Extreme Pain, Extreme Joy

Maggie Shannon and The Grayness of Everything

AHP Note: Every so often I get a great pitch for a guest interview and hand the Culture Study reins over to someone else (usually a reader who *gets it*) to handle the interview (and get paid for it, of course — your subscriptions made it possible for me to pay significantly above the going industry rate).

This week, Zachary Ayotte interviews photographer Maggie Shannon about her new book documenting the work of midwives. It’s a beautiful, expansive interview, and I’m honored to publish it. If you have a spectacularly good idea for a future interview, you know where to find me (aka, my email: annehelenpetersen at gmail dot com)

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In the spring of 2020, photographer Maggie Shannon had a conversation that got her thinking about births. It was the early days of the COVID-19 pandemic, and ordinary life had been upended for millions around the world. Shannon was talking with a friend, a doula named Paige Schwimer, when Schwimer said something that caught Shannon’s attention. She suggested that concerns about giving birth in a hospital—given infection rates and COVID protocols—might have led to a rise in home births, and as a result, to a rise in the number of babies delivered by midwives. Shannon made some calls: Schwimer was right.

Shannon is a photographer with a unique gift for identifying and documenting unique strands of American culture. She’s amassed a body of work that includes pie-eating contests, high school proms, pickleball, political rallies, and Paul Rudd. She is an accomplished portrait photographer, but Shannon’s first love is documentary storytelling—getting to spend time with a subject and let a story take shape. With the work of midwives, Shannon saw an opportunity to tell a deep story about labor and love during a critical moment in history. She started reaching out.

Perhaps no part of American life is as universally relevant and as culturally underrepresented as women’s health. Earlier this year, while promoting her 2024 novel, All Fours, Miranda July spoke about a “grim feeling” that arrived in her 40s as she approached menopause. “It wasn't coming from me,” she said. “It came from this lack of imagery or stories or even just basic medical information about what was going to happen next with my body.”

Similarly, the 2023 release of Dead Ringers, the gender-flipped remake of the David Cronenberg film, prompted a series of editorials about how rarely the truth of childbirth is depicted on screen. While watching a birthing scene in the first episode, Samantha Manne noted: “as I peeked through my fingers, checking to see if the horror had passed, it dawned on me that despite having a 4-year-old son, I had never watched anyone give birth.”

Shannon is interested in this cultural omission. “Childbearing and the work of midwives is not well documented; the realities of childbirth are still taboo,” she writes on her website. But Shannon's work is about more than just the act of birth; it is about the acts of labour and care that surround women’s health.

When I first met Shannon, at a Fotofilmic workshop on Bowen Island, in 2022, she’d been working with midwives in California and Northern Michigan since 2020. She’d come to Bowen with the intention of turning that work into a book, called Extreme Pain, Extreme Joy. For three days, Shannon moved prints around, creating a story out of the work she’d been making for two years.

In person, Shannon exudes a sense of calm. She is patient, thoughtful, and engaging. You also get the sense—as is often true with photographers—that she is paying keen attention to the world around her. Her photographs feel distinctly contemporary, but she also has a keen sense of photographic history and American culture. Her portrait of former California Senator Barbara Boxer, for example, taken after Boxer had retired from the Senate, manages to feel fresh while also paying homage to Terry O’Neill’s iconic image of Faye Dunaway, taken the morning after she won her Oscar.

The photographs Shannon made during her time with midwives are equally considered. All of the black and white images were made with the help of an off-camera flash, used to create shadows and depth. As a result, the photographs feel like they exist both in and out of time—as if they could have been taken yesterday or seventy-five years ago. They offer a frank and tender portrayal of the work that goes into caring for mother and child, as one delivers the other into the world.

In February of 2024, The New Yorker printed a series of images Shannon made at a later-stage abortion clinic in College Park, Maryland. When I saw them, I recognized them instantly as Shannon’s. With the same blend of empathy and detail, she treats abortion just as she treats birth—as both a deeply personal medical procedure and a human interaction. Shannon said she saw the work as “part two” of her project, and that it was important for the images to feel cohesive, like one body of work.

