A Practical Guide to Jennifer Worth's Farewell to the East End
I've read the Call the Midwife series cover to cover more times than I care to count, and I keep going back to Farewell to the East End because it's the most honest account of postwar London nursing writing I know. Jennifer Worth died in 2011, and the book came out in 2002 as her final volume. It covers roughly 1958 to 1960, and unlike some of the earlier books in the series, it deals with increasingly difficult patient cases, staff turnover, and the slow but real institutional changes starting to happen in the NHS. The thing most people miss about this book is how much of a primary source it actually is for midwifery practice in the late 1950s. Worth was a qualified nurse and midwife, not a fiction writer playing dress-up. She worked at Poplar Nursing Home, which became the basis for Church of Jesus Christ missionaries later taking over the building and turning it into a charity — the same setup described in the books. The East End she describes is real. The poverty, the housing conditions, the family dynamics around maternity care. It's not romanticized the way some period medical writing gets. She writes about women delivering at home because they had nowhere else to go, about tetanus in newborns from unsterile cord cutting, about mothers who had no idea what they were doing because nobody had told them. These aren't dramatic flourishes. They're clinical observations from someone who was actually there.
What the book covers and what it doesn't
The narrative follows the midwives through a couple of years at the convent. There are case studies embedded throughout — multiple births, emergency interventions, infant resuscitation, postpartum hemorrhage management, the early days of prenatal screening. Worth also deals with the personal side: burnout, relationships with patients that go beyond clinical boundaries, staff disagreements, the moral weight of decisions made with limited resources. What the book doesn't do well is explain the clinical reasoning behind many of the interventions. If you're looking for a textbook breakdown of why a particular treatment was chosen in a given scenario, you won't find it here. Worth assumes the reader already understands the medical context of the era. I found myself pulling up secondary sources on 1950s obstetrics in the UK after reading passages that mentioned treatments I couldn't fully contextualize from the text alone.
A specific problem I ran into with this book
When I first tried using the book for reference material on midwifery practices of the period, I hit a wall with one section. Worth describes a situation where a patient had prolonged labor and the midwives administered what she calls a "sedative" to help the mother rest. She doesn't name the drug or give dosages, which is probably for privacy reasons. But if you're trying to understand the clinical picture, the vagueness is frustrating. I ended up cross-referencing with UK nursing journals from 1959 to 1961 to figure out what was likely being used. The answer was almost certainly a barbiturate — secobarbital or something similar was common in British maternity wards at the time for this exact indication. Worth's descriptions are clinically accurate in outcome but deliberately imprecise in pharmacology. That's worth knowing if you're citing this for any research purpose. Read chronologically, Farewell to the East End is the natural conclusion to the three-book arc. The first book establishes the setting and the characters. The second deepens the medical cases and shows institutional change starting. This one pulls it together with heavier emotional content and faster turnover of both staff and patient outcomes. Some readers find the final volume more depressing. I think that's accurate to the period. The late 1950s were a transition point in British healthcare where the old ways were ending but the new infrastructure wasn't fully in place yet. The gap between those two realities is where the suffering in these pages lives. The biggest limitation is that Worth's perspective is necessarily narrow. She writes about the patients she encountered at Poplar Nursing Home and the surrounding area. That's a specific slice of the East End, primarily white working-class patients in a particular socioeconomic bracket. The book doesn't address the experiences of immigrant communities, ethnic minority patients, or the fuller range of the East End's population during that era. If you're using this as a source for the social history of London maternity care broadly, you need to supplement it with other accounts.
Get the Full Details
There's also the question of narrative reliability. Worth wrote these books decades after the events they describe. Memory fades, details shift. I'm not saying she fabricated anything, but the kind of precision you'd want from a contemporaneous clinical log isn't what this is. Treat it as memoir, not medical record.
Practical reading notes
The book runs about 350 pages in most editions. If you're reading it for the clinical content rather than the narrative, skim the interstitial personal sections. Worth's own life story, while interesting, takes up roughly a third of the page count across the series. The case material is where the value is. Several editions exist. The original UK hardcover from Transworld Publishers is the standard reference. Paperback reprints from Pan Macmillan and other imprints have different introductions and forewords. Some later editions include material Worth wrote after the initial publication. Check the copyright date on whichever copy you get if you care about chronological accuracy to the events described. For anyone actually working in maternity care or studying the history of midwifery in the UK, this book is useful precisely because it's not trying to be academic. It's a practitioner's account written by someone who stayed in the work long enough to see what changed and what didn't. That experience shows up in every chapter. The limitations are real, but the core observations hold up under scrutiny.
