Old Birthing in the New World

July 12, 2008

I traveled to Cuzco to do a feature different from most news stories. This was to be a project of several days that would give me the chance to photograph in depth without the usual rush to file my pictures. The story was about vertical birthing in a public clinic on the poor outskirts of Cuzco.

Cuzco is a spectacular city full of Incan ruins and history, and it turned out that this was the week of Corpus Christi during which the Catholic faithful parade their saints in procession, under an impressive full moon.

Birthing is a subject capable of overwhelming anyone, even a photographer like me used to maintaining a distance from most subjects. It was impossible not to feel empathy towards these women who in their agony waited patiently alone for their turn to give birth, without taking anything to stop the pain.

Nineteen-year-old Peruvian Jenny Rodriguez prepares to give birth in the vertical position at the Belempampa Health Clinic in Cuzco

The fact of me being a woman and a mother too was like an invitation into their world, even though I had never felt the same pain of birth that they were feeling. They always asked me if I had a child, and that opened the door for me.

Nurses help prepare 19-year-old Peruvian Jenny Rodriguez to give birth in the vertical position at the Belempampa Health Clinic in Cuzco.

On the second day of the story, an obstetrician named Guido told me that this was the night of a full moon, and that there would be many births so I should stay overnight. He was right. I was fortunate to witness four births that night. Just being there was a privilege, as well as an exhausting and hallucinating experience. These births are natural, without anesthesia. The pre-labor room, where the women endure the pains before actually giving birth, is really a chamber of terror in which the women scream out their pain, lying on the floor or pacing. They suffer, endure and survive in spite of not receiving anything for the pain.

Peruvian women endure labor pains as they prepare to give birth in the vertical position at the Belempampa Health Clinic in Cuzco.

They stand, the babies cry out as they are born, and the exhausted mothers make room for the next to take her turn.

Nineteen-year-old Peruvian Jenny Rodriguez (L) and Karin Merma (R) give birth in the vertical position at the Belempampa Health Clinic in Cuzco.

Many times I just hung up my camera to console one of them and give her my hand during the contractions – things that I would normally never do…It was impossible not to.

The third woman of the night was Mary Luz, a 21-year-old single mother. The father of her baby had been killed in a traffic accident on Christmas day. This was her first child and she spent hours in the pre-labor room, crying and very nervous. In the labor room things became complicated when she tried to give birth standing, with great difficulty.

Peruvian Mary Luz Rojas tries to give birth in the vertical position at the Belempampa Health Clinic in Cuzco.

They tried lying her down on a bed to cut her perineum because she wouldn’t dilate enough to allow more than the head to be seen. Amidst an atmosphere of butchery, with the blunt instruments that wouldn’t cut and the lack of anesthesia, there was a blackout. The clinic had neither candles nor flashlights, not to mention a generator. Guido, the obstetrician, very calmly requested a light of any kind, even if it was from a cell phone.

Apart from Mary Luz and myself, inside the labor room there was the obstetrician, a male nurse and a woman nurse, and they didn’t have anything to light with. I took out my Blackberry and offered it to illuminate the mother. I tried to take pictures but there was too little light and the obstetrician couldn’t see to cut the perineum. I turned on the screen of my Canon 5D camera and I got as close as possible, offering just enough light for them to cut. I had been recruited. I spent the rest of the birth helping, following orders to aim the light here and there. Nothing worked for them to cut, not even the blunt scissors. The baby wouldn’t appear and the minutes seemed like hours. Mary Luz screamed and screamed. The blood meant nothing to me compared to the anxiety of wanting to see her baby born.

At last the baby appeared and the first screams flooded the room. We could only hear the baby crying, against a background of darkness and silence. Then, with one hand I illuminated a nurse as she cleaned the baby, and with the other hand I gave light to the obstetrician as he removed the placenta. I was still helping.

Peruvian Mary Luz Rojas receives help in removing her placenta after giving birth in the vertical position during a blackout, at the Belempampa Health Clinic in Cuzco.

Finally, others entered with candles and it looked like the Corpus Christi procession.

