Receiving the call that her client had gone into labor, Lindsay Atkins dropped everything at once. She grabbed her equipment, dropped her children off at a friend’s house and set out, ready to photograph another birth. After photographing a smooth delivery at a hospital, Atkins found the mother pleading with a nurse to stop giving her a vaginal exam just minutes after birth. To the point of screams, the mother desperately tried to claw away from the latex-gloved hand that continued to inch forward, blatantly ignoring her pleas for the exam to stop. Petrified by the exchange unfolding in front of her, Atkins had to make a decision: be the photographer who stays in the background and silently watches the scene unfold or step forward and speak up. Atkins, who is also trained as a doula, put down her camera and stepped towards the nurse. “You heard her,” Atkins said. “She said no.” Pulling her hand away, the nurse snapped back, “but I have to.” Realizing that Atkins wasn’t backing down, the nurse left the room.

This is not the first time that Atkins has seen her client’s pleas’ for procedures to stop be ignored. From behind the lens of her camera, she has seen numerous clients forced to give birth in painful positions, procedures administered without consent and staff not listen to mothers asking for procedures to stop. we

These actions are considered obstetric violence, which is the mistreatment of women during the childbirth process and can lead to a traumatic birth experience. According to Improving Birth, an organization that works to inform families about their rights during the birthing process, one in three women are recorded having a traumatic birth.

Obstetric violence is any action performed on a women before, during or after the birthing process that is not consensual. They can range from smaller actions like denying a women food or water during labor, to larger actions like administering an cesarean birth without informed consent and underlying reason and everything in between.

A rising topic in the birthing community and among activists following the win of a major case where an Alabama mother, Caroline Malatesta, sued Brookwood Medical Center for medical negligence and reckless fraud. With no doctor in the room to official deliver her baby, hospital staff held down a screaming Malatesta as a nurse pushed her newborn’s head back into her vagina, preventing him from being born. The baby was unharmed  but Malatesta was diagnosed with PTSD and has severe nerve damage that prevents her from ever having sex or giving birth again. The winning of this case brought light and attention to the topic and the phrase obstetric violence was coined.

Atkins, a mother, birth photographer, and birth trauma activist in the Hudson Valley, New York, began her journey into birth photography through working as a doula. A doula is someone who provides companionship in birth through emotional support, physical support and coaching before, during and after birth. Unlike in midwifery, doulas are not medically licensed but have taken an extensive course and passed an exam that equip them to help families throughout their birth experience.

According to Evidence Based Birth, an organization focused on informing families about their legal during birth, rights six percent of mothers during birth use doulas throughout their birth experience.

Photo courtesy of Spot of Serendipity

“I decided to bring my camera along one day and started taking photos,” she said. Simply snapping a few photos for the family, she found herself drawn to the moments.

Having experience with time-sensitive photos, Atkins was taking photos of military homecomings. She enjoyed capturing real moments of excitement and happiness that could never be recreated in another moment. Drawn to the same feelings of happiness and excitement of birth, the switch came natural to her.

At first, Atkins didn’t know about birth photography or that it even existed, she just was snapping away and sending the photos over after. Her hobby quickly turned into a career when Atkins met Lyndsay Stradtner, a birth photographer and activist. They quickly became friends and Stradtner introduced her to the underground community of birth photographers. Still small and not heavily circulated, Stradtner would later found the International Association of Professional Birth Photographers.

“I had no idea other people were doing this,” Atkins said. Quickly she would fall in love with capturing the moments that she learned through her practice as a doula.

With over 4 million views on their page, The International Association of Professional Birth Photographers, IAPBP for short, works towards connecting expecting parents with birth photographers in their area. Founded only in 2010, there are over 1,200 members in 42 countries around the world. The page would serve as a tool for Atkins to connect with potential clients.

Photo courtesy of Spot of Serendipity

When you look through Atkin’s work you are greeted with vivid images that gracefully display the raw, natural beauty of childbirth. Unlike in newborn shoots where babies are cleaned, dressed and posed, Atkins showcases the reality that birth is hard work. Through blood and sweat, her images celebrate the mother’s and families involved, never shying away from the process of birth itself.

