It Takes Two Puppeteers and a Custom Rig to Birth a Baby on The Pitt
Spoilers follow for The Pitt episode 11, “5:00 P.M.”
It all begins with a joke. When a woman in labor gets wheeled into The Pitt’s ER, Dr. Mel ducks her head under the blanket draped across the woman’s legs to check her progression. “I see hair!” she announces to a roomful of blank stares. “… Baby’s hair,” she clarifies. It’s a simple line, but it cues up the shot that defines The Pitt’s approach to depicting birth. Mel’s check is a standard-TV version of what birth usually looks like: a quick duck under the blanket, with everything neat and covered up. Then Dr. Collins steps in to confirm, lifting the blanket again — and this time, right in the middle of the frame, there’s a complete, unobscured image of a baby’s head crowning through a vaginal canal. It comes with a whiff of smugness, this coy misdirect. If you thought this would be concealed and clean, you’re quite mistaken. You will see everything.
The birth scene in episode 11, “5:00 P.M.,” is a remarkably realistic depiction of a complicated birth, a medical experience rarely depicted on television in anything approaching its full complexity, and certainly not with this level of frank detail. For The Pitt, it’s a statement of purpose. “It’s really being cognizant of the reality of the medicine, trying to stick to it, trying to present it as authentically as possible,” says series creator R. Scott Gemmill. “That’s why we’re doing it this way: not to cheat it.” But the scene is also a special-effects feat. How can a TV show fake a birth so well that it includes a full-frame shot of a woman pushing a baby out of her body without cutting away to close-ups or hiding the action? “It was really important that I was able to film the baby coming out and then tilt up to the mother so it’s all connected,” director Quyen Tran says. “And at the same time, how do we film it in such a way that we don’t see all the off-camera support?” Tran had a traumatic birth with her own second child, and she felt strongly that she could not take shortcuts. “I was very invested in making this as authentic as possible, because I had lived it.”
The concept: “Family looks different for everyone”
“We knew we wanted to do a birth scene in the ER,” says Elyssa Gershman, the episode’s writer. “It does happen, and we wanted to show something we hadn’t seen before. We also wanted to have it reflect off our characters.” Dr. Collins, who assists with much of the birth, experienced a miscarriage earlier in the shift, and The Pitt’s writing team wanted a birth scene to put even more emphasis on her emotional arc. “Our doctors have to put that aside and do what’s best for the patient. And, in fact, it motivates Collins even more to do everything they can to save this baby,” Gershman says.
The writing team knew the scene would need several layers of complexity to give it enough of an emotional wallop. They began with medical complications: first, a shoulder dystocia, which would threaten the baby’s life and make the birth itself much more challenging. Then a postpartum hemorrhage, which would threaten the birthing person’s life. The writers’ room decided to add the element of a nontraditional family structure to that rough outline, Gershman says, in order to press on the notion of assumptions and expectations in the emergency room. “We wanted to show the idea that family looks different for everyone, and we really wanted to show a positive portrayal of a gay couple, but also this sense that this gay man and his best friend are family as well.” They landed on a premise where Natalie, the birth mother, would serve as a surrogate for her best friend and his husband. “When you first come in, you would assume it’s a husband and wife or boyfriend and girlfriend, but sometimes things aren’t always what they seem on the surface,” says Gershman. This combination of character development and medical complications becomes a series of repeatedly upended expectations and assumptions. First it’s the actual nature of this family, then it’s a fear that the baby may not survive, and finally, just as everything seems to have resolved, Natalie’s life is in danger.
The final element was one more layer of the medical picture. “There is a higher infant and maternal mortality rate for Black women in America,” Gershman says. “We wanted to show a successful story of a birth happening, where even though there are complications that often arise in birth, this woman was treated with the utmost care, and ultimately they were able to save both her and the baby.”
Preproduction: “Mechanical babies were flying off the shelves”
Because Tran had such a strong sense of how she wanted to film the birth, with shots that would include both the birth mother’s face and the emerging baby, The Pitt’s production crew needed outside special-effects artists to help construct an elaborate prosthetic. Autonomous FX created many of The Pitt’s prosthetics, including the degloved foot and the burn victim who requires an escharotomy, and Autonomous’s Mike McCarty had previous experience with creating mechanical babies and prosthetics that could mimic a birth. “It was right before COVID when Autonomous FX started making more babies,” McCarty says, “and then when COVID hit, mechanical babies were flying off the shelves.”
Enuka Okuma, who plays Natalie, originally passed on a different role in the series that she felt was too small. “This one came in and I said, ‘You know what? Now is the time.’” She was cast in August even though the scene wouldn’t shoot until November. “I remember thinking, Wow, this is really early. And they said, ‘Oh, no, they have to fit the rig. It’s a whole thing.’ I was like, Dear God, what does this mean?”
