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Even with Christmas approaching, nothing feels quite right in Poplar after the train crash that devastated the neighborhood. While Trixie has returned from attending her godmother’s death in Italy, Sister Hilda has left Poplar and will not return. Matthew has brought a Christmas tree to Nonnatus House, but even that is a bit crooked.
So Fred decides to organize a talent show to bring everyone together in celebration and raise funds for those affected by the train crash. Violet, Lucille, Cyril, Reggie, and Tim, who’s home for the holidays, will help.
Medical student Tim is also helping out at the maternity clinic, which has moved to a new building. When he meets Susan Mullucks, who was left with foreshortened limbs as a result of a thalidomide-based morning sickness drug that her mother, Rhoda, took while pregnant, he begins to question his previously unshakable faith in medicine.
Susan is at the clinic because Rhoda is pregnant again. Rhoda learns from Shelagh that Susan does not have a part in the upcoming community Christmas show, and confronts the domineering Mrs. Avis, who is in charge of the show. Avis makes excuses in the face of Rhoda’s rage.
Rhoda is also upset with her husband, Bernie: his adoration of Susan and anger at the world’s treatment of her has led him to frequent the pub and the bottle. He even wants to accept a settlement from the company that manufactured the thalidomide drug to gain a sum of money immediately, rather than continue accepting payments that will amount to more in the long run. He does at least have a great idea for Christmas: buying a dollhouse for Susan.
Cindy is looking for any sort of house. Released early from prison on account of good behavior, she’s pregnant and due to be married, but her fiancé Andreas has disappeared. When she visits the flat they shared, she finds a new family living there and a Christmas card from Andreas waiting for her with a meager amount of cash.
She sets out to look for lodging and takes down landlord information from the Buckle general store’s window. Reggie sees her shivering in the cold and goes to offer her his winter coat, but she has already vanished. She eventually finds a room in a dingy house, where she is overcharged; the landlady doesn’t want any officials visiting the condemned structure, and so insists that Cindy move out before having her baby. Cindy assures her she’s not due until Easter. She turns to prostitution to make rent.
Cindy is entitled to government help, but she struggles to access it because she lacks the documentation she needs to fill out any application forms. She’s also Black, the daughter of a British mother who was sent to a mental hospital and American soldier father, and so a social services worker doubts that she is even a British citizen. But she’s determined to provide a good life to her coming child, and buys some baby clothes and knitting patterns from Violet.
Nancy continues to want to build a good life for her daughter Colette, and has purchased a TV so that they can watch it together. But there’s not enough space in the room she shares with Trixie, given both of their collections of clothes, so Sister Monica Joan offers to house the TV in her room.
Nancy’s proximity to Trixie leads Matthew to ask her for a favor. He’s going to propose to Trixie, but he needs to know her ring size. Nurse Crane and Sister Julienne soon learn of the coming proposal, too, and Julienne warns Matthew that when Trixie was previously engaged, she was disappointed by the ring. Unfortunately, Matthew has already bought one.
With snow falling, Susan Mullucks stays home from school: she’s smarter than most of the other students at her school for the handicapped, which she is forced to attend, and it’s a long bus ride. Dr. Turner concedes that the situation is not ideal, but he can’t make the Mullucks’ decisions. Rhoda refuses to take iron supplements despite being anemic while she’s pregnant, fearful that any medicine might affect the baby, as with Susan.
Susan is learning to use new prosthetic legs, but she’s still unsteady in them. So when she wanders outside to watch her brother have a snowball fight, she falls and cracks her head, and has to go to the hospital. Rhoda blames herself for not watching; her other children are upset over her obsessive attention to Susan. Dr. Turner sends her to the maternity clinic to avoid stress while awaiting her next child’s birth.
Cindy is also about to give birth, and her landlady kicks her out when her water breaks—at least giving her a refund in rent and telling her to go the hospital. Instead, Cindy wanders in the snow, looking for help. She finally finds some when she yells out and Nurse Crane and Miss Higgins, rehearsing a talent show act that Crane has reluctantly acquiesced to, hear her.
Cindy is too far along to be taken to the clinic, so Nurse Crane delivers the baby in Miss Higgins’ house. Miss Higgins retrieves Cindy’s scant belongings from her old flat, and sets about helping Cindy fill out forms to receive government assistance.
The Mullucks men are also out in the snow when Rhoda goes into labor. Bernie has lost Susan’s dollhouse, having been drunk when he picked it up. He and his son find it smashed up in a garbage truck.
Bernie is drunk, too, when he bursts into the clinic to see Rhoda. Trixie intercepts him and offers to bring him to AA, but first she brings him to his home and children for Christmas Eve, bustling him into the back of Matthew’s car. Matthew’s plan to propose is stymied.
Rhoda tells Shelagh during her labor that she doesn’t want the coming baby. Shelagh has her talk through it—her struggles with Susan, her fears—and a boy, loved and wanted, is born. Rhoda names him Patrick, after Dr. Turner, in honor of his fights on behalf of the children afflicted by thalidomide.
Matthew, having witnessed how upset Trixie was by witnessing alcoholism’s ruinous effects in Bernie, goes out and buys a new dollhouse for Susan. Back at Nonnatus House, when he again tries to propose to Trixie, Shelagh interrupts at the decisive moment.
Sister Frances, meanwhile, is called out to attend a birth in a garment factory where a young South Asian woman who speaks little English lives. The baby is born healthy, but the placenta won’t appear, so Frances calls for help at a nearby phone booth. She falls off her bike in the snow on her rush to return to the woman, breaking her arm. Lucille arrives and they save the mother together before Lucille sends both the mother and Frances to the hospital.
Frances has been working nonstop to fill Sister Hilda’s place in addition to her own duties. Sister Julienne sends her to Chichester to rest and recuperate until her arm is healed.
Bernie attends an AA meeting with Trixie, and talks about his love for Susan—and the difficulties it causes.
At the talent show, Susan joins the Turner children in a performance, getting to take part in a Christmas spectacle after all. Reggie wanted to play guitar, but becomes nervous when the moment comes. Cindy encourages him, and ends up sitting onstage with her newborn baby, smiling at Reggie as he plays.
After all this, Matthew finally proposes to Trixie next to the Thames. Fearing that she will dislike the ring, he flings it aside after showing it to her—and she rushes off to fetch it from the mud.