Peruvian Mary Luz Rojas receives help in removing her placenta after giving birth in the vertical position during a blackout, at the Belempampa Health Clinic, in Cuzco.

It would have made a wonderful photo, but I was still assisting the nurse with the baby and was barely able to take a couple of pictures before the lights came back on. That was when I realized that I was trembling and had my robe covered with blood. I remained next to the mother, consoling her as she cried while they stitched her up.

Photographer Mariana Bazo stands by as an obstetrician removes the placenta from Mary Luz who gave birth during a blackout in the Belempampa Health clinic in Cuzco.

The blood was not an issue for me. I’ve seen a lot of blood related to death in my work, but this was a story full of life that reached deep into my soul.

Peruvian Mary Luz Rojas receives attention from a nurse after giving birth in the vertical position to her daughter Rous Naomi at the Belempampa Health Clinic in Cuzco.

The next day, after photographing a few more births, I went to the Cuzco Cathedral, an imposing ancient church, and went inside to find thousands of saints still illuminated from the previous night’s Corpus Christi celebration. I kneeled on a pew and when an un-tuned organ began to play along with a Quechua chorus, I covered my face and cried an ocean of tears.

Different Peruvian women are seen after giving birth in vertical positions at the Belempampa Health Clinic in Cuzco.

I followed the mothers during the next few days and the story ended in their homes. These people gave me more than what I gave them. I had only planned to take pictures, but they invited me into their houses, gave me food and beverage, and had me hold their babies. I ended up the last afternoon sitting on the bedside of Viviana, conversing with her family and feeling as if I was in my own home.

Nineteen-year-old Peruvian Jenny Rodriguez carries her newborn baby home after giving birth in the vertical position at the Belempampa Health Clinic, in Cuzco.

Peruvian Gloria Cusi Quispe and her husband Richard Guerra put in their bed their newborn baby that was born to her in the vertical position at the Belempampa Health Clinic, as they arrive at their home from the clinic in Cuzco.

It’s for stories like these that I became a photographer.


We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters. For more information on our comment policy, see http://blogs.reuters.com/fulldisclosure/2010/09/27/toward-a-more-thoughtful-conversation-on-stories/

Oh my goodness, this story and pictures gave me the chills. I am a 63 yr. old mother of three. I was in that birthing room with the author/photographer. I was moved. MANkind needs to be reminded of the agony and pain and often times the complications that accompany giving birth. WOMANkind in most of the world do not have access to pain relief, sterile birthing rooms, necessary nursing care….yet continue to populate the world….and many times die doing so.
God bless you.

Posted by Veronica | Report as abusive

Isn’t it ironic that the Captha for this comment was the word ‘life’…..

These photos are so vivid. Did these mothers consent to having their pictures taken for the Web?

Posted by Universe | Report as abusive

Those pictures nearly made me cry…how could anyone let those poor women suffer like that?? Take up a collection, start a charity fund for them…do SOMETHING. Drug addicts get better treatment than that! I’m sickened by the lack of compassion for these women. And furious.

Posted by Sheryl | Report as abusive

almost all pictures showed the pain of the complication and yet, it gives me a slight happiness to see the picture of a smiling lady.

Posted by sarah seben | Report as abusive

[…] Old Birthing in the New WorldThe Sibuyen ferry disasterRiding the chuckwagon: Audio slideshowGetting your point acrossIn the wink of an eyeBe prepared!Cricket, lovely cricket…The driver saw it first …A slow boat to Myanmar – nearlyCaught in a rebel offensive in eastern Chad […]

Posted by fotowarung.bazuki.com » Blog Archive » Old Birthing in the New World | Report as abusive

i just am startled and i like the way the text is written. very very harsh. it’s a great piece of work, and very well bonded (the text and pictures)

Posted by vlad dumitrescu | Report as abusive

Thank you for a wonderful story. Thank you also for helping these people.

Posted by Danny Kelso | Report as abusive

I hope, “thank you” is enough.

