Birthing In Outlander: The Not So Accurate Debut of Margaret Ellen Murray

Written by: Sara Mordzynski






In honor of Labor Day Weekend…let’s talk about labor, of a different kind.

In reviewing Episode  113, The Watch, it is interesting to note that two distinct, almost separate arcs develop and essentially do not intersect at all.  On the one hand, there is the dynamics of Jamie’s relationship with other men, primarily, Ian Murray, Tarrin MacQuarrie and the deserter, Horrocks; on the other, is the interplay of Claire’s increasingly warm bond with Jenny which is forged in the domestic world of home, hearth and impending motherhood. It will continue to evolve in the subsequent episode, The Search. This article will focus exclusively on the TV version’s portrayal of labor and birth.  In no way is it meant to disparage the expert consultants who were utilized by the production team.  They provide the data; the showrunner, writer and director have the prerogative to alter that information to make it suitable for their narrative. 



What does that mean? Outlander is not the manual of what happens in childbirth—as a TV adaptation of a historical fiction/romance/adventure (and all those other categories it may fall into), it may alter facts to fit its narrative goals.  With that in mind, I will simply separate the drama from what actually happens.



As a physician, I will admit TV’s portrayals of  labor and delivery are often so outrageously and inaccurately overplayed, most times I switch channels because it is irritating for me to watch. Hysterics, chaos and high pitched squeals make the portrayals border on the ridiculous.  

Primary example: Katherine Heigel in the film, Knocked Up
This was was not the case here in Outlander. The visuals were stunningly beautiful. Jenny’s description of what it feels like to carry a child was hypnotic, enchanting:  “In the early days, it’s just a bit like wind in your belly. Later, you start to feel the child move and it’s like a fish on a line, just a quick tug….and towards the end, when the child moves alot, it’s a feeling like when yer man’s inside ye…”.  It is even more, dare I say, almost erotic in the book. 



For those of you who have experienced childbirth, Jenny’s restlessness and movements brought back memories. The drama is not overplayed. While Claire’s examination reveals that the baby is in breech position, as caregiver, although she exudes reassurance, internally she may  not  be feeling completely confident.  Even a subtle humor is seen, as  any of you, who  assisted a parturient, must have laughed when Jenny cries out and blames Claire for her pain ( had Ian been in the room- could you imagine a run of  Gaelic curses including a vow that she will never sleep with him again, EVER!)  Through out those scenes, the connection grows ever stronger between the women.

However some of the choices made did not work for me and as I elaborate on them I will give some obstetrical  insights without turning this into an article for submission to a medical journal. In the US, the incidence of breech presentation at term is 3%. Most  babies deliver head first but here, the arse places itself in the lower uterine segment (ok I had to use “arse”, since this is Outlander).


Certain situations may increase the risk for breech presentation for example: twin gestation, structural anomalies of the pelvis or uterus, prematurity, and too much or too little amniotic fluid surrounding the fetus (for those who want the technical term: poly or oligohydraminos).  Underlying Jenny’s impending joy is the distinct possibility of death. Not only because of her awareness of what happened to her own mother but because of the risk entailed by a breech delivery.



 Living now in the 18th Century, Claire is acutely aware of the limits placed on her ability to intervene if circumstances turn dire.  Infection—no antibiotics. Hemorrhage—surgical intervention or transfusion is impossible. The huge ominous fear looming over the breech birth is head entrapment. If the aftercoming  head can not be delivered smoothly and expediently, asphyxia can lead to major neurologic damage or  fetal demise. Today, the American College of Obstetrics&Gynecology states that cesarean section is the recommended mode of  delivery for breech presentation.   I will not go into all the studies and controversies regarding that recommendation but safe to say, there are emerging opinions that advocate vaginal delivery may be appropriate under selective conditions. 

So back in the 18th Century, Claire is not  only presented with the “usual” risks of birth, now there is the added factor of a breech.  Claire attempts to “turn the baby”. Here is where things did not work for me. External Cephalic Version, the actual term for what Claire is attempting to do, is a valid and recommended procedure to convert a breech to a cephalic (head) presentation. However, the conditions in which the TV adaptation presented it,  may have heightened the dramatic effects for the narrative but it was completely inaccurate and doomed to fail in  reality.



