House of the Dragon Revolutionized The Depiction of Childbirth on Mainstream TV

For better or worse, House of the Dragon depicted the unvarnished realities of difficult labor for a mainstream TV audience.

Rhaenyra (Emma D'Arcy) and Laenor (John MacMillan) on House of the Dragon Episode 6
Photo: Ollie Upton | HBO

Content Warning: This article contains spoilers for House of the Dragon season 1 and discussion of birth trauma and stillbirth.

The childbirth scenes in House of the Dragon have been a talking point among fans online since the horrifying Cesarean section depicted in the first episode. Some of what we’re seeing on the show represents things we’ve seen before – screaming mothers, pacing fathers, crying infants. But there are aspects of childbirth presented on House of the Dragon that we hardly ever see on mainstream television, and that’s really exciting.

Mainstream TV dramas have been showing more and more of the gory details of childbirth over the years and some shows have given us memorable birth-and-labor sequences. We’ve seen a couple having sex in an attempt to help labor along in Outlander, the tragic death of a woman from undiagnosed eclampsia in Downton Abbey, and the exact same tragedy in much more modern context in a famous early episode of ER.

Human beings have always known that childbirth is a dangerous thing to go through for both mother and baby. The ancient Greek playwright Euripides had his title character Medea tell the audience in 431 BCE that she would rather go to battle three times than give birth once. George R.R. Martin and the other writers of House of the Dragon know their ancient Greek plays, and Queen Aemma (Sian Brooke) tells her daughter Rhaenyra (Milly Alcock) in the first episode – not long before the infamous C-section – that birth is a woman’s battlefield.

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The Messy Sides of Childbirth

There are other TV series that show – indeed, sometimes revel in – the pain and danger of childbirth, especially the BBC period drama Call the Midwife and dramatization of an obstetrician’s memoirs, This is Going to Hurt (the clue is in the title there). Both depict just about all the various aspects of childbirth, including the ones often missing from mainstream birth scenes – the need to deliver the placenta after delivering the baby, the need to cut the cord, and so on.

Call the Midwife airs pre-watershed in the U.K.. The “watershed” is 9 p.m. – before then there are strict rules about what can and can’t be shown on mainstream TV channels including the BBC, with more “adult” content airing after 9 p.m. This means Call the Midwife cannot reveal too many gory details, but it shows as much as it can get away with and talks about the “afterbirth” (the placenta), cutting the cord, visiting mothers with incontinence following the birth, and so on. This is Going to Hurt is shown after the watershed and does not hold back on blood, and other bodily substances.

However, there are a few crucial differences between these two shows and House of the Dragon. First and most obviously, the reason we see so much of the gory details of childbirth in these shows is that they focus on births that are complicated, difficult, or that go horribly wrong. In the case of Call the Midwife, this is done for drama, for obvious reasons. And there is even more focus on births going wrong in This Is Going To Hurt because it follows an obstetrician in the U.K., and in the U.K., doctors don’t attend uncomplicated births – midwives take charge of straightforward births, and doctors are only called in if something goes wrong or if the birth is very high risk.

Both also focus on the experiences of the medical staff over the experience of the mother, and this is where House of the Dragon has started to make some changes. Queen Aemma’s labor is the obvious exception, being seen largely from the point of view of her husband. But Laena Velaryon’s (Nanna Blondell) labor scene splits the focus between her experience and her husband’s, while Rhaenyra Targaryen’s (Emma D’Arcy) first birth scene focuses entirely on her.

It’s also important to remember that only people with an interest in seeing the various details of childbirth will watch Call the Midwife, This Is Going to Hurt, or reality series One Born Every Minute (which also focuses on the medical staff, following several women giving birth intercut with previously recorded interviews in each episode), since all are focused entirely on repeated scenes of childbirth. Anyone who does not have a special interest in the subject simply won’t be watching those shows – unlike House of the Dragon, which appeals to a broad audience of fantasy and Game of Thrones fans.

Childbirth Going Wrong

Three of the four birth scenes in House of the Dragon season 1, like Call the Midwife or This is Going to Hurt, focus on just how badly wrong childbirth can go. Two kill the mother; both Queen Aemma in episode 1 and Laena Velaryon in episode 6 suffer the same complication, labor going on too long without the baby appearing. In the modern world, at this point the baby would be delivered by C-section, saving the lives of both mother and baby.

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In medieval Europe the mother was very unlikely to survive such an operation. However, it is also very unlikely that these operations were routinely performed on living women without their consent. A C-section was performed because the mother was already dead, or very close to death. We have actually seen an example of this fairly recently in mainstream TV drama, as Claire Fraser performs the operation on a dead mother in season 6 of Outlander.