In November of 2024, Mother Tongue, the magazine dedicated to stories about modern motherhood, will publish Extreme Pain, Extreme Joy, its first photo book, with accompanying essays by Angela Garbes and Gem Fletcher. When I spoke to Shannon, she said waiting for the right publisher was an important part of the project. “The team at Mother Tongue—they just get it. They get the depth of the story.” I wanted to talk to Shannon—who became a mother, herself, earlier this year—about the work, the beauty, and the depth of her ever-expanding project.

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ZA: In an interview you said some of your favorite stories are when you start with an idea and then something beautiful happens, and it becomes so much deeper. And I was wondering if you can remember what you thought about this project before it got going, when it was just an idea. Can you remember the feeling of what you thought this was going to be?

MS: Oh, man, yeah, I think it's so fun to be proven wrong about things as you learn more about something, to have it shift. I think for the midwife project, it kind of started as a pandemic project, and then the more I got to know the midwives and their patients—just that practice—and witness the relationship between all of these women, it became so much deeper and less about the news peg of “more home birth happening due to the covid 19 pandemic.” It became more about the care and love between the midwives and the women and what labour looked like. A real portrayal of birthing women.

One of the things that I'm so interested in with relation to your work is the role of consent and communication when it comes to documentary work, and I wondered if you could talk a bit about your approach to getting consent in these situations, and how you communicate with somebody both before you're going to take their photo, and then during.

Especially with this work—we are in such intimate settings with women giving birth, or even, at the abortion clinic, being in the procedure room, where people were under sedation—informed consent was super important to me. I would ask for permission to talk to them, and then, once we had a conversation, I would continue checking in. And even while I was photographing, I’d be like, “how are you feeling? Is this okay? Let me know if this is too much, or if you want me to step out for a minute.” You know, to keep checking in on people. I think at a certain point the relationship with the people became more important than getting a good photo. Because I think at some point the story became about my relationship with them and less about the documentary storytelling.

And I think making people feel comfortable—asking for consent and saying hello and introducing yourself, and then having them relax—makes for better pictures because it feels like a collaboration in a neat way. And there's this feeling of safety. For me, photography is about really deep, lovely human connections. And I think that through documentary photography, I can make those connections, but that also involves consent. And since I started taking this approach, I make better pictures, and I'm more confident in it—because it's not like I'm trying to sneak something. It's more about relationship building instead of a gotcha kind of thing. It makes me feel good as a person.

ZA: I feel like there has been a change in how we think about documentary photography and about the rights of people being photographed—over a long period of time, but especially in the last 10 or 15 years. It feels like you've found a way to continue to do documentary work, but not at the expense of subjects, which sometimes can be the case. Does that feel accurate?

MS: Yeah, definitely. I was doing this story for The New York Times about a debate watch party. It was the Biden and the Trump debate, and I was in Laguna Beach photographing this really sweet event put on by the Laguna Beach Democratic Club. There were maybe 100 people there, and they were all watching the debate. And so it's not like I could say, Oh, can I take your picture while you're watching this? So as I would walk around people, I would try and make eye contact with them. And if they looked at me and smiled, or if it felt like, okay, they're okay with me doing this, then I would. And a few people looked at me and didn't seem into it, so I didn't photograph them. I think there's verbal consent and having a conversation, and there's also a gut feeling that you can get from a person.

ZA: I have a friend who does a lot of work in theater, and she talks about this all the time. She does warm-up exercises with her classes, and one of the exercises involves a kind of eye contact consent before you engage in any physical way. It sounds very similar to what you're describing.

MS: That's so neat. Wow, oh, really cool. I love that.