“I want it to look how it does in real life,” she said, “it’s natural, you’re able to feel something. It’s a rite of passage for the child born, but also for the families becoming parents.”

However, some of the births that she has photographed haven’t gone according to plan.

Atkins, along with other birth photographers, has witnessed first-hand traumatic birth experiences that their clients have been subject to-photographing it all.

Atkins reflects on a recent experience at a hospital that left her shaken.

During a different birth Atkins found herself comforting a mother. Just minutes after birth, her newborn was taken into the prenatal intensive care unit, NICU. Her husband and staff following the baby left the new mother alone with no information on what was happening with her child. The mother became upset and started crying to the point where Atkins put her camera down and began to comfort her. With no one giving any answers on what was happening with her baby or if it was okay, the mother progressively got more upset. In the middle of the crying a nurse walked into the room. Seeing the scene unfolding the nurse said to the mother, “don’t worry, you won’t even remember this is 25-years.” Crying and not able to voice her concerns Atkins stepped in, “She’s really upset because she doesn’t know where her baby is and why her baby’s been taken. She would really like to know what’s happening and no one is giving her any information.”

For Atkins, as a birth photographer, this means being a fly on the wall. Capturing every moment in silence, only intervening if there is something that she deems it absolutely necessary.

A boundary that Atkins has set where she will always speak up is when a mother is not informed about an episiotomy procedure that is about to happen. An episiotomy is when an obstetric or midwife will cut your vaginal wall to make a larger opening for the baby to pass through. With many skeptics, episiotomy has become a source of controversy in birth activism with many arguing against the procedure entirely.

“As a photographer, most of the time I have to keep my mouth shut because they haven’t hired me to be their advocate. If there’s something happening, literally an assault and their not informing the mother, I will definitely speak up.”

There has been a recent movement within hospitals that bans photographers during the birthing process. In 2018 Queensland Health and Metro North Health Services in Australia, which covers well-known hospitals and birthing centers throughout the country, allows photographers to photography before and after the birth but not during. Anyone found filming of photographing will be asked to stop and if it continues, to leave the room.

An Australian photographer Michelle Palasia, who frequently photographed births at the Royal Brisbane and Women’s Hospital, started a petition online to try and convince the hospital to change its policy. The petition currently has over 20,000 signatures with support from photographers and mothers alike. However the hospital stays firm on its decision.

In an interview in news.com.au, the hospitals executive director, Dr Amanda Dines, says that the policy was instilled out of safety concerns and has been for numerous years.

Photo courtesy of Spot of Serendipity

“While we make every effort to make our birthing suites as warm and homely as possible, they are clinical procedural areas,” Dines said during the interview, “they are still highly technical areas with a range of emergency equipment on hand, so having additional people with additional equipment can potentially get in the way of the work out clinicians need to do.”

Atkins has run into instances where she has been handed waivers when going to photograph hospital births. By signing these forms, she agrees to not photograph certain actions during the birthing process. She finds that the majority of instances you can’t photograph that are outlines on the waiver are episiotomies, vacuum extractions, and denied access to cesareans.

Vacuum extractions are when a soft suction cup is attached to the baby’s head and used to guide them out of the vaginal canal. Vacuum extractions have garnered skepticism and concern throughout the birthing community because of the added pressure on the newborn’s head, possibly harming them by causing bleeding or fracturing the skull.

“I try and prep my clients ahead of time and say to talk to the doctor before we get to birth day and if they are like oh no birth photography, maybe that’s not the person you want to have a baby with. What are they doing that they don’t want photographed”

Witnessing these events has had lasting impact on Atkin’s clients as well as herself.

At a recent visit to a hospital as a doula Atkin’s found herself shaking. With her palms sweaty, she went to the maternity unit to pick up a placenta for encapsulating. Answering a long list of question, she began to feel anxious and wanted to leave. Finally receiving the placenta and hurrying out the the building, she began to relax. Calling a colleague, they talked about having secondary trauma.

Amy Frish, a licensed psychotherapist who specializes in work with women and girls, stresses the validity of vicarious traumatization, or secondary trauma.

