As I think about these questions and consider why it is that so many women today care about the process of childbirth as much as the result, the answer I come up with is a simple one: because we can. The rational part of our brains will, for the most part, keep all women and their partners focused on their baby’s health. But the way many women approach the emotions of childbirth today appears to be very different from the approach of past generations, largely because of the opportunities we have to control our childbirth experiences and the expectations we bring to the event.

The control we have over our general health and lifestyle choices today has evolved dramatically and no more so than in childbirth. The image of the father pacing the halls while the subdued mother is managed by doctors and nurses is now the rare exception. The advances in pre-natal care and the technology deployed during labor mean that the majority of women can now choose when, where, and how to birth and have wide latitude on who joins them in the birthing room. All of this opportunity for choice is also supported by a wave of media educating and influencing expectant families. From self-help guides and gossip column updates to celebrity reality shows and prime-time movies, there are abundant opportunities to educate ourselves and examine and even obsess about how others have chosen to exercise this freedom.

Of course any change brings benefits and challenges. The medical innovations that have given women the time to consider their emotions and to think beyond the mechanical processes of childbirth are an incredible luxury to some and a powerful challenge to others. The ability to choose an epidural is, for better or for worse, a politically charged act in today's society. For some, a drug-induced pain-free labor is anathema to their notion of a natural event, epitomizing the over-medication of childbirth; for others, there is no other way they could imagine getting through the experience. At the opposite extreme, a home birth with a midwife are clear signs to some of how the nontraditional approaches to medicine and healing have allowed women to believe anything is possible to a level that approaches recklessness.

One thing is clear across the board: the fact that we have so much information and so many choices available to us has raised the level of expectations that we put on ourselves and that has been placed on us by society. It has introduced a slew of conflicting emotions we have to deal with. What are the right options for me and am I making the correct choices? Many women emerge from labor free of any angst or disappointment while others in similar circumstances emerge with a deep and mysterious sense of dissatisfaction. It has in fact become quite commonplace to be overjoyed at the sight of your new baby and simultaneously quietly disappointed at how she was delivered.

I ended up taking advantage of our new childbirth privileges in different ways for each of my children. For my first child, I made the decision not to take pain-relieving drugs during the birth and felt exhilarated by the intensity of the experience. For my second, I upped the ante: I not only used a group of midwives and a hospital birthing center, but I took photographs of the entire, awe-inspiring process, images that serve as the foundation for this book.

For the birth of my third child, circumstances took away the choices I had previously made. But within the unfamiliar constraints of a C-section, I found my own path to a sense of control by focusing on the logistics around the operation rather than the surgery itself. It was as I questioned my fears and disappointment in anticipation of this birth that I realized I was far from alone. Through numerous conversations I found that the management of personal expectations and the desire for retaining control were at the forefront of many birthing experiences today.

The goal of this book is to use my visual journal and a collection of stories that came out of those conversations to start a dialog around the role emotions and expectations play in childbirth. It’s not a call to action for women everywhere to pick up their cameras in a photographic display of unity. It’s not a patented formula for a pain-free birth ("Just follow these three easy steps"). What worked for me to control my experiences so I could manage my expectations aren't the answers for everyone or possibly even anyone else. The essays that follow illustrate other, contrasting examples, highlighting just how hard it is to pigeonhole women or their experiences—and how important it is for women to see themselves as individuals with tremendous power over this life-changing moment.

This book is about exploring my mindset and the mindset of other mothers and fathers who get thrown into one of the most exhilarating, scary, wonderful, chaotic, emotional, painful, and enduring experiences of our lives.

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Going through labor with a camera in my hand sounded like an ambitious and possibly even crazy project that I had no idea whether I could actually complete. 

On the surface the idea was simple enough. Capture the raw intensity of my own progress through labor by taking photographs of what I saw around me as my new baby emerged. The process would be direct and uncomplicated. Breathe. Click. Scream. (Or maybe Scream. Breathe. Click.) And yet I knew that the reality of overcoming the emotional, physical, and logistical hurdles to completing the project would take every ounce of determination I could muster.

As the day of Annika's birth arrived, I drew that determination from the various layers of motivation that drove me to attempt the project, layers that touched almost every aspect of my life as a mother, a photographer, and an essentially curious woman. 

On the simplest level I hoped to produce an intimate journal that I could share with my family. I couldn't think of a more prized gift to share with my child than a journal of her arrival into the world. 

