Yeah... when it comes to what some people want in the Sims 4, a more realistic life simulator isn't actually possible. The entire Sims franchise has always stayed in the balance of realism and fantasy. While the fantastical elements have been lessened with the times, the game still tries to keep the realism at a level that doesn't become too real.
In the first Sims, to have a baby the couple only needed to kiss a lot until a basinet suddenly appeared. Sims 2, there is whoo-hoo, but it is done in a somewhat cartoony way (and has kept to that standard), then when it is time for the baby to be born, it appears out of nowhere, slightly hovering above the mother to gently land in her arms. I know very little of the Sims 3, but I'm pretty sure it follows a similar route as the Sims 2. The Sims 4 is the farthest they have ever gone when it comes to childbirth in that a parent can go to a hospital (via GtW) and have their pregnancy under the care of a physician - and keeping to the careful balance of not going past the set boundary, they made it a very cartoony process. The parent doesn't experience any visible or audible pain. The birth of the baby is pretty much crane-gamed out of the machine used for the process.
In turn, some of the added gameplay features players are asking for would probably have a humorous twist added in, or would have to be dismissed altogether unless the developers can come up with a way to present certain topics in a less serious way without it becoming offensive.
An ultrasound scan would probably have a humorous aspect with what shows up on the screen where something other than the baby pops up, pregnancy cravings would probably fall somewhere in line with how a Sim turning into an Occult suddenly becomes ravenous, mood swings would probably be made humorous in some sort of fashion. Abortion, miscarriage and unpredicted pregnancy... those cross the boundaries set. Yeah, even the unexpected pregnancy (unless it was of course done by aliens abducting a male Sim who can get pregnant - this likely gets by due to the fact that is only happens to male Sims, who in turn do not get pregnant in real life), because of the concept of "unsafe" practices. 🤷♂️ 'Got to teach the kids to practice safety in the matter and an unexpected baby can indicate the participants weren't "taking proper safety measures".