appreciates, Lady Grantham strongly advocates for Dr. Clarkson, the country doctor who has been the family’s physician for years to also attend the birth.

Watching the debate between the physicians over the best course of treatment as Sybil began to show signs of “muddled” thinking and swollen ankles, I began to have a sinking feeling that something would go wrong—either for the mother or the baby. Dr. Clarkson expressed his concern that Sybil may suffer from preeclampsia, which is often characterized by high blood pressure and may result in swelling of the feet and hands. Recognizing that Sybil was exhibiting these symptoms, Dr. Clarkson recommends that Sybil be transported to the local hospital to have a Caesarean section. Clarkson’s recommendation is rebuffed by Sir Phillip, who assures Lord Grantham that his daughter will be fine and can safely deliver at home.

Later in the episode, the family welcomes the newest edition of the Grantham family, a baby girl. After the mounting concern by Dr. Clarkson and Lady Grantham over Sybil’s health, audiences surely breathed a sigh of relief at the sight of the healthy baby. However, moments later the plot shifted and Lady Sybil went into convulsions and was unable to breathe, her mother and husband pleading for the doctors to intervene. Millions of viewers were left as helpless as the doctors and family watching her death.

Moments later, my Facebook feed was filled with comments about the scene, a few sharing similar scares with preeclampsia—a jolting reminder of how we so often see the public posts of happy families, but so rarely hear about the difficulties that may have occurred during pregnancy or delivery.

Soon after “Downton Abbey” was trending on Twitter, and in the following days, various media outlets addressed the linkages between Lady Sybil’s death and ongoing need for women and their doctors to recognize the danger signs of preeclampsia and related disorders. Along with postpartum hemorrhage, sepsis, and unsafe abortion, preeclampsia is among the leading causes of maternal death in the world.

Woman in labor, India

Whether the plot twist intentionally aimed to raise awareness of the issue of preeclampsia/eclampsia, and more broadly of maternal death, or was only an attempt to generate additional buzz for the popular show, I immediately thought of the parallels with Pathfinder’s work in several countries where maternal deaths remain unacceptably high. While the show clearly elevated the profile of preeclampsia as a risk factor for many women, subtler themes that Pathfinder encounters in our work were also present, including complications that arise during home delivery, lack of prenatal care to recognize symptoms, lack of transportation options when emergencies arise, and lack of the mother’s decision-making power as parents, spouses, and others intervene in the delivery process.

For example, in Nigeria, where Pathfinder has to address maternal health since 2007, delivery in a health facility with a skilled attendant is particularly low at just 10 percent.  Similar to Lady Sybil’s experience, when complications occur, Nigerian women often do not make it to hospitals as complications are not recognized as problems or transportation is not available or the distance to travel is too far. Unlike Lady Sybil, women in Nigeria often face the added burden of being unable to pay for transportation or the highest quality of care.

To address the three main causes of maternal deaths—postpartum hemorrhage, sepsis, and high blood pressure (pre-eclampsia/eclampsia)—Pathfinder developed an innovative holistic program model that integrates clinical interventions with efforts to address cultural, economic, and infrastructural barriers that prevent women from seeking and accessing quality maternal health care. The model has been implemented in India, Nigeria, Tanzania, Peru, and Bangladesh. Pathfinder informs women and their communities about birth preparedness and possible risks and trains providers in high-quality antenatal services, ensuring timely detection and management or referral of those at high-risk of obstetric complications.

As we tune in to see how the residents of Downton Abbey carry on after this devastating loss, let’s not forget about the heartbreak, absence, and guilt felt by families who have suffered this loss in real life.Last year in India, Pathfinder worked with frontline community health workers to reach women and their families with information about potential childbirth complications, distributing more than 4,000 birth preparedness calendars that identify the nearest providers and allow mothers to create an action plan in case of emergencies. In addition, Pathfinder successfully facilitated preeclampsia/eclampsia training for more than 250 service providers, increasing their ability to recognize danger signs and provide appropriate treatment.

While Lady Sybil may have had every advantage in the world due to her wealth and status, she suffered from the same complications and the lack of care that many women continue to face throughout the world. As we tune in to see how the residents of Downton Abbey carry on after this devastating loss, let’s not forget about the heartbreak, absence, and guilt felt by families who have suffered this loss in real life.

Want to do more? You can help us prevent the deaths of women around the world. Ask John Kerry to make maternal mortality a US foreign policy priority during his time as Secretary of State.

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