The screams of 28-year-old Irma Lopez Aurelio in labor were heard throughout the town of San Felipe Jalapa de Diaz, Mexico as she gave birth on a patch of grass outside the Oaxaca medical clinic after being denied proper care and treatment.

Aurelio made the front page of La Razon de Mexico newspaper, which printed the disturbing image of the mother and her newborn with the umbilical cord still attached. The photo, which was been widespread nationally in Mexico and overseas, has stirred up controversy as to why Aurelio was forced to give birth outside the health clinic.

Aurelio and her husband, an indigenous couple from the Sierra Mazateca region in Mexico, traveled together hand-in-hand on the pitch black road before dawnon Oct. 2 to seek emergency medical attention. The mother of two, fully dilated as her water broke, was briefly examined by medical staffers but was not admitted to the clinic, according to La Razon.

The Oaxaca staffers claimed that they were too shorthanded — due to the partial work stoppage in Mexico — to treat the pregnant woman. In full labor pains, Aurelio went outside of the clinic and continued to pace back and forth to ease her pain, the NY Daily News reports. After two hours of hoping that a nurse or doctor would signal them to come into the clinic, Aurelio dropped down on one knee on the lawn outside the facility and began to push.

Eloy Pacheco Lopez, a bystander, heard the screams of Aurelio when he ran outside and took the controversial photo of her moments later after she gave birth.