First, Jenny’s water already broke, without adequate fluid within the uterus, successful version is virtually nil and even dangerous.  Second, one needs a relaxed, non-contracting uterus to perform this procedure and being in labor, as you can imagine, the uterus is far from relaxed. To perform this maneuver requires technique but it makes you sweat  ALOT—there is quite a bit of exertional effort required.  In addition,  Jenny looked way too comfortable, while undergoing this  to even make this look believable, let alone have a wee chat with Claire.  Even in this day and age, with spinal/epidural anesthesia available, most women would not sit through this and have a casual conversation with us. FYI, success rates under optimal conditions vary but it’s roughly 50%.

In the end, Margaret Ellen Murray made her debut safely, and despite  Jenny’s prediction “it’s a boy, alright”.  


Did you think the the TV adaptation successfully conveyed Claire and Jenny’s blossoming
relationship? What did you think of it’s portrayal of the birth process?


14 comments

  1. So agree about the version. No way would she not be crying out in agony. Lot of stuff I didn't know, though, like the water breaking making version impossible. Great article!

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  2. Thanks so much! Appreciate the feedback.

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  3. Every comment here is based on our present level of education, knowledge and/or experience, and they all differ - between us and even between the continents ... Most of the o.m. scene wass based a) on the facts of childbirth at about 1744 and b) the advanced knowledge of Claire as a trained 'ex-combat nurse' of WWII ... Giving birth to three children myself 23, 20 and 18 years ago here in Finland (we have one of the lowest rates of child/mother mortality) I can tell first hand, that children sometimes have to be turned - and also in 'modern days when the water has already broke. It's not pleasant!, but it doesn't necessarily hurt. I didn't have an epidural, and I still spoke with my midwife ... so just remember, it's not all 'black and white' - not on Outlander or in modern times ... ;)

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    1. Claire barely put forth an effort. I think that's where the primary problem lies with the "version" attempt. Also, we shouldn't have been dealing with medical knowledge of 1744, but of 1945. In fact, Claire would have NO knowledge of birthing techniques of the 18th century (if she had much knowledge at all . . . I doubt she delivered many babies at the front).

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    2. of course you are entitled to your oppinion. But what ever data I presented was based on research. thanks for your comments

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  4. Sara, more great medical insights. I suspected that what we saw wasn't exactly,the truth about 'turning' the baby - it seemed to me that it would/should hurt more than we were shown. But you told me why it would have done so. Thanks! As the history nut in the group, I am grateful that Diana did so much research as they don't often get the history wrong. I'm sure as a doctor you find more things that make you squirm, but I am thinking they're doing pretty good on the medical front. Do you agree overall?

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  5. Of course. It is a drama and not a PBS documentary. The overall dramatic effect was beautiful. Thanks Barbara.

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  6. Thank you so much for your article. I have been an L&D nurse for over 35 years and this scene in Outlander was probably the most accurate scene of childbirth I have seen on TV or movies. The attempt at external version excepted. Claire did state, "I have seen childbirth".

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    1. thanks for your comments. Yes, definitely a better portrayal then what is usually seen on TV. The ex. version -only those who work in OB would have picked up on it--not a big deal for TV viewing.

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  7. Thank you so much for your article. I have been an L&D nurse for over 35 years and this scene in Outlander was probably the most accurate scene of childbirth I have seen on TV or movies. The attempt at external version excepted. Claire did state, "I have seen childbirth".

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  8. I thought it was pretty good. Far better than the "screaming at the first contraction" style of acting we often see in films / tv. I think that kind of acting has actually meant women expect things to be worse than they are and copy what they see (a Kenyan friend gave birth in the UK and commented, "Why are the women here so noisy when they are having their babies?"). Here it was nice to see things done relatively quietly. As to the external version - unlikely, and surely Claire would have just delivered the baby breach, as was surely standard for 1940's? As a breech baby myself (in the 1960's) from a family that seem to have a high percentage of breech presentations, they were just delivered and midwives had several tricks to help the baby out.

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