Nate has a milestone 40th birthday and receives the surprising news that Brenda is pregnant. Nate's reaction to the news is less than ecstatic, leaving Brenda to question his desire for another child. Later, Nate comes home to an unwanted surprise party and lets it slip to that Brenda is expecting, creating tension.
Claire watches in annoyance and horror as Billy sinks deeper into un-medicated madness. Finally fed up with Billy's manic behavior, Claire has an unexpected one-night fling and ends her relationship with Billy.
David and Keith make an official offer to a surrogate and she accepts. David complains when he and Keith lose most of their day driving Roger's kids to a hair salon, but he quickly changes his tune when Roger's wife pulls some strings to get David and Keith a second shot at adopting a child - leaving them free, once again, to pursue both surrogacy and adoption.
Ruth admits to her knitting circle that she's tired of dealing with George and his madness. George apologizes to Ruth for all he's put her through, but the sentiment does little to salve past wounds.
Federico lays into Vanessa for accidentally forgetting to pick up Julio from a play date. The argument leads to romance, resulting in a night of passion. The following morning, however, Vanessa makes it clear that their encounter was a one-time experience.
Six Feet Under focuses on the cathartic journey of the extended Fisher family, whose personal trials and tribulations are played out against the solemn backdrop of an independent funeral home in LA.
This past season, story elements established in the first four seasons reach a series of emotional climaxes, with Ruth overwhelmed by her mentally fragile husband George, Nate struggling to reaffirm his relationship with Brenda while raising his daughter Maya, David and Keith longing for children of their own, Claire trying to broaden her horizons, and Federico attempting to fill the void left by Vanessa. By season's end, each of the main characters will come to embrace the cycle of life - birth, death, and rebirth - in ways that are both unique and interconnected.