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Tag: Baby Boom

  • The Mothers Who Aren’t Waiting to Give Their Children Cystic-Fibrosis Drugs

    The Mothers Who Aren’t Waiting to Give Their Children Cystic-Fibrosis Drugs

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    At six months pregnant, Sonja Lee Finnegan flew from Switzerland to France to buy $20,000 worth of drugs from a person she had never met. The drug she was after, Trikafta, is legal in Switzerland and approved for cystic fibrosis, a rare genetic disease that fills the lungs with thick mucus. Finnegan could not get it from a doctor, because she herself does not have cystic fibrosis. But the baby she was carrying inside her does, and she wanted to start him on the Trikafta as early as possible—before he was even born.

    She felt so strongly because Trikafta is, without exaggeration, a miracle drug. As I wrote in the latest issue of this magazine, the daily pills have in the past five years transformed cystic fibrosis from a fatal disease into one where most patients can live an essentially normal life. Trikafta, a combination of three drugs, is not a cure, and it does not entirely reverse organ damage already caused by CF, but patients who grew up believing they would die young are instead saving for retirement. And children born with CF today can expect to live to a ripe old age, as long as they start the drugs early.

    How early is best? The drugs are officially approved for CF patients as young as 2, but a handful of enterprising mothers in the United States have gotten it prescribed off-label, to treat children diagnosed in the womb. Where doctors are more cautious, mothers are still pushing the limits of when to start the drugs. A mom in Canada sent her husband across the border to get Trikafta from someone in the United States. And Finnegan flew to France to meet a patient willing to sell their excess supply.

    Getting hold of Trikafta is in fact the hardest part. Parents told me of both insurance plans and obstetricians skeptical of a powerful new medication never tested in pregnant women—and not without reason. Trikafta has side effects, and it is new enough that not all of its ramifications are fully understood. But Finnegan pored over all the research she could find and decided that Trikafta was worth it. For $20,000, she bought a five-months supply—a relative bargain compared with Trikafta’s list price of $300,000-plus a year in the United States.

    To her, it was worth $20,000 for her son to avoid CF complications that can require major surgery at birth. It was worth $20,000 to prevent permanent damage to his organs that begins even in utero. She felt lucky she could afford it at all. Trikafta in pregnancy is not currently standard practice, but a miracle drug was out there. For her son, she would figure out a way to get it.

    The very first expecting moms on Trikafta were women with CF taking the drugs for themselves. Not long after the medication became available, in the fall of 2019, doctors noticed a baby boom in the CF community. Trikafta, it turns out, affects more than the lungs; it can also reverse the infertility common in women with CF, thought to be caused by unusually thick cervical mucus. (Most men with CF are born infertile, because the vas deferens, which carries sperm, never develops.)

    Experts worried at first about what Trikafta could do to developing fetuses. “People were like, ‘Don’t do this. We don’t know if it’s a teratogen’”—a substance that causes birth defects, says Ted Liou, the director of the adult-CF center at the University of Utah. (The CF doctors quoted in this article have all conducted clinical trials for or received speaking or consulting fees from Vertex, the manufacturer of Trikafta and several other drugs for CF.) That fear turned out to be unfounded: Hundreds of babies later, there has been, at least anecdotally, no uptick in severe birth defects.

    Read: The cystic-fibrosis breakthrough that changed everything

    Doctors started to see hints that Trikafta in utero could help babies with CF too. Of the hundreds of children born to mothers on Trikafta, only a few of the babies had CF themselves. This is because cystic fibrosis is a recessive disorder, meaning a mother with CF could have a child with CF only if the father also passed on a CF mutation. But the first documented case came to the attention of Christopher Fortner, the director of the CF center and pediatric-CF program at SUNY Upstate, who published a case report in 2021. Trikafta, he told me, made a clear difference for this baby girl.

