Pregnancy and Childbirth

The first episode of the new female-fronted television adaptation of David Cronenberg’s 1988 psychological thriller, “Dead Ringers,” splices together footage of four live births with shocking forthrightness. A plastic-gloved hand grips the bloody head of a newborn and tugs it from the birth canal as another cradles it from below; a baby is pulled briskly out using a pair of elongated metal forceps clasped around its skull; a scalpel is drawn sharply through the surface of a prepped and sterilized abdomen during an emergency cesarean section; hands are thrust inside and a small body is lifted up. “Why are you wearing my vagina like it’s a [expletive] glove?” shouts one patient at the doctors working busily out of view.The montage is a feverish, pugilistic sequence of grunts and cries that presents modern obstetrics as a high-volume industry, an assembly line made up mostly of soft, fleshy parts and powered by adrenaline. When at last the twin gynecologists who are the focal point of the series (both played with startling acuity by Rachel Weisz) are able to pause and rest for a moment in the quiet of an empty hospital room, I couldn’t help letting out my own sigh of vicarious exhaustion.In the television world, babies are a convenient way to reinvigorate stale interpersonal dynamics, or a point of narrative pressure that forces characters to make dramatic choices. But births, in all their beauty and gore, are rare. We’re used to a certain sleight of hand, carefully placed cuts and scenes where fresh-looking mothers in hospital gowns hold clean, swaddled infants in their arms. Real birthing is something more radical: Pregnancy involves a terraforming of the body that might appear terrifying if you were to see it at time-lapse speed. Inside a pregnant body, the volume of blood can increase by at least a third: It swells the hands and limbs; fluid accumulates in some tissue, like the legs, causing it to bloat like an oversaturated sponge. Soaked in hormones that relax the tendons and ligaments, the joints in the pelvis loosen and the shape of the foot is remolded under greater weight. During labor, the pelvic floor, which helps to hold organs in place, can stretch or tear permanently, causing them to resettle in unfamiliar ways.Thinking about all this puts birth in a different generic register depending on how it is framed and depicted. Having a child might be a blessing or a difficulty within the tropes of a domestic drama, but the actual mechanics of bringing that child into the world verge on body horror, the genre perhaps best typified by the films of David Cronenberg. He made his reputation as a horror auteur with movies like his 1986 remake of “The Fly,” in which a scientist accidentally fuses his DNA with that of a common housefly. In his worlds, familiar physiology is bent into strange new shapes, showing us that the seeming fixity of our bodies is only a soothing illusion.Weisz had been fascinated by both Cronenberg’s “Dead Ringers,” which she saw in the theater in 1988, and the real-life story of the Marcus brothers (renamed Mantle in the film), twin gynecologists who, having withdrawn from public view, were found dead in the apartment they shared in New York City in 1975, their messy lodgings strewn with bottles of opioids and barbiturates. These “miracle workers” who specialized in helping barren women conceive and give birth, met an end that cast doubt on the infallible authority of doctors. The story cut to one of the insoluble tensions in reproductive care: that the individual assigned to work so intimately with your hopes and fears and physiology is essentially a complete stranger — maybe even a dangerous one.Amazon Prime VideoRachel Weisz plays twin gynecologists in “Dead Ringers,” a new series based on David Cronenberg’s 1988 thriller.Niko Tavernise/Amazon Prime VideoCronenberg’s film played up the psychic conjunction of the twins, a monstrous codependency that functions perfectly until, suddenly, it does not. Weisz’s new adaptation is less claustrophobic, less a psychological study than a psychosexual thriller in the vein of some of her favorite films in the genre, “Bad Timing” (1980) and “Don’t Look Now” (1973), in which the externalizing of the characters’ private desires and fears rearranges the world itself. Beverly and Elliot — one a nurturing obstetrician, the other driven by an insatiable appetite for food, sex and biomedical research — are working to open a slick, hyper-modern birthing center and seek funding from an ultrawealthy investor. Beverly’s goal is “to change the way women give birth, forever,” but Elliot’s is something more fluid — she wants to continue her illicit laboratory work growing fetuses