There was a small chance it might save the baby – Shakespeare’s Macbeth character Macduff claims to have been born by C-section for example – but a lot of the time the babies did not survive either. The purpose of doing the operation was a combination of practicality and religion. If nothing was done, mother and baby would both definitely die (and the mother was often already dead), but if the operation was performed, there was a small chance the baby might live. And there was a good chance the baby would live long enough to be baptized, which was considered essential for the baby to get into Heaven in medieval Christianity.

The horrific death scene of Queen Aemma, in which she is still very much alive, conscious, and of sound mind but is given no choice in the matter and cut open against her will, is possible but unlikely in a real historical situation. It might be more likely if the father was a King desperate for a son, but rumors that early modern English King Henry VIII gave such an order are unlikely to be true since his third wife, Jane Seymour, died several days after giving birth to their son and a C-section would have killed her straight away.

Laena Velaryon is allowed a little more agency, as she chooses to be immolated by her own dragon. That keeps the focus more on the danger of the process of childbirth for both mother and baby, especially for anyone who does not have access to a modern hospital. According to the World Health Organization, severe bleeding and pre-existing conditions actually account for the largest number of maternal deaths in childbirth, with statistics from 2014 putting the percentage of deaths caused by ‘obstructed labor and other’ at 9%. That may be because in most places in the modern world, it’s possible to carry out a C-section without killing the mother, though it’s also worth noting that it makes a more dramatic TV episode to have the mother die during the process, rather than over a period of time as a result of either severe bleeding or sepsis.

The final childbirth scene of season 1, the second of Rhaenyra’s six labors that we have seen, shows us an example of every parent’s worst nightmare, as the baby does not survive. This is not such a frequent outcome now as it was in the medieval period, thanks to various advances in medicine including extensive monitoring of high-risk pregnancies. In the case of premature births, like the one seen here, neonatal intensive care units have greatly increased the survival rate, depending how far along the pregnancy is. But it is still a tragedy that affects hundreds of families, with 1 in 175 pregnancies ending in a stillbirth in the US today according to the CDC.

One of the things this birth highlights is the utter helplessness for the mother of being at your most vulnerable, unable to control anything that is happening, and completely reliant on the people around you. A person giving birth relies on the medical professionals helping them – midwives, doctors, doulas – and on their birth partner, who can talk to the medical staff, who can be with them the whole time and who knows them the best. Birth partners could be the person’s own mother, or a friend or partner of any gender, but much of the time they are a man, the father of the baby. The circumstances may be heightened for Rhaenyra, but this scene touches on that feeling of frustration and helplessness, as it shows her desperately struggling to keep everything together while being forced to rely on Daemon and Jacaerys not to start a war unnecessarily – a war in which her premature baby becomes the first casualty.

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When Childbirth Goes Well

But the most important childbirth scene in House of the Dragon isn’t any of the births that go horribly wrong. The most important and game-changing childbirth scene, in terms of what we get to see on mainstream TV, is the one that goes well.

In episode 6, we see Rhaenyra give birth to a baby boy, Joffrey. Both mother and son are healthy and the birth goes well. We then see Rhaenyra undertake an agonizing walk up to a higher floor to bring the new baby to see Queen Alicent (Olivia Cooke) personally.

This is what is so important about this scene – it shows the pain and blood and agony involved in the straightforward birth of a healthy baby. Rhaenyra hastily delivers the placenta while standing and trying to get dressed – something definitely not recommended, even by Westerosi midwives. She can barely walk and the sight of a large flight of stairs is clearly horrifying to her. She leaves a trail of blood behind her as she stumbles back to her own rooms.

These are the parts of childbirth that are so rarely shown – the physical effect on the mother beyond the actual labor, when the screaming is over. For starters, there’s the need to actually give birth to the placenta, which continues to be painful. Then there’s the lingering pain, the strain on every bone and muscle in the pelvis, and the weeks of bleeding that follow. Not even ‘reality’ show One Born Every Minute shows any of that, as it cuts away from the new mother as soon as the baby has emerged.

We do see more of this side of childbirth in Call the Midwife and in This Is Going to Hurt. Call the Midwife might show the midwife carrying away the placenta or blood on the sheets, while This Is Going to Hurt shows the bloody aftermath of even an uncomplicated water birth. But both focus primarily on the medical staff, not the mother, and both spend more time on the complicated or traumatic births. The mother’s experience of this part of a straightforward birth tends to be glossed over. The same is true of most shows that feature detailed depictions of childbirth.

Of course, not every woman’s experience of childbirth is the same, and the experiences of giving birth to two different children can be very different. Some women find the pain is something they can cope with and they eagerly go through it again; some go through it again but dread it; some stop after the first, for many reasons, the pain of childbirth sometimes being one of them. Some women have an almost enjoyable experience, others suffer from PTSD as a result of their experiences. But every single one of them has been in pain; has been exhausted; has had their bones and muscles stretched to breaking point and their body changed forever. That is the simple truth that we see in the first scene of episode 6 of House of the Dragon, and that is what we would love to see more of in mainstream television.

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