ZA: It's so hard to think about almost any documentary work—but especially documentary work about healthcare practitioners—without thinking about [W. Eugene Smith’s] Country Doctor or Nurse Midwife. I was wondering if you went into this work with that in the back of your mind or if you were trying to put it out of your head—or if it wasn’t a consideration.

MS: I mean, it's such a foundation, and I did definitely look at it. Usually for jobs that I do, I have a notes app, and I keep a note for each assignment with the address and information and ideas of what I want to do. And sometimes I'll put images in there as well, just to remind me to, you know, shoot from this angle—or ways to complicate an image, little sketches. And so I would screengrab country doctor images and put them in there. I don't think I was trying to mimic or copy anything in particular, but there were themes that I wanted to think about while I was shooting.

There's one image of a midwife and her apprentice approaching a house, and I remember being so excited about that, like, “Oh, this is such a good reference to Country Doctor.” And I like that; it echoes Smith’s image. I have talked about that a lot—how I wanted it to be an updated version, where it's all these powerful women caring for each other, instead of this guy.

ZA: One thing about the Smith photos was how intimate many of them were. For some, they were almost jarring or uncomfortable because of the vulnerability of what was being depicted in the images. But there are also these glimpses of domestic life—of how people lived. There are so many wonderful details in your images that aren't necessarily of the action, so to speak, but they are details that help to tell the story. I’m thinking about things like wedding photos that show up in the background or the kitchen cabinets or just details about the houses and the homes and the setting. I wondered how you thought about environmental details and how important they were to telling the story.

MS: I think one of the reasons I was so excited to photograph home births is that people's homes are so much fun to photograph in. I remember a photo editor once making fun of me a little bit and saying, "Oh, Maggie, you're such a voyeur." I like all the little personal details, where someone’s said, I love this. I'm going to put this on my shelf. It is just so special. And being invited into the space to photograph a birth, and then also be able to hang out in people's homes—I think it made the photos feel so much more intimate. The wedding photos or all the little blankets that people use for comfort or the shoes by the door—all of these little things make it feel so special. There's one image we just added to the edit—the last image. The composition shows the edge of the door, like you just opened the door and they're walking in on the scene of a woman in labor with a doula supporting her. And I loved that because it feels like opening this door and being invited in.

ZA: There are a lot of overlapping definitions or personifications of labor in the series—the most literal being the act of giving birth. But then there are these acts of domestic labor that get woven into it. And then there's also the physical and emotional labor that the midwives are providing. And I was wondering how you thought about all of those overlapping depictions when you were going into the project, and maybe also when you were thinking about the title of the work.

MS: One of the titles that I had talked about with a friend, who is a writer, before I decided on Extreme Pain, Extreme Joy, was Women's Work. So the work of the midwife, the work of the people in labor. It's so physically and mentally exhausting, and it's so specific. One of the reasons that I started this was that I didn't think that labor was accurately portrayed in the media or in our culture. I had never really seen images of birth and labor that satisfied a curiosity in me. There's a Frasier episode where Roz is in labor. And she's hyperventilating and they wheel her away and everyone's like, bye. And then, five minutes later, she's a little sweaty but has a beautiful, you know, probably six-month-old baby. And from what I saw, this is such a disservice to us, because it's so hard and incredible, and it's insane that our bodies can do this. So I wanted to celebrate this work and to do it justice.

ZA: There's an image in the book where a woman, I assume a midwife, is leaning on the edge of a birthing tub, and she's looking at another woman who's in the process of giving birth. The midwife has a sort of tired smile on her face. There's something about the expression that says so much to me about that sort of labor, that work, but also the kind of interconnectedness of all of the people in your series. It made me think a lot about the recent effort to reframe care work as infrastructure, and how visible that felt in your work. You make visible this kind of interconnectedness that goes into caregiving and into the process of labor—how it isn't one person, but it is this sort of team.