in artificial wombs, but most of all she wants to make her twin sister’s dream a reality. They negotiate, in alternating agreement and opposition, the contradictory drives toward individuation and the need for others, repulsion and love.What “Dead Ringers” manages to get on the screen feels, in terms of television, urgent and new. It publicizes bodily processes long held in a secretive personal space, making them available for discussion. Together with her collaborators, Weisz — who is an executive producer on the show as well as its star — has summoned a discordant vision of female experience: the grisly, unsettling and unexpectedly beautiful fact that birthing is a life-altering event rather than a collective fantasy.In February, I spoke with Weisz over Zoom from her home in upstate New York. She wore a plain shirt and thick glasses of crystal-clear acrylic that gave her the look of the most stylish professor on a comp-lit dissertation committee. Weisz radiates the poise that was the signature of her early career, looking impassive until something unexpected grabs her attention and she breaks into a warm smile. As we spoke, her bearing made me search myself continually for something pleasing to say. Dark-haired, heavy-browed and possessed of an intent gaze, she still has the features of the fresh-faced English rose who stepped into the spotlight in Bernardo Bertolucci’s “Stealing Beauty.” The face holds more emotion now, and has a greater capacity to convey softness or threat or an ambiguous sort of danger lying beneath its placid surface.In recent years, as Weisz has moved into a more boundary-pushing phase of her career, you can see her cracking the beautiful, cultivated exterior to reveal moments of vulnerability and even ugliness that touch the viewer at a visceral level. These characters — like the power-obsessed Lady Sarah of Yorgos Lanthimos’s “The Favourite,” or the willful and transgressive Ronit Krushka of “Disobedience” — are women of appetite who evoke curiosity rather than simple admiration. Watching these performances, you have the feeling that something instinctive and utterly convincing has roared to life within Weisz. Her performance as the driven, obsessive Mantle twins is an extension of this movement toward playing women who don’t represent some ideal, but are instead embodied, desirous beings struggling to negotiate the weight of that desire.We’re used to a certain sleight of hand, carefully placed cuts and scenes where fresh-looking mothers in hospital gowns hold clean, swaddled infants in their arms. Real birthing is something more radical.When Weisz proposed a gender-flipped version of “Dead Ringers” to a producer at Annapurna Pictures, she was intrigued by the intricately enmeshed personalities of the twins, the way they negotiated their fraught obsession with each other. “It just seemed a very fertile ground,” Weisz explained. “A twisted, codependent relationship between identical twins, whatever their gender, who are brilliant in their careers.” Unlike Jeremy Irons’s diametrically opposed siblings in the Cronenberg film, whose complementary personalities could seem to form a single person, Weisz’s are intricately enmeshed: Though Beverly is introverted, she’s hardly passive, and pursues both her love affairs and the mission of creating a more humane, women-directed way of birthing with quiet focus. Elliot curbs her own scientific imagination, her appetite for grander interventions like eliminating menopause or aging, in service of what she perceives to be Beverly’s needs. Weisz fills the dual roles of Beverly and Elliot with her own raw, organic power, guiding patients through labor with quick, steady hands and a tone that’s firm almost to the point of coldness.But some of the most affecting moments in the series come when she’s tapping into maternal vulnerability, as when she portrays Beverly’s discovering that she’s had another miscarriage, the latest in a gutting series. The camera hovers over her hand holding a bloody piece of toilet paper in a shot that is almost from a first-person perspective. The effect for me, as a viewer, was the opposite of an out-of-body experience: It was a sight that I had only experienced in my own life, and for a moment my mind raced through the consequences that it implied — was I menstruating, had I forgotten to take my pill, was there something deeply wrong inside of me? You could say that the series normalizes these physiological processes by showing them onscreen, but they are already normal — they’re just the unseen part of the iceberg that is having a body.Weisz’s experience as a parent — she’s a devoted mother of two who had her second child in 2018 at age 48 — has gone hand in hand with