    Cystic fibrosis is caused by an imbalance of salt and water in the body, and this affects developing organs even before birth. One in five infants with CF are born with an intestinal blockage caused by meconium—the normally sticky black stool of newborns—that has turned too thick and hard to pass. This is called meconium ileus, and in the worst cases, the intestines can rupture. Emergency surgery is necessary. Elsewhere in the body, the pancreas never forms properly with CF. “By the time they’re born, their pancreas is really not a functional organ,” Fortner said. Adults on Trikafta still have to take pancreatic enzymes with every meal, but there is some evidence that young children can gain pancreatic function if they begin the CF drugs early enough.

    When this baby girl was born, though, her meconium and her pancreas levels were normal from the very start; the standard newborn screening for CF would have never caught her. Fortner started her on enzymes as a precaution, but he stopped them after a week. She is 3 years old now and in preschool. Unlike generations of CF kids before her, she will never have to see the school nurse for enzymes every time she wants to eat. And she may never suffer the recurring lung infections that once made CF ultimately fatal. “The life she’s living,” Fortner said, “that was a whole lot like a cure to me.”

    Moms who do not have CF themselves have a much harder time getting their unborn children on Trikafta. In 2021, Yolanda Huffhines’s second child was diagnosed with CF prenatally, after a genetic test was recommended because Huffhines’s first child had cystic fibrosis. The diagnosis did not come as a shock this time, but she began to worry when the baby showed signs of meconium ileus while still in utero.

    After coming across a study in ferrets, Huffhines brought the idea of Trikafta to her doctors, who were not all enthused. Her obstetrician in particular was against it. But she found that CF doctors were more willing to weigh the well-known risks of cystic fibrosis—especially meconium ileus—against the less well-known risks of Trikafta. She asked Patrick Flume, who directs the adult-CF center at the Medical University of South Carolina, what he would do if it were his wife and child. He told her he would get Trikafta, and he agreed to help.

    Even with a sympathetic doctor, getting Trikafta wasn’t easy. First, Flume tried giving her a stash from a patient who no longer needed it, which was vetoed because his hospital couldn’t ensure that it had been properly stored. Then he asked the manufacturer, Vertex, which also said no. (The company told me it couldn’t provide Trikafta to anyone outside the drug’s official indications.) Finally, Flume told me, he decided to write a prescription as if the mother were his patient. When the insurance company asked if she had at least one copy of a specific CF mutation that Trikafta was developed for, he answered yes, truthfully. Because Huffhines is a carrier, she does have one copy. She started Trikafta at 32 weeks, and by the time her daughter was born, the meconium ileus had disappeared.

    Huffhines’s experience on Trikafta was not entirely smooth, though. The drugs come with some well-documented side effects, such as cataracts and liver damage, that have to be monitored, Flume told me, as with any new drug. Although Trikafta during pregnancy went fine for Huffhines, she started to experience unusual symptoms when she continued the medication so her daughter could get it through breast milk. Her usual migraines started going “through the roof,” and her scheduled blood work revealed that her liver enzymes had gone haywire—a sign of liver damage. She had to stop.

    Quitting Trikafta cold turkey could be harmful for newborns, though, which Huffines knew from studying the ferret research. (Suddenly withdrawing, Fortner told me, may cause pancreatitis.) She wondered: Was it possible to give a baby Trikafta directly? The pills would be too big, obviously, but her husband had scales for gunpowder that could weigh down to the milligram. She got a new one overnighted, and she began crushing the pills to give to her daughter—a technique that has since been taught to other moms. Her daughter did well. Huffhines’s doctors ended up publishing a case report in 2022—the first documenting a carrier of CF taking Trikafta.

    The long-term impacts of being on Trikafta in utero still need to be studied. The oldest child is still only 3. In adults, a small minority who have started Trikafta have reported sudden and severe anxiety, insomnia, depression, or other neuropsychiatric symptoms. The link is not fully proven or understood in adults, and it’s completely unexplored for fetal brain development. Elena Schneider-Futschik, a pharmacologist at the University of Melbourne, told me she is collaborating with researchers in the United Kingdom to get long-term developmental data on children exposed to Trikafta before birth. For now, she said, “we don’t know.”

