Content Warning: Mentions of Infant Loss, Stillbirth, and Maternal Mortality

Pandasama’s recent update for the Sims 4 Realistic Childbirth mod is as realistic and detailed as it is sad and a bit heart wrenching. While previous updates included the ability for babies to be premature and experience the difficulties of a neonatal intensive care unit (NICU) stay, this most recent update turns the realism up a notch and includes stillbirths, baby funerals, and postpartum death.

Mod Installation Instructions

While we do recommend reading our Beginner Guide to Mods & CC for a more detailed overview of how to mod The Sims 4 and how those mods should be handled, a quick run down for adding The Sims 4 Realistic Childbirth mod by Pandasama to your game would be…

Using your operating system’s file explorer, find the location of your Sims 4 Mods folder.

To add the items to your game on Windows, follow this folder path:
C:\Users\[USERNAME]\Documents\Electronic Arts\The Sims 4\Mods
To add the items to your game on MacOS, follow this folder path:
Macintosh HD/Users/User/Documents/Electronic Arts/The Sims 4/Mods

Since the mods comes as a compressed zip file, you need to ensure that you have an extraction program installed. You can use 7Zip, Winrar, Winzip, etc., and both Windows and MacOS have an unzipping function native to their system. Right click on the zipped file and choose to Extract Here/Files or Extract to… to extract directly to a folder.

Since the Sims 4 Realistic Childbirth mod includes both a .package file and a .ts4script file, it must not be placed more than a single folder deep in your mods folder. We would recommend separating the mod entirely on its own, or at least keeping it with other script mods. Also, the .ts4script file and .package file must be kept in the same folder.

It is important to watch for updates from the author when the main game receives a patch, and as of November 6th 2025, Pandasama has updated the Sims 4 Realistic Childbirth mod for use with version 1.119.109.1020 (for PC) or version 1.119.109.1220 (for MacOS), which was the update from November 4th 2025.

Existing Features

Referring back to previous updates from Pandasama and their work in progress logs for features on their Patreon for the Sims 4 Realistic Childbirth Mod, they have added so many features to allow for storytelling and gameplay that gives your sims an experience incredibly close to the real world.

The most front and center aspects are the ability for sims to have natural births, unassisted births, water births, medicated births, and cesarean sections. Sims can give birth at home or at a hospital (The hospital requires the Sims 4 Get To Work Expansion Pack), either attended by an OB-GYN, midwife, or just them and their partner or loved one if applicable. While the simple bassinet animation and birth process is still available if you choose to do as such, these options allow for more customization and longer term, realistic gameplay surrounding pregnancy and labor.

During their pregnancy, sims have a new animation for taking pregnancy tests, as well as another for telling the news to their partner. Sims can ask others to accompany them to their childbirth, allowing them to participate in the birth animations and interactions during the pregnancy and labor. Sims can get ultrasounds to find out the sex and number of babies they will have, admire their belly in the mirror, play music for their baby, read to their baby, have special cuddle and nap animations, and so much more featured in our previous update articles for this mod.

On the more realistic yet difficult side of things, Sims can also experience a baby being born prematurely. There are three ways sims can enter premature labor; They can have two possible health events that cause it, or choose to induce early in the case of multiples.

When they give birth at the hospital, if the NICU bassinet is placed, the sims baby will go into it and their model will be shrunk slightly, with new interactions and possible health conditions to recover from.

Other features include hospital visitation while babies are in the NICU, special cards from loved ones, postpartum weight gain and stretchmarks, lactation and more breastfeeding features, and more!

Sims 4 Realistic Childbirth Mod Update

Pandasama’s most recent update to the Sims 4 Realistic Childbirth mod, updated for the November 4th patch with the new features initially released on August 21st, includes multiple new features to bring some realism to the sims world. The way that the topic is tackled is very respectful and true to life, creating funeral and memorial features for those lost without the use of the Sims 4 Life and Death Expansion pack, making this aspect of the mod completely Base Game compatible.

Stillbirths

When giving birth at the hospital via the surgery machine (which transforms into a labor bed in this instance), as well as leading up to labor, sims have a baseline 5% chance of experiencing a stillbirth. Sims will receive a notification that something feels wrong about their pregnancy, similarly to premature labor, which will allow you to head to the hospital for an ultrasound and possible early delivery.

