“A heartbreaking home birth leaves a woman grappling with the profound emotional fallout, isolated from her partner and family by a chasm of grief.”

film description on Google

IMPORTANT: Many are finding Pieces of a Woman to be a wrenchingly difficult story to follow, especially for those affected by loss, sexual abuse, birth trauma, postpartum mood disorders, or toxic relationships — so do tread with care if you happen to resonate with any of the aforementioned. This review also includes plot spoilers!

Discussion of this film “Pieces of a Woman” has permeated a lot of pregnancy and birth board threads since its release in December. Initially I didn’t plan to watch it, given the heavy material and a suspicion that it may promote negative views of homebirth. Because I did hear some reassuring feedback from the birth community that it’s not a clear warning bell for the supposed ‘inherent dangers’ of homebirth, I decided to give it a chance. Some of my fears were confirmed upon viewing, though not exactly in the ways I’d expected.

The story is loosely based on the director Kornél Mundruczó and screenwriter Kata Wéber’s own shared experience as spouses having lost a child through miscarriage.

I’ll be sharing my thoughts on POAW from the view of a doula, childbirth educator, and homebirthing mother.

Birth Scene

The opening act is perhaps the most-discussed element of POAW, particularly among top critics who position the film for big nominations during awards season (though the story really is about so much more than this scene). The 20-some-odd minutes’ long scene is striking after all, and not just because it culminates in the unexpected death of a newborn; but also, because the home labor unfolds in perhaps the most realistic way I’ve seen unmedicated birth portrayed in film or television. (Still, it was certainly not what I’d consider a completely realistic representation of a typical midwife-assisted homebirth… more on that to follow).

The scene was shot in a single take, a narrative choice that allows us to witness the development of natural labor in real time, with such intimate focus we might find ourselves taking deep, moany breaths right along with Martha, the mother-to-be. Actress Vanessa Kirby (who has not given birth herself) says she shadowed midwives at several hospital births in preparation for the role.

What I appreciated about this scene:

Martha’s waters didn’t release at the beginning of labor, as is the eyeroll-inducing custom of virtually all scripted media ever in signaling “it’s go time!”

We witness real signs of transition and labor progression: nausea, burping, slurred speech, lovey-dovey eyes, increased desire for closeness.

There is no panic-screaming, wailing, or cries of desperate suffering. Dad-to-be Sean doesn’t faint or freak out. Everyone remains largely composed. This is quite a few shades different from the dramatized versions of labor we’re provided by most movies and shows.

We see a great representation of the relaxed state achievable by a laborer in a tub of warm water. (Though, how did the partner fill it as fast as he did? Hmm.).

Martha’s grunting noises indicated to the midwife that she was feeling pushy.

The labor is overall gentle, uneventful, standard (until it wasn’t, of course).

What I didn’t like about it:

The most glaring inaccuracy is the midwife Eva (played by Molly Parker) shows up alone and continues working without an assistant of any kind. I don’t know any midwife who operates in this manner. Someone is always monitoring the mother while the other takes care of routine tasks, preps supplies, charts, and so on. When baby is born, someone is keeping an eye on baby while the other is assessing the mother’s condition.

In POAW, Eva briefly turns away to catch her breath in great relief because the baby is born vitally pink and crying, after two contractions’ worth of baby’s heart tones having dropped ominously. In this moment, baby has turned blue. There’s room to assume Eva’s momentary breath-catching had something to do with the baby’s demise. In truth, nothing could have prevented it, even if this birth took place in the hospital. Eva proved to be an attentive and responsible care provider (she immediately instructed Sean to alert 911 when the heart tones looked nonreassuring, and adopted a take-charge routine to get baby out quicker).

However, that said… I did wonder, where are all the midwife’s supplies? This doesn’t bode well for the culturally persistent image of midwives as pseudo-practitioners with no clinical skills or emergency equipment. I only watched the film once and didn’t take note of the specifics, to be honest, but it did seem like she showed up ill-prepared for various turn of events (though I recall her giving the baby oxygen). Of course, in this situation the baby’s demise was clearly NOT her fault regardless. But it does cast an unfortunate shadow on the reality of the professional midwife, and the vast skill set (and toolkit) she typically possesses. Most people believe a midwife shows up to a homebirth with little else but a satchel and notebook, but this is not the case.

Eva is clearly a sweet, gentle, and caring person with a tender soul — the kind of person whose presence at birth is desperately needed. That said, she crossed some hard lines. She did not ask for consent or give an option about the several cervical exams. I experienced a gnawing physical reaction when this occurred. In the pit of my stomach was this deep sadness that our society is trained to accept this treatment as normal, even in one’s own home! She also asked Martha to lay down for the exams, which isn’t necessary. A solid provider can perform a cervical check in any position.

Further, I was extremely disturbed by her usage of inappropriate trigger phrases like “spread your legs” and “wide open” during the vaginal exams. Even her terms of endearment like “honey,” “babe,” and “atta girl” can be problematic when there is a power dynamic. 

We don’t see Eva performing Martha’s aftercare. Labor does not end with a baby’s birth (or in this case, birth and subsequent tragic death). But this is all we ever get to see in movies! It’s little wonder why expecting parents are shocked to learn there is a THIRD stage of labor, the placenta birth. And a lot of procedures may follow in the immediate postpartum, even at home.