    Fortner, who has heard from several pregnant mothers since his first case report, said he does not deter parents already set on getting Trikafta, but he does not, in all cases, push them toward it, either. Given the unknowns, he’s not sure that the benefits outweigh the risks. The clearest exceptions are cases of meconium ileus, in which doing nothing comes with its own costs. Flume told me about a recent patient whose baby was showing signs of an intestinal blockage and whose insurance initially denied Trikafta. The medication was eventually approved—but the mom went into labor the day she was due to start. Her baby needed emergency surgery. “This is something that did not need to happen,” he said.

    By the time Finnegan, in Switzerland, went looking for Trikafta last year, she had the earlier cases as models. Her baby wasn’t showing signs of meconium ileus, but she didn’t want to wait until he did, if he was going to end up down that path. Although her doctors were supportive, they could not get her Trikafta. That’s why she had to take unorthodox measures.

    She took her first pill in August, and her son was born in October with a working pancreas and no intestinal blockage. He is far too young for this to matter, but she hopes that the Trikafta allowed his vas deferens to develop normally too. Someday, he might want children of his own, and the impacts of getting Trikafta in utero might carry over into the next generation.

    Finnegan has been documenting her experience on social media, where she says her posts have inspired other pregnants moms to get on Trikafta for their unborn children. She knows of about 20 now, and after she got in touch with Schneider-Futschik, the researcher decided to survey these moms too. Meanwhile, Finnegan is sharing the stories of other moms as well, making note of details such as how long the mom was on Trikafta, what side effects she experienced, whether meconium ileus was resolved, and if insurance covered the drugs—a case series, of sorts, presented on Instagram. They are still few enough that every case is notable. In the future, though, all of this might become the utterly unremarkable standard of care.

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    Sarah Zhang

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  • The Calendar of Human Fertility Is Changing

    The Calendar of Human Fertility Is Changing

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    As the chair of the department of obstetrics and gynecology at UT Southwestern Medicine, Catherine Spong is used to seeing a lot of baby bumps. But through her decades of practice, she’s been fascinated by a different kind of bump: Year after year after year, she and her colleagues deliver a deluge of babies from June through September, as much as a 10 percent increase in monthly rates over what they see from February through April. “We call it the summer surge,” Spong told me.

    Her hospital isn’t alone in this trend. For decades, demographers have documented a lift in American births in late summer, and a trough in the spring. I see it myself in my own corner of the world: In the past several weeks, the hospital across the street from me has become a revolving door of new parents and infants. When David Lam, an economist at the University of Michigan who helped pioneer several early U.S. studies on seasonal patterns of fertility, first analyzed his data decades ago, “we were kind of surprised how big it was,” he told me. Compare the peak of some years to their nadir, he said, and it was almost like looking at the Baby Boom squished down into 12 months.

    Birth seasonality has been documented since the 1820s, if not earlier. But despite generations of study, we still don’t fully understand the reasons it exists, or why it differs so drastically among even neighboring countries. Teasing apart the contributions of biology and behavior to seasonality is messy because of the many factors involved, says Micaela Martinez, the director of environmental health at the nonprofit WE ACT for Environmental Justice, who has been studying seasonality for years. And even while researchers try to track it, the calendar of human fertility has been changing. As our species has grown more industrialized, claimed more agency over reproduction, and reshaped the climate we are living in, seasonality, in many places, is shifting or weakening.

    Read: The pregnancy risk that doctors won’t mention

    There is no doubt that a big part of human birth seasonality is behavioral. People have more sex when they have more free time; they have less sex when they’re overworked or overheated or stressed. Certain holidays have long been known to carry this effect: In parts of the Western world with a heavy Christian presence, baby boomlets fall roughly nine months after Christmas; the same patterns have been spotted with Spring Festival and Lunar New Year in certain Chinese communities. (Why these holidays strike such a note, and not others, isn’t entirely clear, experts told me.)