her decisions to explore these looser, rawer, less polished characters with their unusual thirsts and hungers. When I asked her about her own experience with birthing, what she remembered most intensely was the horrifying tales of deliveries gone wrong that others seemed eager to tell her. “The one thing I did notice the first time I was pregnant was the amount of times people came to me to tell me terrible stories, some terrible things that happened,” Weisz said. In response, she actively sought out accounts of positive outcomes, to get a sense of all the possibilities, all the branching pathways. She gravitated toward Ina May Gaskin, a midwife and prolific author who pioneered techniques for low-intervention birth and home birthing. In the then-male-dominated field of obstetrics, Gaskin was the first midwife to have a procedure named after her — the Gaskin maneuver, adapted from the practice of Guatemalan midwives, in which turning a woman from her back onto her hands and knees helps to ease the baby’s shoulder through the birth canal. Just as Gaskin pushed for women to be able to give birth outside the specialized medical environment of the hospital, a common refrain throughout the show is the idea that pregnancy is not a disease, and pregnant women are not sick. “You don’t have to possibly be cured,” Weisz said, paraphrasing Beverly. “There’s nothing wrong with you. It’s just a natural part of life.”Weisz, a producer and an actor, has moved into a more boundary-pushing phase of her career. Thea Traff for The New York Times“Dead Ringers” is a sort of antidote to this culture of pressurized, overdetermined moralizing over the ways that women choose to navigate the experience of pregnancy — or at least a temporary anesthetic. Though it engages with important issues about reproductive technology and birthing, it also seeks out a deliciously profane set of possibilities. The notion of the nuclear family could be retooled, could mean a pair of identical twin sisters raising the offspring of an ex-lover’s brother, or an uncanny Southern Gothic brood of perpetually pregnant daughters, headed up by a pontificating patriarch obsessed with the eminent gynecologist J. Marion Sims, who conducted experimental anesthesia-free surgical operations on enslaved women. Breeding could be a house of horrors, or a laboratory of startlingly new kinds of tenderness, as in a scene in which Beverly’s lover, Genevieve, a TV star who was once her patient, delivers an erotic monologue about how she wants to impregnate her. Under the existing laws of biology and anatomy, the fantasy is impossible, but only narrowly so: In the world the twins want to create, desire can meet reality in dark, mischievous, complex ways.To bring that vision to life, Weisz collaborated with the screenwriter and award-winning playwright Alice Birch, whose play “Anatomy of a Suicide,” an exploration of mental illness as experienced by three generations of women within a single family, was performed at the Atlantic Theater Company across a stage divided into three sections. “She’s so brilliant at creating all those levels of complexity where you’re, hopefully, in a state of pleasure, being entertained and you can’t tell what’s right or wrong,” Weisz explained. “It simply isn’t clear.”Soon after meeting, they began riffing on topics such as the French performance artist Sophie Calle and imagining the twins’ parents — ordinary anorak-wearing Brits — standing in the rain gazing at the magnificent birthing center created by their terrifying daughters. In the end they agreed that the Mantle twins’ new gender changed “everything and nothing.” Though their anatomy allowed for plot points that the male Mantles would never have encountered, the twisted specificity of their entanglement is in a moral and psychological world all their own.In Cronenberg’s “Dead Ringers,” the twins’ female patients are little more than loci for the projection of male fantasies and fears. The mutated women Beverly hallucinates signal his alienation from the female bodies that are the site of his work. Unsurprisingly, the consequence of swapping the gender of the story’s protagonists is a more robust interest in women and pregnancy — the deliveries, miscarriages, the intense and intractable particularity of each patient’s reproductive situation. “It just, I suppose, happened as a result of the doctors having the same bodies as their patients,” Weisz said. “They weren’t ‘other’ to them.” Women in Weisz’s series are what they are — complex, self-destructive, occasionally destructive of others — and the horror comes directly from their actions, from whom they can’t help being. The most graphic and upsetting moments of the series foreground