The earliest version of The Pitt’s birth rig was designed for the Showtime series SMILF, in which a woman gives birth in the shower; then it was reworked and adapted for Dead Ringers, which required full-frame shots of a birth situated on a more traditional hospital gurney. “It’s not too complicated, even though it seems really complicated,” says McCarty. The rig consists of a gurney with a silicone prosthetic of a belly, legs, and a vaginal canal anchored on top. The actress, seated in a chair directly behind the rig, leans over the prosthetic so that her body aligns with the pregnant belly. Her real legs are disguised by the gurney and other medical draping, and the draping also helps disguise two separate puppeteers who crouch in front of the actress between her chair and the rig. One puppeteer uses tubing to add blood and other fluids at appropriate points during the birth; the other has an arm inside the hollow pregnant belly in order to squeeze the silicone baby out of the vaginal canal.
Prep: “Let’s make this actress comfortable”
McCarty and the Autonomous crew adapted the rig they’d designed for Dead Ringers by recoloring it to match Okuma’s skin tone and reshaping some of the belly to fit it more comfortably onto her body. But in initial rehearsals, both Okuma and Tran realized some elements needed adjusting. “I got in the rig,” Tran says, “and it didn’t feel great, because the chair didn’t allow the perfect marriage of the prosthetic with the actress.” The original Dead Ringers setup had a prosthetic that included breasts, which needed to be cut off to better fit Okuma’s body. “So we made adjustments. Round two, she got in and it still wasn’t right with the seat. She wasn’t comfortable, she couldn’t hold herself up,” Tran says. “I knew the scene was going to be mentally exhausting, physically exhausting.” For the third round, Tran had the idea to use a kneeling-style chair that would give Okuma more support as she leaned over the prosthetic and would put her in a more natural position to curl around the silicone legs and belly.
Although the body on the hospital gurney was a silicone model, The Pitt’s production team still included an intimacy coordinator to assist with shooting. “Everyone understood it wasn’t me, but it’s still a vulnerable position to be there, with people kind of gawking,” Okuma says. “I really, truly appreciated it. Even though we all know it’s make-believe! It’s just, Let’s make this actress comfortable.”
Filming: “It was pretty grisly”
Most medical shows film one setup at a time, condensing all of a specific patient’s events into one or two days of shooting in order to make production simpler. But The Pitt films multiple patients at once, in the sequence of how their doctors will encounter each new person. “Normally, we’ll go down and do a sequence in a day, maybe two,” says McCarty. “Here, it was like seven or eight days of filming because they shot everything in order. It was like, ‘Okay, let’s do the crowning! Great, you guys can go home and come back tomorrow.’” Filming this way adds time and complication: There are so many more moving parts, and for each new take of a scene, every patient and special effect has to be reset, and the entire set has to be cleaned and reorganized. “It’s really challenging to do it that way,” says Noah Wyle, who plays The Pitt’s protagonist Dr. Robby. But the benefits of filming in sequence outweigh the downsides: “Incidents build on each other,” Wyle says. “It’s already in your body, it’s already in your memory. You carry that with you into the moment you’re about to do.”
The Pitt’s cast of doctors use EM:RAP, a database of medical knowledge used by ER physicians, to help prepare for performing specific procedures. But the scene’s rig setup was really the key. “I want to underscore the impressiveness of the prosthetic,” says Wyle. “It allowed me to not have to simulate or imagine anything that I was doing. It’s very rare in a medical show. Usually, you’re not really doing the stuff you’re doing. But this one, my hands were inside. The baby was in there. The baby’s shoulder is caught on a pubic bone. I was trying to manipulate it and rotate it around so I could get this thing clear. Everything we did was possible because of the beautiful artistry behind the prosthetic.”
The prosthetic and the puppeteers continue to feature in the story even after the baby is born. Natalie delivers the placenta and experiences a hemorrhage, which involves enormous amounts of blood being pumped through the prosthetic. “It was pretty grisly,” McCarty says. “We were like, Really? That’s what you want?” The on-set consulting doctor assured them that yes, that’s how much blood it would actually involve. Then there was the question of the umbilical cord, which is made of piano wire and has to be glued back together after it gets cut in each take. Then there were the mechanics of swapping out the silicone baby, the one that gets manipulated through the birth canal, for a robotic baby that could show signs of life. McCarty was one of the two puppeteers who manipulated the robotic baby, and the trick, he says, is making it “not crazy. Subtle, subtle little movements.”
Okuma, who only saw the full script after she’d booked the part, was honestly taken aback by her character’s arc. “I was like, She’s gonna die. This is a realistic show, and they’re gonna show a realistic situation. I was surprised that I survived. I really was.” This is precisely what makes The Pitt so beguiling, even in the many stories with much more tragic endings. “There’s a humanizing and leveling aspect to depicting something so universal, a birth that could have been rife with complication and attendant tragedy,” says Wyle. “And there’s a miraculous save that underscores the heroism of the practitioners who do this every day.”