Game of Thrones viewers are used to watching people decapitated and burned alive by dragonfire. But some of the 10 million viewers who tuned in to Sunday’s premiere of the prequel series House of the Dragon found themselves unexpectedly triggered by the franchise’s latest bit of buzzy body horror: a scene in which Queen Aemma (Sian Brooke), laboring to bring forth a possible heir to the Targaryen throne, who is stuck in the breech position, undergoes a very visually unpleasant non-consensual caesarean operation, okayed by her loving but weak husband, King Viserys (Paddy Considine), who is desperate to have a male heir to his throne.
On r/Mommit, a Reddit board for mothers where one user posted spoilers for the scene as a public service, another user wrote, “That scene just triggered me … I’m 3 months [postpartum] and I was crying my eyes out. It was too much.” Some of their male partners, these women reported, laughed at their squeamishness; others got it. “I don’t understand why TV shows don’t have to have a warning for birth trauma triggers,” another poster added. “Birth trauma is actually pretty widespread even if people don’t talk about it and the impact from seeing a birth scene when you have experienced birth trauma is huge.”
For others, the birth scene’s outcome was even worse to watch. Aemma dies, as the maesters warned Viserys she would, and the baby pulled out of her lives only a few hours. So we’re treated to the sight of a tiny body in a winding sheet, and the whole ugly thing was for naught—unless you count the addition to the mountain of textual evidence we already have that the world of GoT is not a great place for women. Those who made the show point to history as a reason for the sequence’s inclusion. Episode director and co-showrunner Miguel Sapochnik told the Hollywood Reporter, “We felt that was an interesting way to explore the fact that for a woman in medieval times, giving birth was violence. It’s as dangerous as it gets. You have a 50/50 chance of making it. Many women didn’t. If given the choice, the father would choose the child over the mother as a cesarean would kill you. It was an extremely violent part of life.”
In Fire & Blood, Martin’s Targaryen novel, which is written in the voice of a latter-day historian, Queen Aemma dies in childbirth, but we don’t get many details. The story of a later Queen, Alyssa, aligns more with that of the show’s Queen Aemma. At Alyssa’s last birth, the attending maester says that he can’t save her, but could possibly save the child by c-section: “The babe might live, or not. The woman will die.” The king gives his go-ahead, and the historian/narrator records conflicting accounts of what happens next. Either Alyssa agrees to the procedure, or she dies during it, without waking. The child, a girl, survives, but one of Alyssa’s grown daughters blames her husband for her death, and curses him: “Save my wife, you should have said, but what are wives to men like you?” (Edmund Bridgerton, he wasn’t.)
Analyzing Game of Thrones as history is a fool’s errand. First, it’s made up, and like any historical fiction, it takes liberties; second, it’s pulling from a pastiche of historical influence that makes a classic “fact vs. fiction” analysis hard to execute. As Benjamin Breen argued convincingly back in 2014, many aspects of Martin’s epic fantasy world—including, Breen pointed out, some of the most interesting things about Westeros, like its cities, its diversity of overlapping and conflicting cultures, and the incipient decay of its monarchy—are far more early modern or Renaissance than medieval.
House of the Dragon takes place earlier than Game of Thrones—172 years before the birth of would-be queen Daenerys Targaryen—and so maybe you could squint and call this the Middle Ages. Sapochnik and Martin certainly think that this world is taking cues from the medieval period, and often use that idea to justify their choices when it comes to things like women getting cut open against their will, so I think it’s possibly fair—and definitely interesting—to ask how true to that history this scene would be.
I asked Sara McDougall, a scholar of medieval history who writes about gender, whether Queen Aemma’s c-section scene rang true. Not very, she replied. “The idea that they would do it and do it in this way is a gross imposition of a medievalism—the idea that medieval patriarchy must be the same or worse than ours, therefore since we don’t care about mothers and only love fetuses, so too they,” wrote McDougall in an email. “Totally no. They were very keen on protecting mothers from harm.”
Our knowledge about how many c-sections might have been attempted in the Middle Ages is extremely scant, but what we do know points to the idea that the operation would have been performed on dead women, not the living. It was extremely uncommon for medical texts from the time to recommend the performance of cesareans on living women—before the 20th century, only a few outlying (and often-mocked) doctors even believed that c-section could result in a living mother and child. But the church did require midwives to do (very primitive) c-sections after maternal death, if they thought the fetus was still alive, in order to remove and baptize the baby.
Could some men, as Sapochnik describes it, have chosen the fetus over the mother and ordered a c-section done anyway? McDougall points out that men were usually not at all involved with birth, which was the province of female relatives, neighbors, and midwives. And historian Renate Blumenfeld-Kosinski, who wrote a book on medieval c-sections, finds that church advice in this period did not recommend elevating the fetus over the mother in decision-making during birth. In fact, some writers offering guidance on the matter explicitly recommended the opposite. One contemporaneous English translation of Saint Thomas Aquinas’ writings on baptism (a topic that overlapped with medical ethics around birth because of the importance the church placed on it) contained the following line: “Whan the woman is feble and the child may noght comyn out, then it is better that the chylde be slayne than the moder of the child also dye.” “Of course the church was against abortion,” wrote Blumenfeld-Kosinski, “but it seems that at least in the context of Caesarean birth the question of a choice between the mother’s or the child’s life never arose.”
This is not to say that this kind of situation, in which a husband sacrificed a wife for a child, never, ever happened. No less a prince than Henry VIII supposedly said, as Jane Seymour lay in childbed in 1537: “Save the child by all means, for it is easier to get wives than children.” (Although there was once a rumor that Seymour was delivered by c-section, we don’t know what happened to cause her to die shortly after Edward VI’s birth—possibly, puerperal fever, an embolism, or a retained placenta.) But before the advent of anesthesia and antibiotics and the perfection of the c-section operation in the 20th century, many birth attendants faced with a crisis operated on the theory that it was better to come out with (as one 19th-century doctor put it) “a childless mother than a motherless child.” As female midwives were increasingly replaced by male doctors at births, those doctors, armed with metal instruments, might even make the difficult call to use a technique called craniotomy to collapse a fetus’ head and pull it out in pieces, killing it in order to save the mother.
These strange little quirks of history, in which people in earlier time periods were actually more accepting of women’s autonomy in reproductive matters than we are today, are starting to get some play in the media in the post-Dobbs era, but it’s very hard to get past a popular conception of time’s trajectory in which things used to be terrible, got slowly better, and now are getting worse. As Martin said last month, “I don’t think Westeros is particularly more anti-woman or more misogynistic than real life and what we call history … I get inspiration from history, and then I take elements from history and I turn it up to 11.” Martin’s use of history in his world-building depends on people responding strongly to the idea that “things used to be terrible.” Childbirth is a great candidate for the “up to 11” treatment.
The remainder of the birth scenes in House of the Dragon’s season (we’ve been promised more) will be interesting to track. As one minority voice on r/Mommit wrote, “I actually semi- appreciated the fact that they didn’t shy away from showing the negative side of giving birth. They really hammered in the fact that women have no agency in this world and that giving birth is tough and at times dangerous. The number of people who don’t know how dangerous birth can be is alarmingly high.” After a few decades of natural-birth activism popularizing the idea that birth is easy, beautiful, and spiritual, we are experiencing something of a cultural shift, as abortion-rights advocates try to reinstall the idea that pregnancy and birth can be life or death in the national psyche. House of the Dragon, filmed (of course) before the Dobbs decision dropped, is an unlikely locus for this conversation. But life finds a way.