If your sim is confirmed to have at least one stillborn child, they can receive an early induction with pitocin. There is a unique animation for stillbirths, allowing sims to hold and say goodbye to their lost little ones. The model for a stillborn newborn will also be different, bundled in a blanket with a small knitted hat.

Sims with multiples who experience a stillbirth have about a 50% chance of one of the babies surviving, or a 50% chance of all of the babies being stillborn. The custom animation provided in the mod can support up to three babies, similarly to the animations created for live births.

Any stillborn children your sim has will still be named the standard way all babies are named with the pop-up menu, and will appear in your family tree. After the birth, your sim will receive a headstone/urn as well as a custom memory box item for each child lost. You can also use the cheat pie menu for Childbirth Settings to manually trigger stillbirths.

Postpartum Death

During the postpartum period, there is a standard 5% chance for the sim who just gave birth to die postpartum. This is sudden and random, typically without warning, just as sudden as the stillbirth mechanic itself. Sims will keel over using the same animation as other deaths, and you will get a notification alerting you.

I also found that, I’m assuming to avoid the ghost differences found with other death types in the base game, that I received a notification alerting me to the death, and then a secondary base game notification telling me my sim was passing from old age.

Like base game and DLC deaths, your sim can be saved via beating the grim reaper, a death flower, and other standard methods of saving a sim from death. They can also become a playable ghost, be released as a freely wandering ghost, released to the netherworld (and removed from the game), etc. They can also be revived or reborn, depending on their soul’s journey if you have The Sims 4 Life & Death.

You can also disable the death for individual sims. Use testingcheats true, shift-click on the preferred sim, go to the Childbirth Settings… option in the pie menu, and select to disable postpartum death for this sim. You can use the same menu to trigger a postpartum death, as well. This action is only available on sims who are postpartum, so you cannot disable it or trigger it until said sim has given birth.

Baby Funerals

Added as a base game feature, Pandasama created custom items to allow you to hold a funeral for stillborn newborns. This comes with an newborn-sized casket, a special memorial photo frame, and a display stand for said memorial photo.

The “Baby Funeral” event is added through the mod as a base game feature in Sims 4 Realistic Childbirth Mod, with added interactions similar to the funerals added in The Sims 4 Life & Death. The funerals have multitudes of available activities and use the same event player as other available events, allowing for customization of the date, start time, guests, lot, and more.

The memorial photo is a converted version of the one available in The Sims 4 Life & Death, added to the base game with Sims 4 Realistic Childbirth Mod and coming in the same swatches. This frame allows you to select an image from babies found in your relationship panel but who are not within your household. Meaning that all newborns, including surviving siblings, are not selectable. The image generated in the frame is custom as well as the pose, the newborn in a still and peaceful position as though they are sleeping.

The casket provided includes multiple standard mourning interactions, allowing your sims to show their love for their little one through toasts, eulogies, flowers, and more, depending on what you select. While not all of them are, some interactions are also available on the tombstone and the memorial photo frame.

Added Interactions & Details

After experiencing a stillbirth, your sim can choose to “cry it out” with their partner or loved one if they’re in a sad mood while mourning. This can provide special mood buffs that can pull them out of that sad mood quicker, even while experiencing grief.

While a sim experiencing labor, including stillbirths and induction with pitocin, is reclined on the exam bed, their partner or other present loved ones can provide support via clicking on the sim or by selecting the partner sim/loved one. A sweet interaction plays where they caress the expectant sims’ face, dab a cloth on their head, and just sweetly support them during this difficult time.

The unique tombstone and urn combination can be switched between the two models using the pie menu and has the available mourning actions for your sims. Sims receive custom moodlets when mourning or grieving a stillbirth, both for the pregnant sim and their partner.

Are mods that add the more difficult aspects of life something you enjoy, or do you prefer the Sims’ limitations and restrictions on these aspects of life? Be sure to follow The Sims Community for more mod guides and updates on Pandasama’s Sims 4 Realistic Childbirth Mod!