Birth photography is a particularly raw and intimate form of art. To celebrate this work, the International Association of Professional Birth Photographers holds an annual contest with winners selected by a panel of judges, as well as members of the organization around the world.

On Thursday, the IAPBP announced the winners of its ninth annual Birth Photography Image Competition, which honors excellence in categories including Labor, Delivery, Postpartum, Birth Details and Fresh 48.

“Winners were chosen on a point system and judged on technique, lighting, composition, emotional impact, creativity and storytelling,” says the competition’s website, adding, “While birth is beautiful, it is also messy and real.”