I saw my first cesarean section when I was 18, during a school trip to the Dominican Republic.
I had expected to learn Spanish and make friends, but I ended up with a volunteer job on the maternity ward of an under-resourced public hospital, watching babies come into the world.
I had no qualifications or experience, but I inserted catheters and IVs as instructed, shocked by the low-quality care and poor sanitation.
The scenes of laboring neglect, loneliness and struggle were unforgettable — but so was the unbelievable experience of being the first face a newborn saw. Years later, I remembered what I’d been asked to do as a high school student with disbelief, and my curiosity about birth remained with me.
I’ve always asked questions by taking pictures, so in 2006 I started a photography project to learn more about birth. Since then, I have documented efforts to provide safe, effective, respectful maternity care in difficult circumstances around the world.
Birth is a strange mix of violence and beauty, force and surrender, being and not yet being. It is a universal experience, but the mother, caregivers and circumstances shape each delivery.
On the last day of my trip to Tuba City, Arizona, a nurse invited me to photograph his son’s hopi naming ceremony. The baby had stayed indoors for 21 days, and I photographed his female relatives introducing him to the rising sun for the first time.
In this dusty reservation town with dismal health statistics, the Navajo nation runs a maternity ward with exemplary outcomes including the lowest rate of cesarean in the state. Midwives, doctors and traditional medicine practitioners collaborate so women can labor at their own pace, supported by the traditions they choose.
In San Cristóbal, Dominican Republic, a small female OB/GYN slid her scalpel down a woman’s taught belly, and then reached in to pull out a baby — it took a surprising amount of force — which she put into a broken bassinet.
The blood, smells and heat made me nervous, but I remembered why I was there when I looked through my camera. I concentrated on organizing the shapes and movements into a coherent picture, and paid attention to my work as the doctor did hers.
Nigerian midwives employed by Doctors Without Borders offered free care to women living in Lagos’ Makoko slum, a crowded area dotted with puddles of dirty water breeding malarial mosquitoes. The edges of the slum had spread out onto a lagoon, where families built homes on platforms anchored in heaps of garbage sunk in the water.
Patients traveled in dugout canoes to the clinic, often arriving ready to push. Doctors in the state and federal hospitals were on strike, and the clinic lacked the ability to offer c-sections or blood transfusions. But the midwives assisted a mother giving birth to twins, and later she arranged her hijab over her hair to pose proudly with her newborn daughters.
A Winter Garden, Florida, midwifery practice provided comprehensive pre-natal care, birth education, doulas, obstetrical care and post-partum support to women regardless of their immigration status or ability to pay. Emergency Medicaid is available to pregnant women, but paperwork takes time, and pregnancies don’t wait.
In my hometown of Greenfield, Massachusetts, hospital staff agreed that midwives are trained to manage normal births and to recognize signs of danger, and doctors are trained to solve health problems. So patients saw only midwives unless complications arose. Mothers made decisions about their care, choosing from a range of pain relief options including birthing tubs and epidurals.
And a group of students from Mexico’s only midwifery program traveled across the country to study with traditional Mayan midwives in the small town of Chunhuhub. The midwives explained how to use massage and labor positioning in hammocks; the students gave demonstrations on contraception, sanitation and neonatal resuscitation.
Birth’s physical rawness — the sounds, smells and inevitability — is daunting. At times I’ve wondered whether I should be photographing naked, birthing mothers, especially as an American abroad. But I trust that the women I’m photographing want their stories told, and that they meant it when they said yes.
Labor seemed like such an intense experience that in my own blurry post-partum weeks, I found it hard to believe it was common. But almost every mother I saw had gone through that physical endurance and hard-won beauty. Now we were rocking our babies, sniffing sweet-smelling necks and boring our Facebook friends. But I knew how we got here, and I knew what we’d done. It felt like an incredible secret.
I’ve learned about traditions, statistics and biological processes, but birth is still mysterious to me. A slow, heavy woman enters a room — and two people leave. How can this be? I will keep photographing until I figure it out.
If possible, talk to the mom about what she’s comfortable with beforehand so you can work around any limitations to find the pictures you need while respecting your subject.
Know when to blend in.
I hang back when it seems necessary, and compose my images carefully so I’m not incessantly clicking the shutter while a mom is trying to focus.
Know when to stand out.
Be confident when you come in the room; it puts everyone at ease. Explain why you’re there, ask permission, and don’t apologize.
I’ve spent so much time watching bad cop shows with families while we wait for labor to get going. Waiting drives me crazy, but it’s a great opportunity for families and birth attendants to get to know and trust you, and to find the quiet pictures that add context.
Most labors take a while, so you’ll have several chances for each shot. Compose images in your mind and wait for the action you want to take place.
Trust your subjects.
If someone tells you she wants her birth documented, she means it. Tell the whole story, and don’t edit your photos before you’ve taken them.