Posted by JoeyO | Report as abusive

lack of compassion? I am a mother of three and what I wouldn’t have given to be able to bring my children into this world naturally, using the vertical method which is the least painful because gravity does most of the work, and without any pain killers at all. I was forced by my doctors to have three c sections and if you want to see lack of compassion it is in those operating rooms. I am to this day mentally scarred from it. I was humiliated and degraded with every single delivery. And the pain medicine after the operations had side effects that were difficult to deal with and which in turn made my children very lethargic after being nursed. If you want compassion for women in labor, we ought to follow the example of the Peruvians. I only hope that the next time I am expecting a child I will be fortunate and blessed enough to deliver at home naturally.

Posted by Ana | Report as abusive

in the old days there is a world that many types of life prevailed synchronous…..

Posted by michael | Report as abusive

Now you know why I decided “that’s it” — two witnessed childbirths — spiritually incredible … but that pain and trauma ….two’s plenty! And me only the husband! Fine journalism.

Posted by John | Report as abusive

Brilliant, moving piece! Ana, thank you for your response. Up here in North American we have a lot to learn/relearn. These are pictures of real life; birth isn’t the perfect posed picture with everyone smiling and numb. Let’s get back to reality.

Posted by Eileen | Report as abusive

excellent piece of work, nothing more can be defined.

Posted by Rahul agrawal | Report as abusive

Mariana this story is soooooooooo incredible photographed and very very touching! Thanks and all the best from Frankfurt


Posted by Kai | Report as abusive

This is incredible! Terrifying and beautiful all at the same time. The way childbirth should be, absolutely amazing. It must have been wonderful to have been present at the begining of so many lives!

Posted by Zoe | Report as abusive

Ummm, Ana….seriously? I would imagine childbirth of any kind is no picnic, but you’re seriously whining about giving birth in a sterile hospital environment with plenty of medical professionals and instruments? Cause these women sound like they’re having a blast:

“The pre-labor room, where the women endure the pains before actually giving birth, is really a chamber of terror in which the women scream out their pain, lying on the floor or pacing. They suffer, endure and survive in spite of not receiving anything for the pain.”

Tsk tsk. Typical selfish American (I’m guessing) woman with no concept of the pain, humiliation, and constant fear of death women in less-fortunate countries must face on a regular basis.

Ms. Bazo, this was a fabulous article, with a very moving story and pictures.

Posted by Sophia | Report as abusive

lack of compassion? I am a mother of three and what I wouldn’t have given to be able to bring my children into this world naturally, using the vertical method which is the least painful because gravity does most of the work, and without any pain killers at all. I was forced by my doctors to have three c sections and if you want to see lack of compassion it is in those operating rooms. I am to this day mentally scarred from it. I was humiliated and degraded with every single delivery. And the pain medicine after the operations had side effects that were difficult to deal with and which in turn made my children very lethargic after being nursed. If you want compassion for women in labor, we ought to follow the example of the Peruvians. I only hope that the next time I am expecting a child I will be fortunate and blessed enough to deliver at home naturally.”

That’s probably one of the most stupid damn things I’ve ever read.

You were never ‘forced’ to have a C Section. Don’t be so ridiculous. Anywhere in the world, no-one can operate on you without your written consent. What did they do? Pin you down?

What actually happened, is that you were probably advised to have a c section. Advice you were quite free to ignore & have a home birth if you wanted. They probably advised you to have a c section because you were deemed high risk for some reason. c sections are very expensive, after all.

Grow up you silly, spoilt woman, and learn your rights.