On a creative level my ambitions were to produce a series of raw and starkly honest images of the day from a unique perspective. As a photographer, I am never far from my camera, and I had taken self-portraits while I was pregnant. In some ways this was merely the next step in that creative process. In an effort to ensure the freshness of the images I intentionally stayed away from the hospital and birthing center until the day of the birth itself. I feared that walking through the corridors and rooms would start a planning process that would impact the quality of the images.

On another level still I was hoping to use the camera as a tool to help me through the birthing process itself; both by distracting me from the pain and focusing me on the intensity of the experience. Something that often becomes clear only after having a baby is that despite birthing plans and breathing classes, consultations with doulas and midwives, any plans for a mother to retain control during labor and delivery are often overwhelmed by the chaos that ensues in a maternity ward. Its something of a reality that there are many other players involved in a birth, with the soon to arrive infant the most attention grabbing of the lot. By taking photographs, I was hoping to be able to take some control back. Not of the entire proceedings for sure, but definitely for those brief frozen instants when my camera would do its thing.

I was lucky enough to have a short, trouble-free delivery, which played a huge role in allowing me to take the photographs. The camera-as-distraction device idea played out exactly as I had hoped. When I was having painful contractions, the process of trying to capture that sensation through a still image was all consuming and for those few moments the pain and discomfort were pushed aside. The anticipation, and as it turned out, the reality of this was a powerful force. During the few hours of the labor and delivery, thinking about the photographs added immensely to my ability to endure and even relish the birthing experience. I had been concerned that taking photographs myself during the birth might somehow distract me from the experience. In truth, my awareness of the entire birth was elevated as I was forced to take those few moments to really look and observe the reality of what was happening to me and around me. Taking photographs while I was in childbirth was without a doubt one of the most exhilarating moments in my life. The essential elements of who I am, a woman, a mother, and a photographer combined with a synergy I would never have thought possible.

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For our first child, we were finally admitted to the hospital in Berkeley after only a week of in and out visits to the maternity ward triage room. After 10 hours of labor, a doctor I had never met before came into the delivery room and informed me that he had just ordered an epidural. "Why did you do that?" I asked. 'Well," he shot back, "most women say they don't want it, but everyone has one in the end." I hadn't arrived at the hospital as a militant anti-drug activist but I temporarily transformed into one. Of all the things that drove my determination and helped me through the pain in the hours that followed, that one sentence dominated. I'd be damned if I was going to give Dr. What's-his-name the satisfaction of dismissing me so glibly. I never took the epidural.

Nurses came and went repeating the same tests to update their shift. Stark fluorescent lights glared down reminding me how exposed I felt in my easy-access tissue-thin gown. More doctors I didn't know and who barely introduced themselves prodded and offered empty and unsatisfying reassurances as they studied my cervix and my baby's heartbeat. Despite this constant flow of staff we felt intensely alone. We hoped in vain for one of the nurses to stick around long enough to offer us some consistency, some maternal nurturing we could put our trust in.

The most intimate moment of my life so far was rushing by and yet the strongest sensation I felt was of being a cog in a machine. Orderlies came and went as they cleaned the room. The door remained open allowing us to hear the progress of other soon-to-be mothers down the corridor. When my contractions finally took hold, we were thrust into the large and well-oiled hands of a nurse/drill sergeant from Tennessee. It would be hard to describe her as maternal—she knew exactly what to do and told us as much—but she declared her intention of staying with us until the baby arrived and that was going to have to do. With her intense, barked directions fading into the background, I bore down and Max appeared in our world.

Annika arrived three years later in Brooklyn and the contrast in our experiences couldn't have been more stark. The medical details were surprisingly similar: natural, drug-free births in a hospital. And while the timing was very different—Max took his sweet old time coming out over the course of a week, whereas Annika showed up over the course of a morning—the real difference was in the choices we made. In fact, almost everything we did with Annika's birth stemmed from a reaction to our almost complete lack of control with Max's delivery. The anonymity of the staff that had left us cold and isolated the first time round drove me to find a group of midwives who were affiliated with our local hospital and whom I could get to know and trust ahead of this delivery. When the shift changed during Annika's labor, I now felt the warm embrace of Debbie, one of the midwives I had had check-ups with throughout my pregnancy. Her familiar face and calm, assured touch settled my anxieties and gave me confidence that I could handle anything Annika was going to throw at me during labor. My response to the doctor pushing the epidural during Max's delivery wasn't specifically a reaction to the drug or the gender of the messenger. It was me recoiling from the idea that someone else could have that much power over my body. For Annika's birth I deliberately chose to give birth in a recently completed birthing center in my neighborhood hospital. The center was located in a quiet corner inside the hospital and offered a calm oasis from the rigorous and formal maternity ward. While the unit benefited from having a pediatric ER on another floor in the hospital, the one stipulation of the center was that patients had to commit to not taking an epidural since the unit didn't have the equipment or staff to support it.