routine obstetric procedures that are rarely viewed outside their specialized audience — C-sections, vaginal births, the movements and turnings of infants beneath the skin of the mother’s stomach — which brings up the question of why we as viewers are so insulated from the realities of reproduction. Horrific to whom? Disturbing for what reason? And whom does it serve to make birthing so opaque, so secretive?As Weisz and Birch’s vision began to take shape, Birch gathered a writers’ room made up of eight women. Weisz sat in on writing sessions, and there were occasional visitors: midwives, gynecologists, endocrinologists and embryologists who gave their thoughts on what needed to change in the way we view and support birthing. Under lockdown and Zooming in from various locations — some had moved back in with their parents; another became pregnant during the writing sessions while living on a boat off the coast of Cornwall — the writers shared stories and experiences of their own. Even amid discussions about the dystopian state of modern reproductive care, there was a distinctly utopian imagination at work. “How do we unthink what we think of as normal, and how do we make unmysterious what is still inherently mysterious?” asked Lileana Blain-Cruz, a director who participated in the writers’ room as a dramaturg. “It becomes a philosophical question — not just of the mystery of it, but of how systems inhibit progress and thinking.”Thea Traff for The New York TimesThe writers’ room was intent on directing the viewer’s attention away from the debate over how a pregnant body should be, and toward the more open-ended question of how pregnancy could be: There could be soothing depictions of natural landscapes, soft silicon instruments, rigorously tailored personalized care. There could be gene editing, immortal wombs, eternally youthful skin and freshly grafted ovarian tissue. There’s an argument to be made that it’s impossible to talk about improving reproductive outcomes without talking about abortion rights; that it’s discriminatory to talk about fixing the way women give birth without addressing the high maternal mortality rates of Black and Native American patients; that it’s anachronistic to talk about pregnancy as though it were a thing experienced only by cis women — this show engages only tangentially with these topics. Instead, it takes hold of contemporary debates over medical ethics and class inequities in reproductive care, and treats them as playground equipment, as the terrain on which psychological dramas of a wild and unpredictable nature can be played out. As the arc of the show grows increasingly macabre, some of the portentous weight of birthing — the need to make the perfect choices, to give birth in an ideal and aspirational way — gives way to a wicked sense of fun.So much of the anxiety around reproduction in the United States has to do with the contradiction of being dependent and isolated at once: dependent on a health care system that must be paid for privately; dependent on a political apparatus outside your control that can force you to give birth while denying any resources or care to the baby that is born; isolated by the moral codes and prescriptions that circulate in the media and among the people in our lives. We often approach pregnancy with a hunger for clean, clear answers — the exact week at which a pregnant body should no longer be allowed caffeine or soft cheese, or the moment at which a bundle of cells becomes a legally protected human being — but living matter resists these attempts at containment.The womb is itself a paradoxical thing. In preparing for pregnancy, an entirely new organ, the placenta, is created. It infiltrates the uterine blood vessels and grows over 150 miles of capillaries to provide nutrients and oxygen to the developing fetus before it is unceremoniously expelled from the womb during birthing. But the placenta’s origin blurs the distinction between host body and fetus: Though it originates from cells in the outer layer of the embryo that burrow their way into the womb using a combination of digestive enzymes, substances that trigger suicide in target cells and by impersonating the host’s blood vessels, it is built in part from motherly resources. One’s self mingles with another across a semiporous border. By drawing boundaries, we lose sight of our radical interrelation.Alexandra Kleeman is a professor at the New School and a Guggenheim fellow in literature. Her newest novel is “Something New Under the Sun.” Thea Traff is a photographer and photo editor based in New York who frequently contributes to The Times. Her work focuses on human emotion conveyed through facial expressions and body movement. More