Posted by JJ | Report as abusive

are the conditions ideal? no. is this the worst thing in the world? no. in the pictures, it appears they are making attempts at infection control(sterile gloves, sterilized intruments), i saw a woman with an iv(hence access to treat a postpartum hemorrhage), i saw a doppler to listen to baby’s heartbeat(which is just as good as the fetal monitors women in our country allow themselves to be strapped to). should they have a generator so they are not in the dark? yes. should they have access to proper supplies and equipment? yes. but the tone of the article seemed to be that the worst thing these women are subjected to is not having access to (medical)pain relief! birth is not a sterile, numb event. pain is not a bad thing. just because the women of our country have decided they want to be removed from the intense experience of birth does not mean women who birth naturally are to be pitied. there are other ways to reduce or work with the pain of labor. birthing vertically, allowing the women to choose the position of choice(pacing was mentioned), allowing vocalizations, etc. these women are to be admired, not pitied. i am a l&d nurse here in the u.s., but i work mostly with central/south american immigrants. my patients, even here with all the availability of drugs/epidurals, CHOOSE to birth naturally. this is what is normal to them. and our hospitals c/s rate? half that of the rest of the u.s. all the bells and whistles, interventions such as continuous monitoring, inductions and epidurals lead to more c/s. we nurses at our hospital have learned from our patients… the vast majority of us birth “naturally,” including myself. just a doppler to monitor heartrate, laboring and birthing upright. these women need access to dependable electricity, sterile supplies, and medications to treat hemorrhage and such. those are the important things… access to pain relief is not.

Posted by Michelle | Report as abusive

I would not have had my children any other way. I had both of mine natural. The first I delivered by myself from a kneeling position. This was by far the most comfortable way to deliver a child. My second the hospital staff insisted that I be lying down. Who’s idea of torture is THAT?! Mother nature never intended us to labor lying on our backs. All to make it easier on the doctor. Yeah ok.

The story is beautifully written and artfully captured. Thanks for sharing your perspective into their world.

I do so much prefer their style to ours though.

Posted by Mother of Two | Report as abusive

This was a really interesting story and made me want to know more about how laboring and birthing women are cared for in Cuzco. I don’t necessarily think that what women need to have childbirth be a positive experience is drugs — I had my daughter without any medication and it was a peaceful, empowering experience, because I was surrounded by a midwife and a doula and my partner and was given tools to help me relax and progress. And standing up is actually a physiologically great position to give birth in — gravity is helping you, and your pelvis can be open. Our bodies are made to give birth, and there is a purpose to labor pain, but we also need a safe space and supportive people around us, and help if there are complications. I am a doula and I do some of the same support that you felt compelled to offer these birthing women — it makes a big difference and its something that is often lacking in our culture (and, it seems, in others like the one you observed).

Posted by sara baum | Report as abusive

Thank you for your comments. Here you can see the full story.

http://blogs.reuters.com/photo/2008/07/1 2/old-birthing-in-the-new-world/

In the blog I just write from the perspective of a photograph in one place. Definitely it is better for mothers in rural areas for Peru, giving birth in hospitals like this that respect their traditions, because the other choice is do it at home which is more dangerous.
The theme of pain caught my attention as an outsider… but for the mothers it is natural of course.

Posted by Mariana Bazo | Report as abusive

sorry…Here is the story:

http://www.reuters.com/news/globalcovera ge/verticalbirthing

Posted by Mariana Bazo | Report as abusive

I’ll admit this is a bit off topic, but — to the person who commented about c-sections always being a choice — if you pick up a copy of “Pushed” by Jennifer Block, you can see descriptions of several documented cases where women were legally forced (through court orders) to have cesareans, or where women stated out loud that they did not consent to a cesarean but were given one anyway. Also, while cesareans may technically be a choice in a lot of cases, women are often given incorrect information (your baby is too big, your pelvis is too small, etc.). They trust their doctors and have a cesarean, only to find with their future babies that they can in fact vaginally birth babies bigger than the ones they were told they couldn’t birth the first time. Choice is one thing, but informed choice is entirely another, and that is something that is often lacking in maternity care. i guess my point here is that women all over the world (including here in the US) do not always have the opportunity to make informed choices about how and where to birth.

Posted by sara | Report as abusive

It was hard for me to view these photos without immediately thinking about what they said about the way the women were being cared for, but I also want to say that the photos themselves are beautiful and really give a sense for what this birthing place was like, and what it must have been like to witness these ordinary yet extraordinary moments in the lives of the women and their families.