MS: Everybody's working. The partners, as well. Everybody's working towards this goal, to bring this baby out into the world. There are the midwives and the mothers and the partners. And there's this one goal—whether it takes two hours or 48 hours. And it's exhausting. When I was in Michigan working on this project we were with one family for like 10 hours, and then she ended up being transported to the hospital, so I wasn't allowed to go in at that point because of COVID protocols. So I went and fell asleep at the midwife assistant's house. And then three hours later, we get a call that another woman is in labor, so we all rush over there. It's back to back.

I think it takes a very passionate and specific type of personality to want to do this work, because I think it's so special, and I think it's almost addicting to be in the room during this intense, beautiful moment where new life is brought into the world. But you don't get sick days or anything. You never know when someone's going to go into labor. I remember when I was on call for this I was afraid to have more than one glass of wine.

ZA: I was thinking a lot about the word maintenance as I went through the work. The etymology of the word means to hold in the hand, and there's so much physical contact in the book. I wondered if that felt important to you, especially given that it started during COVID.

MS: For me, it kind of felt like the only way to comfort someone was to touch them. So many of these people were in such pain, and it felt very useless to not be able to help them. So it almost felt like I was helping them in a way, by photographing their partner comforting them, or the midwives or nurses comforting them. There's one photo of a mother kind of massaging her daughter's feet when she was going through a pretty rough contraction. And I just love that. I mean, to witness a mother just trying—being unable to really prevent the pain but doing all that she can to help.

ZA: I think that men play such an interesting role in the images because they're present and they're clearly engaged, but there are these moments where they can feel helpless or lost. There's a photo in the series of a young man bent over a birthing tub next to his partner. He has this look of concern on his face—it almost has this comic element to it. I wonder how you thought about men in the work.

MS: Yeah, I mean, what a great transition from the last thing we were just talking about. I feel like the men felt just as frustrated with their inability to help as I did, and they loved these people going through all this pain. They cared so much. So I think that that showed up—the frustration of not being able to help. And I think that’s the look in that man's eyes—that fear of not knowing and just watching his partner go through so much pain and not knowing what to do, and having never experienced this before.

ZA: I found myself thinking about the contrast between the men in your images and the mostly male lawmakers who make such impactful decisions that affect women’s health.

MS: Yeah, I love that. Maybe they should all have to come down and help out.

ZA: I read that when you were working in Maryland at the later-term abortion clinic, you talked about feeling sad after you came home from shooting for the first day or the first few days, and then feeling bad for feeling sad, as if you were betraying your beliefs. But then you got to this point where you could give yourself permission to feel sad, and one of the things you said is that the sadness is real. It is sad, but there's also joy and relief, and that makes this gray and not a black and white thing at all.

Conversations around abortion are so often pushed into this place where they have to be binary, you’re on one side or the other. And I was thinking about how extremity in politics and extremity in policy can rob people of that gray area. I wondered if you think that photography is a good way of reclaiming that—if you're able to convey those conflicting things at the same time in images.

MS: I feel like I learned a lot about myself working on that project. And I think it's affecting so many different aspects of my life now, and I've been thinking a lot about how things aren't black and white. Nothing's black and white. I feel very lucky: I've started to get more work in women's health and tell stories that start to feel connected to this project—they feel connected in a really interesting way. And I'm curious to make little prints and start to see how they all align.

It all feels like this giant project that I somehow stumbled my way into during the pandemic, and now it's taking over. But it's so fulfilling to do because I think the people I'm meeting while doing it are teaching me so much about myself and my own body, and also how to be a better photographer. I feel like I've learned so much about empathy, and I don't know, just the grayness of everything. ●

You can buy Extreme Pain, Extreme Joy here, and you can follow Maggie on Instagram.

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About the Interviewer: Zachary Ayotte works with images and text to explore what we can and can't know from looking. His work often focuses on the intersection of masculinity and acts of maintenance and care. He writes the newsletter Plain Sight, and he lives in Edmonton, AB. (zacharyayotte.com)

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