It Takes Two Puppeteers and a Custom Rig to Birth a Baby on The Pitt

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Spoilers follow for The Pitt episode 11, “5:00 P.M.”

The narrative commences with a jest. As a woman in labor is wheeled into the ER of ‘The Pitt’, Dr. Mel discreetly peeks beneath the blanket covering the woman’s legs to assess her progress. “I see hair!” she declares, drawing puzzled looks from the surrounding crowd. “…Hair from the baby,” she clarifies. This seemingly innocuous remark sets the stage for a shot that encapsulates ‘The Pitt’s’ unique portrayal of childbirth. Mel’s examination mirrors typical television depictions of labor: a swift glance under the blanket, maintaining an air of neatness and modesty. However, Dr. Collins soon intervenes, lifting the blanket once more – right in the center of the frame, there appears an unfiltered, clear image of a baby’s head emerging from a vaginal canal. This subtle misdirection carries a hint of self-satisfaction. If you assumed this would be hidden and sanitized, you are quite mistaken. In ‘The Pitt’, you will witness everything openly.

In episode 11 titled “5:00 P.M.”, the depiction of childbirth is strikingly accurate, a rarity on television given its intricate complexity. This scene for The Pitt serves as a testament to their commitment to authenticity in portraying medical procedures. As series creator R. Scott Gemmill puts it, “We aim to be mindful of the true nature of medicine, to represent it truthfully, and not to compromise.” However, this scene is more than just a testament to authenticity; it’s also an impressive feat in special effects. The show manages to convincingly portray childbirth, even including a full-frame shot of a woman delivering a baby without resorting to close-ups or concealing the action. Director Quyen Tran explains, “It was crucial that I could film the baby being born and then pan up to the mother so it all flows seamlessly.” At the same time, they had to find a way to film this in a way that doesn’t reveal the off-camera support. Tran, who experienced a traumatic birth with her second child, was determined to avoid shortcuts, stating, “I was deeply invested in making this as authentic as possible because I have lived it.

The concept: “Family looks different for everyone”

According to Elyssa Gershman, the writer of the episode, they decided to include a birth scene in the ER setting because such occurrences are real and they wanted to present something fresh and unique. Additionally, they wanted the scene to resonate with their characters. Dr. Collins, who plays a significant role in the delivery, had previously suffered a miscarriage during her shift, and the writing team of The Pitt felt that incorporating this birth scene would further emphasize Collins’ emotional journey. As Gershman explains, “Our doctors must set aside their personal feelings and focus on what’s best for the patient. In fact, the effort to save this baby becomes even more motivating for Collins.

The writing team understood that the scene required multiple intricate aspects to create a profound emotional impact. Initially, they introduced medical difficulties such as shoulder dystocia, which endangered the baby’s life and complicated the delivery process. Following this, they added a postpartum hemorrhage, which posed a threat to the birthing person’s life. To further emphasize societal assumptions and expectations in emergency rooms, Gershman explained, they chose to incorporate a non-conventional family structure into their plan. The aim was to demonstrate that family structures can vary greatly for everyone, and to present a favorable representation of a gay couple, while also highlighting the idea that this gay man and his best friend were equally family. They ultimately settled on a narrative where Natalie, the birth mother, would act as a surrogate for her best friend and his husband. As Gershman explained, at first glance, it might appear to be a heterosexual couple, but appearances can often be deceiving. This blend of character development and medical difficulties results in a series of constantly challenged expectations and assumptions. First, it’s the true nature of this family, then there’s the fear that the baby may not make it, and finally, just when everything seems to have stabilized, Natalie’s life is put at risk.

In the grand scheme of healthcare for women, one crucial aspect was another piece of the puzzle, particularly when it comes to Black American mothers. Gershman points out that there is a higher rate of infant and maternal mortality among this group. To illustrate a positive outcome amidst these challenges, Gershman shares a story about a delivery where complications were present but careful treatment resulted in the successful birth and survival of both mother and child.

Preproduction: “Mechanical babies were flying off the shelves”

Due to Tran’s firm vision for capturing the birth scene with close-ups of both the mother’s face and the newborn, The Pitt‘s film crew found it necessary to enlist expert special-effects artists from outside sources. Autonomous FX was one of these companies, responsible for producing several prosthetics seen in The Pitt, such as the degloved foot and the burn victim requiring an escharotomy. Mike McCarty from Autonomous FX had a history of crafting mechanical babies and prosthetics that could convincingly simulate childbirth. “Autonomous FX started creating more baby props just before COVID,” McCarty explains, “and when COVID hit, there was an increased demand for these mechanical babies.

Initially, Enuka Okuma, portraying Natalie, declined another role in the series that she believed was insignificant. Later on, a different opportunity presented itself, and she thought, “It seems like the perfect moment.” She was cast in August, despite filming not happening until November. “I recall thinking, ‘Wow, this is quite early.’ And they replied, ‘Oh, no, they need to set up the rig. It’s a complex process.’ I was puzzled, wondering, ‘What on earth does that imply?’

