Casey Calvert pulls off Seth Gamble's condom in mid-fuck, starting the ball rolling in this drama about pregnancy and birth. Calvert is disappointed when her pregnancy test comes up goose eggs, but later, when she squeezes the contents of Gamble's used condom deep inside her ... that doesn’t work either. Her attempts at seducing Gamble aren’t working ("Why do you take your clothes off so easily? And spread your legs? I didn't marry a fuckin' whore!"), and when he leaves on a business trip she imagines him in bed with other women.

When he gets back from the trip, though, he's totally on Team Let's Have A Baby and the passionless condomed let's-get-it-over-with missionary-position intercourse they were having before is replaced with exuberant impromptu fucking and Internet searches on how to best conceive and diet and exercise for a healthy pregnancy, leading them to a doctor-assisted insemination and conception.

Calvert's first trimester starts with morning sickness, loss of appetite, and nightmares, and when doula Grace (Leana Lovings) comes in for support, her quiet determination and religious fervor—and deliberate stonewalling when Calvert tries to draw her out about her past—adds a sinister touch.

In the second trimester, a trip to the doctor (Daniel Shar) is unproductive ("Her hormones are raging today, I don’t think we're going to get what we need") and her idea to get a pregnancy photographer is brushed off by Gamble as "too expensive"—and she's not mollified by Grace offering to take the pictures herself, or the dowdy clothes Grace has gotten for her newly-expanded figure.

A confrontation with Gamble about his refusal to touch her lately ("I'm worried about the baby!") brings Grace to their bedroom, quietly asking, "Is everything all right?"—leading Gamble to explain things to Grace as Calvert incredulously watches, and when Grace offers Calvert a "yoni massage" to calm her, she's even more freaked out, telling Gamble, "If she does this, you stay!"

Come the third trimester, Calvert sees—or maybe hallucinates—affectionate moments between Grace and Gamble. When Calvert phases in the kitchen with a big knife in her hands, they take her to the doctor, who prescribes bed rest ("Let's get the crankiness down"), but Calvert resists, telling Grace, "I don't want you here any more!" and hallucinating herself into a gangbang with three guys in scrubs and surgical masks, repeating, "I want you to make me a mother" like a mantra as the doctor paternally says, "Our top clinicians are going to take good care of you" as he makes notes in a journal—leading to Calvert catching, or maybe hallucinating, Gamble and Grace in some baby-making activity as her water breaks ... leading to a revelatory series of flashbacks that redefine everything that came before.

Birth is a throwback to the best of the '70s Golden Age, a plot-driven production with some explicit sex scenes. It received an eye-popping 10 nominations for the 2025 AVN Awards: Best Leading Actress for Casey Calvert, Best Leading Actor for Seth Gamble, Best Supporting Actress for Leana Lovings, Best Non-Sex Performance for Daniel Shar, Best Screenplay – Feature/Extended Work and Outstanding Directing – Individual Work for Bree Mills, Best Cinematography, Best Editing, Best Hair & Makeup, Best Music, Most Outrageous Sex Scene for the gangbang, and Grand Reel.