I’ve been looking into the debate as to whether or not Queen Aemma was doomed to die – i.e. whether Viserys’s choice was between:
A. Aemma experiencing a less-painful death vs. the baby surviving, -OR- B. Aemma surviving vs. the baby surviving
Ryan Condal, the episode's writer, settled it from his own perspective in a post-broadcast behind-the-scenes feature:
“We were trying to show how dangerous childbirth was, but also to dramatize the terrible position that Viserys is put in, because it’s made very clear to him that Aemma is going to die either way. The only choice that you really have in the matter is whether you try to save the child, and he knows that it’s his duty to put forward a male heir, especially if his wife is not going to make it and not be able to generate another heir for him.”
Yet I’m not sure it’s made so clear in the context of the episode. Below is the relevant dialog:
Mellos: “During a difficult birth, it sometimes becomes necessary for the father to make an impossible choice… to sacrifice one, or to lose them both. There is a chance that we can save the child. A technique is taught at the Citadel, which involves cutting directly into the womb to free the infant. But the resulting blood loss…”
Viserys: “Seven Hells, Mellos. … You can save the child?”
Mellos: “We must either act now, or leave it with the gods.”
External knowledge aside, either interpretation could be consistent at least with Mellos's first three sentences. On the one hand, Mellos only suggests saving the baby, making no explicit mention of a possibility to save Aemma. On the other hand, “sacrifice one” is ambiguous, and Mellos makes no explicit mention of Aemma’s fate being sealed, nor is any evidence made obvious to the audience such as significant present bleeding; he may have just been encouraging the choice he felt was right (as he has done in most of his scenes so far). My own interpretation was admittedly the former on my first watch; however, it shifted towards the latter vice-versa scenario on a second viewing.
The hitch I see in retrospect is Mellos’s reference to blood loss. Forgive me if I misunderstand maternal death, but given that destructive vaginal extraction was a very real procedure for attempting to save a mother's life in the event of an obstructed labor (due to breech or a variety of other reasons) prior to safe C-sections, it's a little odd for a mother to be declared doomed to die simply because the baby is failing to exit alive. IF Aemma’s death was assured, and given that we don't see any indicative external signs, it would presumably have to be on account of either present internal hemorrhaging or some inevitable future hemorrhage. OR maybe inevitable infection (though doubtfully diagnosable). OR maybe fatal hypertension (again, doubtfully diagnosable). So Aemma was already most likely going to die by blood loss, or otherwise she was going to die by (doubtfully) some other means. Really in whichever case – but especially if she was going to hemorrhage – why call attention to the resulting blood loss of a C-section? The only reason I can think of is maybe Mellos’s statement, interrupted by Viserys, was meant to suggest not just that Aemma would die but that the high rate of blood loss would cause Aemma to die sooner? That Viserys would lose Aemma more quickly?
It seems the official interpretation could be the case, but it requires both a very particular reason for Aemma's diagnosis that was not specified, AND a very particular meaning behind Mellos’s blood loss warning that was not specified. On the other hand, a vice-versa scenario, where a destructive vaginal extraction could have possibly saved Aemma, strikes me as much more easily plausible. Moreover, the vice-versa interpretation lends the sequence greater shock, and cruelty, and tragedy – Westeros's brand, after all – and makes a more complicated, conflicted character of Viserys. All around, a more compelling story in my opinion.
Thoughts?