The season four premiere of HBO’s The Gilded Age thrusts viewers into a tense childbirth scene for Gladys Russell, portrayed by Taissa Farmiga. The episode, which picks up six months after the previous season, opens with a doctor attending to Gladys at Sidmouth Castle during a difficult labor, where the baby is found to be in a breached position.

Farmiga shared that she was aware of Gladys’ storyline prior to filming, which eased her personal anxiety, though she acknowledged the intensity of the experience. "I knew it was going to be a harrowing experience for her. Obviously it was intense to film," Farmiga told DECIDER. "I really do love heavy emotional scenes and well, you know [I’m a] ‘scream queen.’ I got to exercise that in The Gilded Age? That’s exciting!"

Bertha Russell (Carrie Coon) is present during the ordeal and is horrified when the Duke of Buckingham’s sister, Lady Sarah (Hattie Morahan), states that the Duke might have to choose between saving Gladys or the infant. Coon explained that in that era, particularly within aristocracy, an heir was paramount. "The heir was everything, and especially when you’re considering the aristocracy in England," Coon said. "I mean, Gladys is ostensibly married off in order to save that family; their fortune and their lineage."

Despite the grim prognosis, the Duke of Buckingham ultimately pleads to save both mother and child. For Gladys, the Duke’s choice to prioritize her is a significant validation. Farmiga noted that Gladys felt she was "forced into a marriage that she thought was going to be a hellish experience," and that the Duke’s actions suggest she "can have what my mother’s been wanting for me."

Morgan Spector, who plays George Russell and Gladys’ father, agreed that the Duke’s choice serves as a moment of vindication for Bertha, confirming her judgment of his character.

However, the episode’s drama does not end with the birth. After the delivery, Gladys experiences heavy bleeding. While she is ultimately saved, it requires a hysterectomy performed without her prior consent. This means Gladys will be unable to have more children, a fact known to Bertha and the Duke, but not yet to Gladys herself. The narrative sets up this revelation as a potential future storyline for the series.

New episodes of The Gilded Age Season 4 air Sundays on HBO and stream on HBO Max.