The all-white cast, including Jessica Raine as Jenny Lee, Miranda Hart as Chummy, Jenny Agutter as Sister Julienne, and Pam Ferris as Sister Evangelina, aligns directly with the historical 1950s East End setting without any race- or gender-swapping of established characters or imposition of modern diversity mandates. Storylines drawn from real midwifery cases center on concrete episodes such as a woman pregnant for the 25th time, a runaway teen, an old soldier's ulcers, a baby abduction, a brother's cancer diagnosis, and Chummy's wedding despite her mother's disapproval. Creator Heidi Thomas adapted authentic memoirs for social history rather than contemporary messaging, resulting in no LGBTQ+ representation, DEI framing, or critiques of traditional norms. Later series additions such as the first Black nurse in series 7 and queer storylines are entirely absent, preserving the focus on period-accurate community life.