    In addition to free time, family-focused celebrations probably help set the mood, Luis Rocha, a systems scientist at Binghamton University, told me. Cold weather might help people get snuggly around Christmastime, too, but it’s not necessary; Rocha’s studies and others have shown the so-called Christmas effect in southern-hemisphere countries as well. No matter whether Christmas falls in the winter or summer, around the end of December, Google searches for sex skyrocket and people report more sexual activity on health-tracking apps. In a few countries, including the U.S., condom sales rise too.

    But cultural norms have never been able to explain everything about the Homo sapiens birth calendar. “It’s pretty common for mammals to have a specific breeding season” dictated by all sorts of environmental cues, Martinez told me. Deer, for instance, mate in the fall, triggered by the shortening length of daylight, effectively scheduling their fawns to be born in the spring; horses, whose gestations are longer, breed as the days lengthen in the spring and into summer, so they can foal the following year.

    Humans, of course, aren’t horses or deer. Our closest relatives among primates “are much more flexible” about when they mate, Élise Huchard, a behavioral ecologist at the University of Montpellier, in France, told me. But those apes are not immune to their surroundings, and neither are we. All sorts of hormones in the human body, including reproductive ones, wax and wane with the seasons. Researchers in the United States and Australia have found that couples hoping to conceive via in vitro fertilization have a higher chance of success if the eggs are retrieved during the summer. At the same time, summer conceptions appear to be less common, or less successfully carried to term, in some countries, a trend that sharpens at lower latitudes and, Lam told me, during hotter years. The subsequent spring lulls may be explained in part by heat waves dissuading people from sex. But Alan Barreca, an economist at UCLA, suspects that ultrahigh temperatures may also physiologically compromise fertility, potentially by affecting factors such as sperm quantity and quality, ovulation success, or the likelihood of early fetal loss.

    Read: Life can’t get much hotter than this

    No matter its exact drivers, seasonality is clearly weakening in many countries, Martinez told me; in some parts of the world, it may be entirely gone. The change isn’t uniform or entirely understood, but it’s probably to some extent a product of just how much human lifestyles have changed. In many communities that have historically planted and harvested their own food, people may have been more disinclined to, and less physically able to, conceive a child when labor demands were high or when crops were scarce—trends that are still prominent in certain countries today. People in industrial and high-income areas of the modern world, though, are more shielded from those stressors and others, in ways that may even out the annual birth schedule, Kathryn Grace, a geographer at the University of Minnesota, told me. The heat-driven dip in America’s spring births, for instance, has softened substantially in recent decades, likely due in part to increased access to air-conditioning, Lam said. And as certain populations get more relaxed about religion, the cultural drivers of birth times may be easing up, too, several experts told me. Sweden, for example, appears to have lost the “Christmas effect” of December sex boosting September births.

    Advances in contraception and fertility treatments have also put much more of fertility under personal control. People in well-resourced parts of the world can now, to a decent degree, realize their preferences for when they want their babies to be born. In Sweden, parents seem to avoid November and December deliveries because that would make their child among the youngest in their grade (which carries a stereotype of potentially having major impacts on their behavioral health, social skills, academics, and athletic success). In the U.S., people have reported preferring to give birth in the spring; there’s also a tax incentive to deliver early-winter babies before January 1, says Neel Shah, the chief medical officer of Maven Clinic, a women’s health and fertility clinic in New York.

    Humans aren’t yet, and never will be, completely divorced from the influences of our surroundings. We are also constantly altering the environment in which we reproduce—which could, in turn, change the implications of being born during a particular season. Births are not only more common at certain times of the year; they can also be riskier, because of the seasonal perils posed to fetuses and newborns, Mary-Alice Doyle, a social-policy researcher at the London School of Economics, told me. Babies born during summer may be at higher risk of asthma, for instance—a trend that’s likely to get only stronger as heat waves, wildfires, and air pollution become more routine during the year’s hottest months.

    The way we manage infectious disease matters too. Being born shortly after the peak of flu season—typically winter, in temperate parts of the world—can also be dangerous: Infections during pregnancy have been linked to lower birth weight, preterm delivery, even an increased likelihood of the baby developing certain mental-health issues later on. Comparable concerns exist in the tropics, where mosquitoes, carrying birth-defect-causing viruses such as dengue or Zika, can wax and wane with the rainy season. The more humans allow pathogens to spill over from wildlife and spread, the bigger these effects are likely to be.