Posted by s | Report as abusive

This is outstanding reportage, both for the quality of the pictures and text, and for the compassion shown. Exactly the kind of work that inspires other photographers and definitely the kind of story that made us want to do this job in the first place. Thank you for sharing the lives and struggles of these brave, generous women. -Finbarr

Posted by Finbarr O’Reilly | Report as abusive

Giving birth/life is not easy…but notice the smiles on those holding their infants when the birthing process is completed. Perhaps, as we’re told, they have forgotten the pain. I did after each of my six children.

Posted by Hulananni | Report as abusive

Beautiful article

To those criticizing Ama, C-sections can be very very traumatic. Anyone who has seen one knows that. It’s not just a surgery, it’s a physically rough way for a child to be pulled out of a body. I had my child naturally with a midwife and doula and even with the 1st degree rips (had stiches too by my doctor with no medicine)would not have traded it for a c-section. What she means by “forced” is that there are many unnecessary c-sections done in the united states, not the elected ones. More than any other developed country and increasing because they’re faster and to insurance companies time is money. I personally know many women who still feel scarred from their c-sections whether it’s in a fancy hospital or not. When you’re in the heat of labor, have been laboring for 10 hours and someone says “you need a c-section” a mother is not going to argue and many have found out after that in fact, they didn’t. It’s a different for of brutality, mentally perhaps.

Birth is a very intense, painful, and joyful experience. When it’s tampered with in any way through lack of proper medical care or lack of people who realize the sanctity of the experience, it leaves deep emotional ridges. Please show compassion.

Posted by M | Report as abusive

Thanks so much for the touching story, I was so moved reading it. And thank you for bringing this story to the world, it reminds me that truthful, compassionate journalism still has a role to play in a world of spin.

Posted by Vivek Prakash | Report as abusive

this is a wonderful article, i cannot wait to give birth and have my own child. I used to want to adopt but giving birth to life is something else!

Posted by nianne | Report as abusive

Beautiful pics and moving story. As a labor nurse I know the sounds of the birthing room and what you are hearing there is what happens here in the heartland, but we force them onto their backs, push their legs back and humiliate them by exposing them to their families.
A birth without drugs is usually a birth with less complications.I hope these birth houses help with the maternal mortality rates, another way to help would be training midwives and letting them use life saving drugs like pitocin when needed. Or antibiotics. We use them with no thought to cost here in America.

Posted by Cindy | Report as abusive

Mariana, how can I say this?
That’s some real stuff right there… the joy of being a mother, great but the pain of getting there…hmmmm, another story but worth it all the same i guess. Deep stuff

Posted by Diana Ngila | Report as abusive

As a pregnant woman and as someone who has given birth without drugs twice before, these images are striking…a reminder of the pain we go through and the joy we have afterwards. It makes me look forward to this new baby while dreading those last few hours.
I agree that the majority of women don’t NEED pain relief but without a support person and being among strangers, it could be terrifying. And obviously, these facilities need generators and some types of pain relief. Cutting into people over and over without pain relief and not getting results is horrifying. Yes, we did the same thing in the Civil war and people survived but no one asks for that kind of experience!
We should keep the things from the past that work well…vertical birthing, natural pain relievers, etc. while trying to save lives and horrors by finding a way to get the NECESSARY equipment, drugs, and medical clinics that so many people lack.

Posted by Erica | Report as abusive

I intentionally gave birth, in sterile, medication filled, technology ridden America, in very much the same way these women did. I LIKE giving birth. It is hard, hard work, but it is empowering, liberating, and spiritual for me.

Immigrants from Latin America frequently choose to birth similarly when given the option of the American model. It’s good stuff and (when things are clean and sterile) unmedicated, vertical birth is actually the safest method, as well as the easiest recovery.

I am a huge wimp. I am no martyr. I had natural, vertical childbirth because it was safest and most comfortable. Labor was hard (labor does actually mean work) and sometimes I moaned in feeling something so powerful, but it was never agony and it was not a hardship. I would’ve been heartbroken to need technology or medication.

Those are wonderful photographs and I’m sure it was a moving experience, but I think you’re projecting a lot of your own cultural birth biases onto women who may be experiencing this far differently than you describe.