The original design for “The Pitt” birthing rig was initially crafted for the TV series “SMILF,” where a character delivers a baby in the shower. Later, it was modified and tailored for “Dead Ringers,” necessitating full-frame shots of a more conventional hospital birth scene on a gurney. As McCarty explains, despite its complex appearance, it’s not overly complicated. The rig itself is a gurney with a silicone prosthetic of a belly, legs, and vaginal canal placed on top. The actress sits behind the rig in a chair, leaning over the prosthetic so her body aligns with the pregnant belly. Her legs are hidden by the gurney and medical drapes, while these also conceal two puppeteers crouching between the actress’s chair and the rig. One puppeteer controls the addition of blood and other fluids via tubing at appropriate moments during the birth; the other manipulates an arm inside the hollow pregnant belly to push the silicone baby out through the vaginal canal.

Prep: “Let’s make this actress comfortable”

In our quest to tailor the rig from the Dead Ringers project for Okuma, McCarty and the Autonomous team modified it by painting it to match Okuma’s skin tone and altering some aspects of its belly to ensure a better fit. However, during initial trials, both Okuma and I recognized that certain aspects required fine-tuning. As I stepped into the rig, I immediately felt discomfort because the chair didn’t facilitate an ideal union between the prosthetic and myself. The original Dead Ringers setup incorporated a prosthetic with breasts, which needed to be removed for a better fit on Okuma’s body. After making adjustments, round two saw Okuma trying it again, but the seat was still not right for her comfort. She struggled to maintain herself in position. I knew the scene would demand immense mental and physical exertion. For the third attempt, inspired by the need for more support, I suggested a kneeling-style chair that would provide additional support as Okuma leaned over the prosthetic and help her assume a more natural position to envelop the silicone legs and belly.

Despite the fact that the figure on the hospital stretcher was a silicone model, the production team of “The Pitt” saw fit to have an intimacy coordinator assist during filming. As Okuma explains, “Although I knew it wasn’t me, being in such an exposed position with people looking was still uncomfortable. I truly appreciated it. Even though we all know it’s fake, let’s make this actress feel at ease.

Filming: “It was pretty grisly”

In most medical shows, scenes involving a single patient are filmed sequentially and compressed into a few days of shooting for ease of production. However, “The Pitt” opts for a different approach, filming multiple patients’ stories concurrently in the order their doctors will encounter them. As McCarty explains, “We usually do a sequence in a day or two, but here it was more like seven to eight days of shooting because everything was filmed in sequence.” This method adds complexity and time: There are many more moving parts, and each new take requires resetting every patient and special effect, as well as cleaning and reorganizing the entire set. Despite these challenges, Noah Wyle, who plays Dr. Robby on “The Pitt”, believes the benefits of shooting in sequence outweigh the difficulties: “Events accumulate, creating a sense of continuity. It’s like you’re carrying the previous incident with you into the next scene.

In the series “The Pitt,” the medical team relies on EM:RAP, a valuable resource for ER physicians, to ready themselves for executing specific procedures. However, it’s important to highlight that the setup of the props was truly remarkable. As Wyle mentions, “I’d like to emphasize the skillfulness of the prosthetic. It allowed me not to pretend or visualize anything I was doing. It’s quite unusual in a medical drama. Normally, you’re not actually performing the actions you’re showing. But with this one, my hands were immersed. The baby was inside. The baby’s shoulder was stuck on a pubic bone. I was struggling to adjust and move it so I could free that area. Everything we did was feasible because of the outstanding craftsmanship behind the prosthetic.

In the narrative, both the prosthetic and the puppeteers remain integral parts even post the baby’s birth. During childbirth, Natalie expels the placenta and encounters a heavy bleeding incident involving an excessive flow of blood through the prosthetic. McCarty expresses, “It was quite gruesome, we were taken aback, wondering Is this really necessary?” The on-set medical consultant confirmed that such a quantity of blood loss was indeed expected. Another challenge was managing the umbilical cord, made of piano wire, which needed to be reattached following each cut during filming. Additionally, there were the logistics of replacing the silicone baby, which is controlled through the birth canal, with a robotic one that could exhibit signs of life. McCarty was among the two puppeteers responsible for controlling the robotic baby, emphasizing the importance of making its movements “subtle and restrained.

As a devoted fan, I was taken aback when I discovered my character’s arc in “The Pitt” after already securing the role. To be honest, I thought, “She’s going to die. This show is known for its realism and they’re likely to portray a grim reality.” But surprisingly, I managed to survive, which left me genuinely surprised.

What makes “The Pitt” so captivating, even amidst numerous heartbreaking tales, is the way it humanizes and levels universal experiences. As Wyle puts it, “There’s something profound about depicting a birth that could have been fraught with complications and potential tragedy.” And the miraculous rescue serves as a testament to the everyday heroism of those who undertake such challenges in real life.

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2025-03-14 04:55