    Read: One more COVID summer?

    Children born in the spring—in many countries, a more sparsely populated group—tend to be healthier on several metrics, Barreca told me. It’s possible that they’re able to “thread the needle,” he said, between the perils of flu in winter and extreme heat in summer. But these infants might also thrive because they are born to families with more socioeconomic privilege, who could afford to beat the heat that might have compromised other conceptions. As heat waves become more intense and frequent, people without access to air-conditioning might have an even harder time getting pregnant in the summer.

    The point of all this isn’t that there is a right or wrong time of year to be born, Grace told me. If seasonality will continue to have any sway over when we conceive and give birth, health-care systems and public-health experts might be able to use that knowledge to improve outcomes, shuttling resources to maternity wards and childhood-vaccination clinics, for instance, during the months they might be in highest demand.

    Humans may never have had as strict a breeding season as horses and deer. But the fact that so many people can now deliver safely throughout the year is a testament to our ingenuity—and to our sometimes-inadvertent power to reshape the world we live in. We have, without always meaning to, altered a fundamental aspect of human reproduction. And we’re still not done changing it.

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    Katherine J. Wu

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  • M3GAN Is Ultimately A Techno-Horror Version of Baby Boom and Raising Helen

    M3GAN Is Ultimately A Techno-Horror Version of Baby Boom and Raising Helen

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    Although the automatic correlation to make with M3GAN is that it’s a mere pale imitation of the Child’s Play movies (particularly the 2019 one), at the core of the story is “the Baby Boom narrative.” Directed by Gerard Johnstone and written by Akela Cooper, M3GAN wields the same Nancy Meyers trope established in this seminal 1987 film from her oeuvre. One that screenwriters Jack Amiel and Michael Begler would also emulate in the 2004 Garry Marshall-directed film, Raising Helen. In Baby Boom, the career woman at the center of the story who suddenly gets an unexpected child plopped in her lap is J. C. Wiatt (Diane Keaton). As a high-powered management consultant, this is the last thing she could possibly want or need. The same goes for her investment banker boyfriend, Steven Buchner (Harold Ramis), who has as little interest in the burden of a child as J. C. (deemed, offensively, “the Tiger Lady” at her workplace—because any successful woman would be given such a belittling nickname, no?).

    The “bequest” of the child, named Elizabeth, came from a distant cousin. And, as such, J. C. feels no real sense of obligation or guilt about giving her up… at first. Naturally, as this is a Charles Shyer-Nancy Meyers movie, J. C. finds herself growing quickly attached to Elizabeth despite her lack of maternal aptitude, as well as the upheaval this baby is causing in J. C.’s professional life. Not to mention her romantic one, for when she tells Steven she wants to keep the baby (“Papa Don’t Preach”-style), he essentially says, “Fuck that, I’m out.” Nonetheless, it’s an “amicable” split and J. C. goes about the grueling task of balancing the dual roles of mother and supposedly indispensable employee, which is something women have been expected to manage ever since “equality” became “a thing.” A “rock n’ roll, deal with it” attitude foisted upon women by the men who aren’t expected to perform any such feat (except in “comedic” 80s movies like Mr. Mom and Three Men and a Baby).

    Well, J. C. isn’t quite “dealing with it”—not in the way her boss, Fritz Curtis (Sam Wanamaker), finds satisfactory anyway. The same goes for David Lin (Ronny Chieng), the boss of star roboticist/toymaker Gemma (Allison Williams) in M3GAN (a.k.a. Model 3 Generative Android). Except David’s dissatisfaction is expressed before the arrival of an unwanted and unexpected child in Gemma’s life: her niece, Cady (Violet McGraw). While she’s supposed to be perfecting a new prototype for Perpetual Petz (sort of like a Giga Pets concept meets a Furby aesthetic, but far more sinister), she has instead been working on a more advanced project in the form of Megan, an AI-powered doll that blows up right in her face (literally) when she’s caught by David running tests on it with her coworkers and collaborators, Tess (Jen Van Epps) and Cole (Brian Jordan Alvarez). Having secretly spent one hundred thousand dollars of company money to work on it, Gemma drops further down the workplace shit list when her now-deceased sister leaves her only child in Gemma’s care right at this time.