Posted by Jessica | Report as abusive

Kuddos for Reuters and this serie of articles ,videos and photos, encouraging non invasive methods to improve perinatal mortality is one of the soundest things to do… I am not condemning technology, (I actually work with South American Pregnant ladies in the Atlanta Area) but I am seeing too many abusive and non justified interventions on this populations pretending to save them..

Posted by Regine MArton | Report as abusive

As a certified and home birth midife for over 20 yrs, I am still shaking my head , becasue most all women if left to there own choice will give birth squating or standing or hands and knees.
It is only in american hospitals that vertical birthing is so “pushed” on women.
Hospitals, that follow the american way of birthing are not helping women.
Inductions, c-sections, forceps are are very dangerous. With all the modern medical tools used for labor and delivery ,the amerian stats have not changed in 30+ yrs.
The reason most women die in childbirth in most countries is lack of prenatal care and good nutrition.
Technology will not improve maternal or infant mortality.
Good food, sanitation,and education will.
I have delivered over 1500 babies at home in a number of countries. Vertical birthing is the norm!
Glad that Peru is discovering the old ways are most times the best when it comes to birthing postions.
America has not “discovered” this as yet ! Will they ever?

Gail Johnson

Posted by Gail Johnson CPM | Report as abusive

They way you described pain during these birth experiences is so typical of an uninformed, ignorant American. (And this is not to say these women could not have had better support, however…) Pain in childbirth is constructive. It isn’t telling you something is wrong, it is telling you how to move your baby to get it out. Taking away the pain, no matter what means you use, is introducing risk to the baby and the mother. Should pain relief be available? YES. Of course. But it should be used judiciously after other comfort measure have been tried. And the woman must know the risks she is introducing to a natural, normal health process (for 80-90% of women).

Please read my essay about birth at www.myspace.com/normalchildbirth.

There is also a list of links to become more informed about the subject. And this author obviuosly needs some education regarding interventions during birth.

Posted by Adriane | Report as abusive

Mariana, amazing pictures and story, congratulations!
It is possible to, sometimes even brilliantly, document a fraction of the life of others, but it is almost impossible not to get somehow and unintentionally, involved and that is what makes the difference in your pictures.

The day we stop caring for what we see and experience, we will lose it all. To feel great empathy, the urge to reach out and being able to share with others is what empowers us as photographers and makes us grow as human beings. This is precisely what makes our profession so very different from other jobs.

Stories like these make me proud of being a photographer and having the opportunity to work with one like you.

Posted by Claudia Daut | Report as abusive

Dear Mariana,
Wonderful, wonderful journalism, compassion and presentation. I am a homebirth midwife and a doula trainer. I’ve helped women with natural childbirth for over 25 years. Birth is hard work. There is a difference between pain and suffering. Of course we want to ease suffering, prevent suffering. The mother in your audio slide show said she was “afraid of the pain, oh well.”
Her “oh well” shows how she acknowledged pain and then set about her work.
I have been honored to help women 15-46 who have faced their fear of pain and chosen natural, supported birth. More women here have the kind of support that was given by the nurse student in your audio slideshow (some of the same pics are here).

Please, readers, realize that these women are not birthing in their own environment, and that adds stress; that risk of maternal death also has to be emotionally born in labor, there more than here in the US, and death in the hospital is a fear as well especially since hospital birth is newer there.

Your blog, Mariana, is such an intimate unfolding of your night’s experience. Ending with your tears in the Cathedral was so moving and, having once been in a Catherdral in the Yucatan, I had a little bit of what that image may have been. Thank you, so much.
I followed the link to reuters and you through the blog at OrgasmicBirth.com portraying a film that shows an entirely different view of natural childbirth. One that I have also been witness to.

Gail Tully, CPM

Posted by Gail Tully | Report as abusive

This way of birthing does the most for the emotional well-being of the baby. The experience of pain is not to feel pity for these women, but to admire them. This women needs to be accompanied by her relatives in order to feel more security and the pain will be less, also.

Posted by Yolanda | Report as abusive