“YOU HEARD HER, SHE SAID NO”:
A Birth Photographer’s Journey
Askins got the call: her client was in labor. She grabbed her equipment, dropped her children off at a friend’s house and set out to the hospital, ready to photograph another birth.
Just minutes after a smooth delivery at a hospital, Askins saw the mother pleading with a nurse to stop giving her a vaginal exam. To the point of screams, the mother tried to claw away from the latex-gloved hand that continued to inch forward. The nurse ignored her.
Petrified by the exchange unfolding in front of her, Askins had to make a decision: be the photographer who stays in the background, clicks away, silently watching the scene unfold. Or speak up. Askins, who is also a practicing doula, put her camera down and stepped towards the nurse.
“You heard her,” Askins said. “She said no.” Pulling her hand away, the nurse snapped back, “but I have to.” Askins didn’t back down. The nurse scurried out of the room.
This is not the first time that Askins has seen her client’s pleas for procedures to stop be ignored. Through the lens of her camera, she has seen many clients forced to give birth in painful positions, procedures administered without consent, and staff that didn’t listen to mothers.
Askins, a birth photographer and birth trauma activist in the Hudson Valley, N.Y., began her journey into birth photography through working as a doula. A doula is someone who provides companionship in birth through emotional support, physical assistance and coaching before, during and after birth. According to Evidence Based Birth, six percent of mothers use doulas throughout their birth. Unlike in midwifery, doulas are not medically licensed but take an extensive course followed an exam that certifies them to help families throughout their birth experience.
“I decided to bring my camera along one day and started taking photos,” Askins said. Simply snapping a few photos for the family, she found herself drawn to these moments.
Askins has a history of taking time-sensitive photos during her time photographing military homecomings. She enjoyed capturing real moments of excitement and happiness that could never be recreated again. Drawn to the same feelings, the switch to photographing birth came natural to her.
At first, Askins didn’t know about birth photography or that it even existed. She was just snapping away while she attended births as a doula and sending the photos over to the family after. Her hobby turned into a career when she discovered Lyndsay Stradtner, a birth photographer who founded the International Association of Professional Birth Photographers.
“I had no idea other people were doing this,” Askins said. She quickly fell in love with capturing the moments that she witnessed 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.
Brittany, a mother and instagram personality from Cleveland, Ohio, hired a birth photographer for all three of her children’s births after seeing other photos online.
“It was my first time pregnant and as I was planning to give birth, I saw photos of other women giving birth and wanted to have the memories,” she said. “The second and third time, I hired a photographer because I cherished the pictures from the first birth so greatly, I couldn’t imagine not having them for the other babies.”
Askins’ work greets viewers with vivid images that gracefully display the raw, natural beauty of childbirth. Unlike in newborn shoots where babies are cleaned, dressed and posed, Askins showcases the reality of birth-that it’s hard work. Through blood and sweat, her images celebrate the mothers and families involved, never shying away from the process.
“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.”
Some of the births that she has photographed have been difficult rites of passage.
Just minutes after Askins photographed a birth, she watched the newborn be taken to the neonatal intensive care unit, or NICU. The father and staff followed the baby, leaving the new mother alone with no information on what was happening with her child or whether the baby was okay.
The mother started crying. Atkins put her camera down to comfort her. She had so many questions about what was happening to her baby, and no one was available to answer them. The mother grew increasingly more upset. A nurse walked into the room saw the mother. The nurse told her, “don’t worry, you won’t even remember this in 25 years.” She began to cry harder.
Askins 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,” Askins said.
For Askins, as a birth photographer, this means being a fly on the wall. Capturing every moment in silence, and only intervening if she deems it absolutely necessary.
Askins will always speak up is when a mother is not informed about an episiotomy procedure that is about to happen. This is her ultimate boundary. An episiotomy is when an obstetrician or midwife will cut your perineum to make a larger opening for the baby to pass through. Episiotomies have become a source of controversy in the birth activism community, with many arguing against the procedure entirely. In a study published on Obstetrics & Gynaecology, research suggests that with a simple switch of positions, from lying on your back to squatting or on all fours, can open the pelvis significantly in diameter-possibly avoiding intervention altogether.
“As a photographer, most of the time I have to keep my mouth shut because they haven’t hired me to be their advocate,” Askins said. “If there’s something happening, literally an assault, and they’re not informing the mother, I will definitely speak up.”
These actions are considered obstetric violence, which is the mistreatment of women during the childbirth process. According to Improving Birth, an organization that focuses on informing families about their rights throughout the birthing process, one in three women are recorded having a traumatic birth.
Obstetric violence is “the appropriation of a woman’s body and reproductive processes by health personnel, in the form of dehumanizing treatment, abusive medicalization and [treating someone as if they were incapable] of natural processes, involving a woman’s loss of autonomy and of the capacity to freely make her own decisions about her body and her sexuality, which has negative consequences for a woman’s quality of life,” according to a law that was first recognized in Venezuela and later adapted by other countries.
It can range from minor actions like denying a women food or water during labor, to larger actions like administering an cesarean birth without informed consent and medical indication.
Although obstetric violence is not a term legally recognized by the United States, it has gained traction following a major lawsuit between an Alabama mother, Caroline Malatesta, and Brookwood Medical Center.
Malatesta turned to the center for the birth of her fourth child after seeing ads that aligned natural birth and mother-centric care. However, once she was there, she found herself in a struggle with nurses that left her permanent nerve damage and PTSD.
During the birth of her child, nurses held down a screaming Malatesta after her attempts to change positions because of the pain felt from lying on her back. With the baby crowning, nurses told her she had to wait until a doctor was available to officially deliver the child, a policy that is reinforced in the hospital.