    Indeed, just as it was in Raising Helen, Cady’s parents die in a car crash. In such a way, mind you, that gives one cause to believe that their stupidity in not putting chains on their tires might have been Darwinism at work, if you catch one’s drift. At least in Lindsay (Felicity Huffman) and Paul Davis’ (Sean O’Bryan) case, it wasn’t their fault they were mowed down by another car (minding their own business when another vehicle jumped the center divide and crashed into them). In Cady’s parents’ case, it definitely was, as they chose to remain at a standstill in a snowstorm without pulling over to the side of the road. Cady, who was in the backseat trying to take her seatbelt off to save her Perpetual Pet, remains unscathed. And yes, her unhealthy attachment to an inanimate object is far more disturbing than the one Helen Harris’ (Kate Hudson) youngest niece, Sarah (Abigail Breslin), has to a hippo stuffed animal (named, what else, Hippo). In truth, her clinginess to this simple, “analog” hippo smacks of a far simpler time, when AI wasn’t a factor in the manufacture of “toys.” Now merely tech devices in disguise. That Gemma was the one who gifted the Perpetual Pet (which, as mentioned, she designed herself for Funki, the Seattle-based toy company where she works) to Cady not only indicates that she had no idea how annoying it would be to a parent subjected to it, but also serves as a foreshadowing of the Frankenstein to come. For that’s what Megan is: a monstrous creature of Gemma’s own making.

    And yet, she might not ever have continued focusing on the project were it not for the unwitting urging of Cady, who sees another prototype named Bruce from Gemma’s college-era robotics days and regards its capabilities in awe. When Gemma explains that advanced toys like these are impossible to market because of how expensive they would retail, Cady off-handedly notes, “If I had a toy like that, I don’t think I would ever need another one.” Bring on the “determined” scene of Gemma magically being able to finish her creation anew (no explanation as to where she suddenly got all the “extra” supplies to do it). And voilà, Megan. An Olsen twin-looking creep (though Johnstone stated she was meant to be modeled after a combination of Grace Kelly, Kim Novak, Audrey Hepburn and Peggy Lipton). But Cady seems to like her. Mainly because she’s far more interested in paying attention to Cady than Gemma is—still set in her “selfish” (i.e., liberated) ways to the point where we’re given a scene of Gemma and Cady sitting across the table from one another with the latter totally desperate to be noticed by her aunt as she concentrates on some work through her phone—a total inverse of the dynamic we’ve become accustomed to seeing between parent and child. Or “guardian” and child. But it is Megan who swiftly takes over the role of caretaker for Gemma, who really can’t be bothered. Sure, she had the chance to foist Cady onto her grandparents in Florida (Helen’s nieces and nephew also have grandparents in Florida, theirs in Miami as opposed to Jacksonville), but perhaps we’re supposed to believe something like guilt was too powerful of an emotion for her to do such a thing. So yeah, Megan turns out to be a great unpaid nanny to pick up the slack where Gemma can’t (read: doesn’t want to).