Of course the decision to resist the medication would come at a price. The screams were real and the intensity of the pain was as deep as anything I had felt before or since. However, another common thread between Max and Annika's births was my awareness of my control over this pain. Despite the long hours of discomfort during Max's delivery, the pain was far more manageable than I had anticipated. The reality was that the pain of childbirth was easier to deal with than the pain I endured from Chrone's disease, a condition I suffered from since adolescence. After Max's birth I had initially suppressed the idea that controlling the pain was anything more than instinct kicking in; the powerful effect of my beautiful baby, all blue eyes and smiles, with his intoxicating smell of newness. Possibly some form of genetic mind-wipe designed to erase all memory of pain to ensure that procreation continued uninterrupted. But as I reflected on it in anticipation of Annika's birth, my belief that this was a strength that I controlled began to grow. My high expectations that I would be able to succeed in taking the photographs grew in large part out of my confidence that I would be able to focus through the pain. In some ways I had been training for this my whole life. Suffering through stomach pain on a regular basis was a curse I bore with ingratitude. I was now beginning to see it as something much closer to an odd gift, received begrudgingly and kept hidden from sight waiting for just the right moment to pull it out. One of those moments came when Annika let out her first breath. I was exhausted, in pain, and exhilarated, and I clicked the shutter focusing on her tiny taught body with a huge smile on my face.

This notion of control showed up in a different form for the birth of our third child, Wolfe. I learned early in the pregnancy that due to complications from surgery related to my Chrone's, a natural birth was out of the question and a Caesarean section was my only option. The experience of pushing my babies out in my first two pregnancies was in many ways exhilarating, and a part of me immediately recoiled at the thought that I would not get to experience that feeling this time around. (Of course there were moments closer to the birth when the idea of not having to go through painful contractions started to sound like a great idea!) I had been able to get through the first two births without drugs, never mind a team of surgeons. In the aftermath of my Chrone's surgery I had worked intensely to recover my health and considered myself to be as energetic and healthy as I had ever been in my life. How was it possible that my body would fail me now? I initially refused to believe the diagnosis and spent many hours searching for a doctor who would support my desire to once again deliver naturally. When I finally came to terms with my reality, after repeatedly hearing the same diagnosis, I was forced to confront that I would be going under the knife whether I liked it or not.

What I started to understand was that the diagnosis that I would need to have a C-section, while different on so many levels, struck a nerve in the same way that the flippant comment that the doctor back in Berkeley had made about the epidural. Again, it wasn't the mechanics of the procedure that I was afraid of or disappointed about. The problem was that it wasn't my decision. My ability to control the birth of my child was being stripped away from me. Being able to take ownership of the logistics of the event—to dictate the time, date, and location—was going to be as much as I could do to assert some power over the event. But as I lay there helplessly, my swollen belly hidden from sight, waiting for Wolfe to be taken from me, I knew it was never going to be enough. What I feared and in fact what I felt during the delivery was that rather than being an active participant I was a mere observer, disconnected from the physical and emotional intensity of the experience. I couldn't reconcile this numbness with the fact that other women actively choose to have a C-section. During the surgery I felt as though I had been relegated to a surrogate, left to hear Wolfe's first scream from behind a curtain.

An uneasy separation followed the delivery. I snatched a moment of contact with Wolfe, marveling at his beautifully round head, before he was pulled off me for a second time, taken away to the nursery for tests. Jonni paced the halls trying to grab the attention of the nurse doing her job behind the glass wall of the nursery, while I lay numb and teary in the recovery room. After four hours we finally got him back with official confirmation of his ten-fingered, ten-toed perfection, proudly on display in his window bassinet. Any disappointment over the birth or distress at the separation that followed washed away. I felt as though I was being reunited with a long lost love; I clung to him, giggling at his similarity to his siblings and breathing in his newness.