With no doctor to be seen and the baby’s head in sight, a nurse began to push the baby’s head back into her vagina. She was preventing him from being born against the force of Malatesta’s contractions. Screaming and fighting against the nurses, Malatesta attempted to free herself. The nurses only became more agitated and aggressive. After six minutes, a doctor finally entered the room and the nurse let go of the baby’s head, allowing Malatesta to give birth.
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. Following a two-year lawsuit, she was awarded $16 million from the hospital and her story quickly gained public attention on the news. Shown alongside various articles was a picture of Malatesta with a wry smile and weary eyes after her birth, baby in hand and husband by her side.
Askins points to this case as a major breakthrough in birth advocacy. “It really shows how women are being treated,” she said, “and it’s obviously not that well.”
With the newfound attention surrounding the story, Askins has seen a shift in redirect, practice and purpose within the birth advocacy community after the case. It’s a major breakthrough.
Spaces of birth have also felt this new pressure and some have acted by changing policies surrounding recording. Askins points to a possible fear of liability that could arise from having births recorded.
There has been a recent movement within hospitals that bans photographers during childbirth. In 2018, Queensland Health and Metro North Health Services in Australia, which covers many popular hospitals and birthing centers throughout the country, allows photographers before and after the birth, but not during. Anyone found filming or photographing will be asked to stop. If it continues, they’ll be told to leave the room.
Australian photographer Michelle Palasia, who frequently photographed births at the Royal Brisbane and Women’s Hospital where the policy was enacted, started a petition online to try and convince the hospital to reconsider. The petition currently has over 20,000 signatures with support from photographers and mothers alike. However, the hospital has stayed firm on its decision.
In a 2018 interview, the hospital’s executive director, Dr Amanda Dines, said that the policy was enacted out of safety concerns and has been for numerous years.
“While we make every effort to make our birthing suites as warm and homely as possible, they are clinical procedural areas,” Dines said, “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 our clinicians need to do.”
Askins 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 birth. She finds that the majority of instances that can’t be photographed are episiotomies, vacuum extractions, and cesarean births.
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,” Askins said. “What are they doing that they don’t want to be photographed?”
Sarah Colomello, the manager of public and community affairs at Northern Dutchess Hospitals, explains their policy as a process that requires everyone’s consent in the room, from staff to the families involved.
Colomello also stresses that the hospital wants families to have their memories captured and that there have been many beautiful moments photographed at Northern Dutchess Hospitals. Within embracing photography and video, the hospital and it’s staff do retain the authority to tell those involved what can or cannot be recorded if they feel it is necessary to do so.
“HIPAA is always a concern in a hospital, we do our best to protect patients. Someone could be recording their birth experience and accidently capture someone else, a mom in labor walking the hallway, for example, or a provider’s conversation about another patient’s protected medical information,” Colomello said. “Birth is also unpredictable. If the baby or/and mom are in distress, we generally ask that the filming or photos stop. And just as in general life, some staff don’t like to be recorded or photographed.”
Witnessing traumatic births has had a lasting impact on Askins, too.
At a recent visit to a hospital as a doula, Askins found herself shaking. With her palms sweaty, she went to the maternity unit to pick up a placenta for encapsulating. After answering a long list of questions, she began to feel anxious and wanted to leave. Finally receiving the placenta and hurrying out the the building, she began to relax. She called a colleague and they talked about secondary trauma.
Amy Frisch, a licensed clinical social worker who specializes in work with teenage girls, stresses the validity of vicarious traumatization, or secondary trauma.
“It’s the product of someone being traumatized from indirect trauma,” Frisch said. “Sometimes you are not given the same validity. People may say that she was only taking pictures.”
Witnessing first-hand the lapse in care for women and further feeling the effects within herself, Askins harnessed her knowledge and experience to become an advocate for those in the birth process.
“Birth is empowering. A lot of women who give birth in the system don’t experience that, I want people to see that it’s really awesome,” Askins said.
In a recent project crafted by Askins and colleague Cristen Pascucci, Exposing the Silence Project, she highlights traumatic experiences mothers have gone through during their childbirth. Decorated with photos of the mothers and powerful quotes, other families can look at the page and find a story they can identify with.
“I wanted to create a place where mothers could come together and talk about it. It doesn’t fix things,” Askins said, “but it does make some feel better.”
Using birth photography to share stories as a tool for advocacy can shine a light on these experiences. Mothers and families can enter a situation better equipped with the tools, knowledge and confidence to assert what they want and need.
Frisch 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 inform families, it contributes to a the healing process. Showing that they are not alone, they can support and listen to other mothers who have had traumatic experiences. Reflecting in this safe space can be a positive step forward.
Askins isn’t certain how her photos are used after she sends them over to her clients. They can be used to reflect and help memorialize a day that may not have 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, Askins receives mixed opinions.
When speaking about birth photography Askins finds that the reactions are age dependent. She finds that older women 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 during birth.
However, when speaking to her peers or young mothers, Askins finds that more people are enthusiastic or even had a birth photographer themselves.
With a long history of the birthing process being shrouded in secrecy and 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 showed explicit nudity was considered inappropriate 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. With over 23,000 signatures, Askins teamed up with other birth photographers to flood the platforms 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. Malfacinia 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 person’s 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,” Askins said, “I’ll never understand why it is so startling to see a vagina.”
Askins continues to challenge societal norms in place towards birth and birth photography. Continuing to update Exposing the Silence Project with additional stories, Askins photography will work towards normalizing childbirth.