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“I don’t want to die in childbirth.”

That’s what Victoria Buchanan, a Black Virginia midwife, hears all too often from her clients. Nationally, Black women are three times more likely than white women to die while giving birth. Maternal mortality rates, even in affluent states like Virginia, rival those in many developing countries. For this project photographer Karen Kasmauski documents the roles of Black midwives and doulas in Virginia who struggle to increase healthy births.

In northern Virginia, Black midwife Marsha Jackson aids highly educated middle class Black women expecting children. In southern Virginia, Buchanan works with other Black midwives helping less affluent Black populations. Kasmauski's photographs vividly portray the challenges confronted by these midwives as they navigate thickets of complex regulations and insurance restrictions in struggling to provide vital services to an often-underserved population.

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