BIRTH is an ongoing project through which Inside/Out contributor Kelly Marshall documents women of color who are birth facilitators shining a light on the process and the experience of working in the birthing industry today.

All images by Kelly Marshall

All images by Kelly Marshall

Combining recorded interviews and portraiture to present individual birth-workers and how they have built their lives around their calling, BIRTH also explores the complicated connection between birth and racial injustice in America and examines how birth work touches on the spiritual and the divine.

Read on for more on Kelly's intention, commitment and unique storytelling approach.


"My motivation for this project began with an enlightening conversation with a doula friend of mine about her work. She was briefing me on the most recent statistics of infant and mother mortality rates among African American women. I was like..."What?" The numbers sounded straight out of a third world country. I was surprised to learn that a woman is more likely to die from pregnancy-related causes in the United States than in any other developed country other than Mexico; also that African Americans have 2.2 times the infant mortality rate over whites, a statistic that can double depending on varying urban areas. All women are less empowered than they could be in their approach to childbearing, but women of color are consistently receiving lower levels of pre- and postnatal care due to systemic class and racial injustices, as well as old-fashioned bias. I started to ask myself who are the women of color who are advocating for other women of color in doctors offices and birthing centers and helping them navigate a watershed moment in their lives?


I decided to begin my project interviewing and photographing birth workers of color and listening to their perspectives on the birthing industry and the choices women have around their reproductive lives. I’ve become fascinated by the way these women are called to their professions, and how they build their lives around the uncertain and exhaustive schedule of labor and delivery. I want to both explore the complicated connection between birth and racial injustice in America and also look at how birth work touches on the spiritual and the divine. As a photographer who has been shooting long-term photo series primarily around race, gender, and class for the last 15 years, this project felt like an exciting and fitting direction for my work.

BIRTH by Kelly Marshall
BIRTH by Kelly Marshall
BIRTH by Kelly Marshall

We know that women of color who enter hospitals are sometimes not given the appropriate level of attention because of assumptions doctors and hospital workers of all genders make about them. But, when a black woman walks into a hospital to give birth, she is at her most vulnerable and, literally, her most naked, and there’s only a 2% chance that her doctor will also be a black woman. Whether or not there’s a lack of empathy in a specific hospital setting, there are implicit biases systematic injustices that affect how black women are treated during pregnancy and childbirth.

I am focusing my project on women of color who are in these rooms, showing other women that they have choices in the hospital, and helping women to be advocates for themselves. Many of the doulas and midwives I’ve spoken to assist in both home and hospital births. Although it’s empowering to have complete control and the help of a trained midwife, a homebirth isn’t accessible to everyone, and it isn’t an option many WOC know is possible for them. It’s also not recommended for high-risk pregnancies, which disproportionately impacts black women. My process of interviewing birth workers and collaborating with them on beautiful portraits of themselves aims to make these women visible to people who wouldn’t otherwise know about the work they do advocating for everyone to have more control over their reproductive health. These women are all fascinating, charming, funny, strong AND ferocious. I hope that both their words and their images will render their unique spirits.

My interviews have touched on racial injustice, women working with women, black women working for white women, spiritual traditions and practices, religious beliefs and self-care rituals. One midwife I interviewed spent 10 years in rural Pennsylvania working with the Amish and other predominantly white communities. She became used to white women asking for the kind of births they wanted and having permission to make decisions with complete autonomy. She had a rude awakening coming back to New York City and watching women of color having important decisions made for them, and worse, not being properly counseled about the consequences of those decisions. Despite her 20 years of experience in the field, her guidance was shrugged off and her instructions were disrespected by hospital staff in New York City in a way she hadn’t experienced in rural Pennsylvania. “They just don’t trust black women,” she told me.

Doulas and midwives approach birth as a naturally occurring experience rather than treating it pathologically. They are not covered by most insurances, and therefore aren’t available to a large percentage of the population.

I always ask birth workers what’s the first thing they tell their clients, and the answers are deep and surprising. A lot of birth workers tell their clients to trust the power of their bodies during labor and let gravity do most of the work - often, we see scenes of women being told to push when they don’t want to. A doula I spoke with recently told me that she tells all of her clients to expose their bellies to the sun during pregnancy. Many of the birth workers involved in the project also do placenta encapsulation and have been teaching me about the process of harvesting the placenta after a birth, cleaning it, steaming it, and dehydrating it and then grinding it into pill form for consumption. I’m also finding that some doulas and midwives integrate acupuncture and chiropractic work into their services. Doulas and midwives approach birth as a naturally occurring experience rather than treating it pathologically. They are not covered by most insurances, and therefore aren’t available to a large percentage of the population. I’m continuing my research into the ways doulas and midwives are integrated into hospital settings and how home births are regulated differently by various state governments.


I’m also very interested in how birth workers maintain their own well being while supporting their clients. A lot of the women I spoke with talked about the adrenalin rush of assisting with a birth and how no matter how tired they are when they get home, they like to take baths and gently transition out of the mental space of the birth. Sunlight has also been a theme. Many of the birth workers I’ve spoken with talk about how important it is for them to get some sun the day after a birth. One doula told me she has an altar where she lights a candle for each one of the births she assists. She believes that when a child is born, an ancestor is coming into the world and she feels like she’s been given special permissions by each woman she assists to help usher in both a child and the ancestor. I’m very interested in how a woman’s personal belief system affects how she approaches the work of bringing life into the world.

Overall, I am very excited about empowering more women to advocate for themselves and to showcase women of color who are role models in a field that desperately needs them." 


Follow Kelly Marshall and BIRTH via Instagram to see the upcoming interviews and photo shoots she has through the new year. Her next steps entail expanding the project's scope to include women of color who are doctors and nurses in addition to the midwives and doulas. Should you care to give to BIRTH or learn more, click on the "connect" button below.