    It is Tess who is the one to point out to Gemma that, if Megan is doing all the parenting, what are the moral implications of this “toy”? What’s the purpose of being a parent at all if you’re just going to have “someone else” do the job for you? Here, the same old guilt trip is reinstated for women who would dare to think they could “have it all.” But, as usual, they must eventually choose. Granted, at least in M3GAN, some sign of “progress” has been shown in that Gemma’s boss seems totally uninterested in Gemma’s new status as “Mom,” so much as the dollar signs the kid is providing by becoming a test subject with Megan, “pairing” with her (like any device does), as it were, so that Gemma can collect as much data as possible before rolling out the product to the public. In contrast, the bosses in Baby Boom and Raising Helen are utterly vexed by the plight of juggling motherhood with work. For, just as J. C. is expected to magically make her situation “work,” so is Helen, with no understanding from her Miranda Priestly-esque boss, Dominique (Helen Mirren). The Dominique in Dominique Modeling Agency where Helen serves as her assistant a.k.a. right-hand woman. A role that has become increasingly difficult to uphold with three kids to consider. Dominique is especially horrified when Helen dares to bring the trio to a fashion show, sucking all the glamor out of the front row. When Helen subsequently causes one of the agency’s top models, Martina (Amber Valletta), to get her face covered in permanent marker by the kids at Sarah’s school, it’s the final straw for Dominique. She cannot fucking deal with this children bullshit anymore. That’s how Gemma herself feels, a sentiment that eventually extends to Megan as she becomes just another “child” to concern herself over—what with Megan interpreting Gemma’s instruction to “protect Cady” as license to kill whoever she deems a threat.

    With the “doll” having transmuted into a serial killer, Gemma accepts that such a “toy” (slated to sell for ten thousand dollars a pop) can’t be released. But her revelations are too little, too late, with David in full-tilt launch party mode and Cady so addicted to her “best friend” that she acts like a heroin addict in withdrawal when Gemma takes Megan away from her to try “troubleshooting.” Having been so focused on not wanting Cady to be sad (therefore, not feel anything at all) by distracting her with Megan, when Cady tells her she needs the “doll” back because she doesn’t feel so awful when Megan’s around, Gemma has the epiphany, “You’re supposed to feel this way. The worst thing that could have happened to you happened.” As it did for the Davis children in Raising Helen. By the same token, these children losing their parents is also the worst thing that could have happened to the free-spirited, independent woman forced to take them on. At one moment in Raising Helen, she demands of her potential love interest, “Pastor Dan” (John Corbett), “Do you have any idea what this has done to my life?” Pastor Dan retorts, “Do you have any idea what it’s done to theirs?” Because no, there is not supposed to be any empathy for the woman in such a scenario who, for all intents and purposes, gets fucked over with this responsibility, but instead for the children who end up “stuck” with her.

    Raising Helen is the only film of the three that wants us to briefly believe that Helen might have actually come to her senses and embraced who she is as a person by forking the children over to her more responsible sister, Jenny (Joan Cusack). Afterward, Dominique “joyfully” (or as much joy as the plastic surgery will allow her to express) welcomes Helen back, noting, “Ibsen wrote, ‘Not all women are meant to be mothers.’” And yet, in Movie World, of course they are. That’s the message that always gets reiterated: no woman is so “heartless” a.k.a. career-oriented that she wouldn’t soon realize that the “reward” of having a child far outweighs any sense of gratification she might have gotten in her job. Even someone as overtly single-minded and self-oriented as Gemma.

    This, too, is why, upon briefly going back to her old life toward the end of Raising Helen’s third act, Helen suddenly fathoms that it doesn’t “fit” her anymore. So we cue the scene of her half-heartedly clubbing while looking completely empty inside before she begs Jenny to let her have the kids back. Similarly, Gemma dips out on the launch David has been planning so that she can keep Cady separated from Megan and reestablish herself as the “dominant force” that Cady should be attaching to in the wake of her parents’ death—not some killer robot. A forced attachment that conveniently comes just in time for Gemma to be spared from getting passed over by Cady in favor of a non-human.

    Now that she’s fully committed to motherhood with no AI help, perhaps we can try to naively believe that Gemma will be able to carry on with her work as before, even getting plenty of useful tips on successful toymaking from an actual child. But, in the end, she’ll sacrifice in the same manner as J. C. and Helen, all while telling herself that this “job” is far more important and worthwhile. Thus, the filmic method for brainwashing the last “holdouts” against motherhood continues. Even in something as ostensibly un-romantic-comedy as M3GAN—for there are now more “covert” ways to sell motherhood to single, job-loving women in techno-horror-comedy.

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    Genna Rivieccio

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