“It’s the product of someone being traumatized from indirect trauma,” Frish said, “sometimes you are not given the same validity, people may say that she was only taking pictures”

Seeing a lapse in care for women, Atkins harnessed her knowledge and experience to become an advocate for those in the birth process.

“Birth is empowering. A lot of women that have birth in the system don’t experience that, I want people to see that it’s really awesome and empowering,” Atkins said.

In a recent project crafted by Atkins, Exposing the Silence Project, she highlights traumatic experiences mother’s went through during their child’s birth. Decorated with photos of the mothers and powerful quotes, others can look at the page and can find a story that may be similar to theirs.

“I wanted to create a place where mothers could come together and talk about it. It doesn’t fix things,” Atkins said, “but it does make them feel better.”

Photo courtesy of Spot of Serendipity

Sharing their stories and using birth photography as a tool for advocacy can shine light on these experiences. Mothers and families can enter a situation better equipped with the tools, knowledge and confidence to assert what they want.

Frish advises that in the correct environment and circumstance, groups with shared trauma can be productive.

“It’s important to share our traumatic birth stories, not to scare women who haven’t given birth yet, but to prepare them, kind of in the same way that terrifying folktales used to be told to children to warn them of real dangers,” said Taylor McComb Campbell, a doula and birth activist from Walla Walla, Washington, “women going into childbirth are protected by a societal bubble of ignorance, or even avoidance about the challenges, and sometimes even horrors, they could be up against in childbirth.”

Sharing traumatic birth experiences are not only to help families expecting children, it contributes to a healthing process. Showing that they are not alone, supporting and listening to mothers who have had traumatic experiences can be a step forward in healing.

Atkins can’t be certain how her photos are used after she sends them over to her clients, but they can be used to reflect and help memorialize a day that may not of gone as planned.

“Photos make things tangible,” Frisch says, “it is physical data to help understand someone’s experiences.”

When spreading awareness through her photography, Atkins receives mixed opinions.

When speaking about birth photography Atkins finds that other’s reactions are age dependent. When speaking to older women, they tend to be horrified. She accounts this to a long history of mistreatment and misunderstanding of women and birth that these women have had to endure, like twilight sleep. Twilight sleep is a practice that began in the early 1900s and was fazed out in the 1970s because of the inhumane treatment of mothers through drugging and binding patients throughout their birth. However, when speaking to her peers or younger mothers, Atkins finds that more people are enthusiastic and had a birth photographer themselves. With a long history of the birthing process being shrouded in secrecy white being ran by a male dominated field, mothers are faced with a long history that isn’t necessarily explained or displayed for the public.

But the fight for public openness in birth is not ancient.

Up until a year ago, birthing photos were heavily censored on Facebook and Instagram. Any photo of a mother giving birth that depicted explicit nudity were considered not appropriate for the platforms, flagged and taken down.  

Katie Vigos, a registered nurse, founder of the Empowered Birth Project and birth advocate, launched a petition in December of 2018 to allow uncensored birth images on social media platforms. With over 23,000 signatures Atkins teamed up with other birth photographers to flood the platform to raise awareness under the hashtag #IGallowuncensoredbirth. Photographers posted photos that were flagged and taken down, some had their accounts deleted due to violation of the platforms terms of service.

Vigos goals, outlined in the petition, were to re-categorize all birth photos and content as educational, allow graphic images with a content warning for users to have control over the photos they view and to create additional protection for photographers and influencers who post this content.

In early January, only a month after the launching of the petition, Vigos received a call from Facebook’s Associate Manager of Public Policy, Kim Malfacini, who told her that Instagram and Facebook’s policy would be updated to allow birth photography and content on their sites. After the change, the bold letters VICTORY! stand strongly on Vigos homepage.

Although the guidelines were changed there are still those who misinterpret the photos.

“I remember on one post, there was an entire conversation about if the persons vagina was shaved or not. Do you not see a baby being born here? Why is whether they shaved or not the most important part,” Atkins said, “I’ll never understand why it is so startling to see a vagina.”

Atkins continues to challenge societal norms in place towards birth and birth photography. Continuing to update Exposing the Silence Project with additional stories, Atkins will continue to photograph births and work towards normalizing childbirth.

Photo courtesy of Spot of Serendipity

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