Call the Midwife series 5 episode 4 recap: fresh starts and surprise discoveries

At clinic, Shelagh is explaining the difference between home births and hospital deliveries to the expectant mums, while Sister Julienne examines Mrs Ruby Cottingham. She's already got a brood of rowdy boys and is desperately hoping her new arrival will be a girl.

Nonnatus has been quiet all afternoon. There haven't been any calls and it's normally a busy time of year, so when Sister Julienne is asked on secondment to St Cuthberts hospital she jumps at the chance. Nurse Crane is worried the pace might be too much, but Julienne is intrigued. She wants to find out why more and more women are opting for hospital births.

Meanwhile not everyone is as pleased about Ian's plans for further education. "I'm going to get us both right out of here," he tells his long-term girlfriend Linda, making grand plans for their future once he's a graduate. But there's a problem. Linda's been to the doctors and they've confirmed she's "in the family way."

Tensions are running high between Trixie and Barbara, who still hasn't come clean about her date with Tom. The girls are browning their legs on the steps of Nonnatus with the help of cooking grease and making plans to see La Dolce Vita at the cinema. Barbara says she might not be able to make it because she could have other plans and Trixie storms off to have a face mask out of salad cream.

The next day Trixie returns to Sadie's to change her bandage and walks into a family drama. Sadie wants to know when Ian will be saying 'I do' but he's still determined to go to the university. Desperate, Linda tells her dad who takes matters into his own hands... "You will do the right thing by my daughter, do you hear me?" he shouts, pushing Ian up against the wall. Tom intervenes but Ian still won't be swayed. He wants a better life, to be a teacher or to make programmes about poetry for the BBC. He needs three years, but he only has seven months.

The drama's all got too much for Barbara, who goes to talk to Tom. Trixie is upset with her and it's too much to bear. Tom admits he's still struggling with the end of their engagement too and Barb burst into tears, saying it's not enough that he likes spending time with her when it's causing pain to them and Trixie. "You really are the sweetest, loveliest girl I ever met," Tom replies, as Trixie, who has just returned home, runs into Nonnatus house in tears too.

At St Cuthberts, Julienne finds out how different hospital births are when she's scolded for giving a labouring mother a cup of tea. But there is soon a familiar face on the ward. Ruby Cottingham has been admitted after Barb and Phyllis realised her baby was being born in a brow presentation. A caesarian section is required so Sister Julienne promises to look after the baby when it arrives. Julienne watches on as the doctor pulls the baby out and the room falls silent. "Oh God. Another one," he says. The baby is limbless and seriously unwell – they can't tell if it's a boy or a girl – but alive.

Ian has proposed to Linda, but he doesn't seem overly happy about it. They have a party to celebrate and Linda's dad gives a speech, presenting Ian with a brown jumpsuit for his new job at the factory where he works. Everyone claps and clinks glasses but Ian sneaks off to the men's room. Tom follows him and Ian admits his reservations about his new and unexpected path in life. “I don’t love her more than anything else in the world,” Ian admits of Linda. But enough to do the right thing, asks Tom? “Sometimes enough love is enough. It has to be.”

Sister Julienne looks for Ruby's baby in the nursery but there is no record of a baby Cottingham. She soon finds the newborn, in an empty room with 'Do not enter' taped on the door. The baby has been left, naked by a cold open window to die. She picks it up, wraps it in a blanket and says a prayer as the newborn passes in her arms. A nurse enters and Julienne expresses her shock at the way the baby has been left. It cannot live, replies the nurse. There will be a proper funeral, but a post mortem first. This is the third baby they've delivered like this in the last year, she reveals.

Later Sister Julienne seeks comfort from Sister Mary Cynthia and Monica Joan before telling Doctor Turner and Shelagh the surprising news about the other babies born like Susan Mullocks. Turner is confused that no official notification has been sent and decides to look into what happened to the other babies. "Until someone tells us otherwise we have to look at this as a local problem," he frowns.

The next morning, Sister Julienne tells Ruby about her baby's death. Ruby asks if it was a girl and Julienne lies, telling her it was. Both women sob while Julienne promises: "When she took her last breath she was warm and safe and I believe she was aware she was loved."

Newly engaged Linda's at the clinic for a regular check when Trixie realises she's bleeding. She's losing the baby, a spontaneous miscarriage after eight weeks. Linda cries in the toilet while Trixie comforts her, before she and Sadie walk her back home.

Once there they meet Tom. Ian is supposed to be at his first day at the factory, but he didn't turn up so he's come looking for him. The would-be uni student is in the house and the gas is on. He's tried to kill himself by putting his head in the oven. Tom bursts in and Trixie opens the window, before the pair take him outside and make sure he's okay.

Back at Nonnatus, Tom and Trixie talk about their relationship. It's been one year and 10 days since they ended their engagement. "It's a recipe for misery" neither of them moving on, says Tom, telling Trixie that he and Barbara have broken up so as not to cause any more upset.

Doctor Turner can't stop thinking about the babies with birth defeats. He wonders if it's connected to the H bomb and has been sitting up all night and going over his medical journals. "I don’t know. I don’t know if there is anything to know. And I’m scared," he says.

Trixie goes to check on Linda. Ian's up and ready for work but his mum Sadie says he's not going. He has to go to university now there isn't a baby to worry about. Linda hands the engagement ring back suggesting he sells it to buy his course books. "I'm doing the right thing because you did the right thing," she says. "I'm not standing in your way."

Ian refuses, so Sadie takes the band and puts it on the mantlepiece. It can stay there until he's finished his degree. "You can't stand in the way of what life wants, or what love wants. One way or another things end up as they should," she says.

Trixie walks home thoughtfully before going to speak to Barbara. "I'm not going to stand in your way," she says of her relationship with Tom, repeating Sadie's sentiment. "Things will end up as they should."

As the nuns remember Sister Hildergard, Ian packs for university while Linda and Sadie look on smiling. And friendships are mended as Trixie helps Barbara do up her bracelet to go on a date with Tom.

Call the Midwife continues on Sundays at 8:00pm on BBC1