Effects of Grief

This is the heart of the movie: a journey through the stages of grief. 

With each stage we move forward a month. We see where she’s at as the weeks continue. She doesn’t seem to have progressed much in her journey through grief, from the outsider’s view at least. It causes us to reconsider our own ideas of what grieving should look like, what grief has looked like for ourselves, and how time continues onward in ‘real life’ while Martha appears to be spinning her tires. Enveloped, immersed, stuck in the mud of stagnation.

Martha presses a lit cigarette into her birth ball and it deflates, a symbol of apathy but also of building a barricade around her heart — ‘what is gone should no longer hurt me.’ The houseplants are neglected, wilty and brown. She sees children everywhere. She is isolated — where are her friends? 

She must make huge, impossible decisions so quickly. What to do with baby’s body? What about a funeral? Her mother and partner have their opinions. They mess up the baby’s name on the tombstone — but hey, no big deal they say. Martha is forced to concede “it doesn’t really matter,” though it does. It truly does. And there is so little support. Then there is the public scrutiny generated by an ongoing litigious case against the midwife.

Martha is drawn to apples in the months following the loss of her baby. They’re employed as a plot device through her devastation and healing — she cradles them in her hand at the market, we see them turn brown on her kitchen counter, she develops a ritual of cultivating their seeds. Later we discover she thought her newborn smelled like apples.

Though we hope with all our power that Martha can find resolve in the autopsy report, the coroner confirms there is no explanation for the baby’s death. 

Raw Realities of Postpartum 

Even without a baby to bring home, postpartum still happens. Martha’s breasts are engorged, she’s leaking milk, and we’re shown a flash of the mesh postpartum underwear she’s still wearing even after returning to work. I appreciate these insights into the invisible struggles and healing processes endured by women after a pregnancy.

External Struggles

Martha faces snowballing relationship problems. Her partner Sean is grieving in his own self-destructive way — breaking his sobriety, aggressive outbursts, having an affair with their lawyer (Martha’s cousin), and pressuring Martha to resume intimacy. The scenes of Sean (played by Shia LaBeouf) groping Martha when her body language clearly demonstrated an unreceptive “no,” coercing her into sex, and throwing a birth ball at her face, were especially rattling considering the recent allegations of domestic abuse against the actor. I won’t spotlight him too much here, but these were perhaps too-believable scenes for a (real and terrible) reason.

Martha’s mother Elizabeth (played by the incredible Ellen Burstyn) is critical, overbearing, and triggers Martha with manipulatively caustic goading. She pressures Martha to aggressively pursue Eva in court, despite Martha’s hesitance to do so. It’s implied that she deems Martha’s different views from her own as a personal failure. Elizabeth’s character arc serves as the catalyst for Martha’s reclaiming of her voice in the movie’s climax, when she finally “picks her head up” and tells the story HER way in the courtroom.

Implications on Homebirth

There is a quick shot of news covering the ‘midwifery witch-hunt’ that exists off-screen as well (the headline was inspired by a real case in which Hungarian midwife Ágnes Geréb faced criminal charges after the death of a homebirth baby).

“It was a very political case about the question of who owns your child’s body: the state or you as the woman? And can you decide where you want to give birth or not?” Mundruczó explained.

I believe this moment hints at why the filmmakers chose to set this birth at home. It’s apparent in Martha’s conclusive declaration that she does not blame Eva for her baby’s death, that the filmmakers hoped to draw attention to the unfair bias of these trials.

Still, I worry about the further vilification of homebirth and midwifery that may be ignited by viewers of this film who have little education on these areas. Without context of the filmmakers’ personal views, it isn’t immediately obvious which way we should be leaning as viewers.

Here is some information on hospital birth lawsuits: Boston-based liability insurer Coverys discovered that 80% of obstetrics claims in their study spanning 2013-2017 were high clinical severity cases. In 24% of these claims, either the mother, infant or both died. In the Medscape Medical Malpractice Report 2015, it was shown that 85% of OBGYNS have been sued, making them far more likely to be named in a malpractice lawsuit than any other type of physician. Still they are less likely than a professional midwife to be fined, prosecuted, or jailed for the same offense.

While homebirth isn’t directly implicated as the ‘cause’ of the baby’s death here, the filmmakers lack nuance in directly addressing this issue. Either they’re oblivious to American birth controversies or simply wished to leave much open for interpretation. Alas, I don’t feel this is the movie our natural birth community needed to finally earn long-deserved respect and understanding. 

I would love to see critical mass attention for many of the existing films about homebirth (documentaries unlike POAW), such as Why Not Home, The Face of Birth, Birth Story and These Are My Hours.

In Conclusion

Ultimately, POAW is the story of a woman’s grief, and how it warps relationships and transcends generations. I would say the film’s genre is a mix between a tragic coming-of-age tale and courtroom drama. Phenomenally acted, likely to inspire widespread attention to the painful and taboo issues it highlights, and deserving of accolades on many fronts.

The final scene depicting a little girl we assume is a future child of Martha’s, climbing care-free in an apple tree, is one of healing and hope.

If you are a parent facing loss of a child and needing resources and support, please visit Stillbirthday.

Stillbirthday.com