A half-century ago, the birthing room was a different place for women.
Throughout their labor, many women were needlessly sedated to “help them” forget the pain, and their husbands often were banned from the room. Rather than a time of celebration, delivery was a time of solitude and lost memories.
Since then, Penny Simkin, PT, CCE, CD (DONA), has helped change that experience for as many as 12,000 women and their families through childbirth education and other classes for new families, which she now teaches others to facilitate at Bastyr University’s Simkin Center for Allied Birth Vocations.
“There is no one in maternity care who has had always at the center of her work an interest in exploring and optimizing women’s experience in childbirth like Penny Simkin,” says Annie Kennedy, CD (PALS), Simkin Center director. “Her fierce dedication to the vision of a positive and satisfying memory of efficacy in childbirth is Penny’s contribution.”
But Simkin is modest about the beginning of her journey as a childbirth instructor in the late 1960s. Already a physical therapist, Simkin says she believed teaching childbirth education classes would simply be a good fit.
“I took the training to be a childbirth instructor and taught my first series,” she says. “Then I discovered that I just loved it. I really started to care about the women.”
As she grew closer to the students in her classes, a few of them began to invite her to their births.
“At first I had no idea of any role that I could play,” Simkin says. “I thought they were doing me a favor by asking me to come, so I just stood there as a silent observer to learn.”
After she’d attended close to a dozen births, one of her students asked why she hadn’t said anything while she was in the birthing room. “’I thought you disapproved,’” Simkin says the student told her.
“I decided that maybe they were inviting me to their births for a different reason,” Simkin says. “Maybe they’re thinking I could bring something to their experience.”
She changed her approach with her future students, taking a more active role when she was invited into the birthing room. “I tried to encourage the women, tried to help them do the things I had taught them to do,” she says.
Essentially, she became a birth doula before such a role even had a name.
The Birth of the Modern Doula
Women have been assisting other women through birth as long as humans have walked on the planet. But in the United States, modern medicine eventually reduced women’s status in the birthing process, aside from pockets where midwives and nurse practitioners were still the preferred choice.
The tide started to turn in the 1960s and ’70s, as more husbands began fighting for the right to be with their wives during childbirth, and midwives became a more popular choice among the middle class (see our article “Midwifery Chair Has History of Advocacy”).
Simkin continued attending births and supporting women in the birthing room, but it wasn’t until the 1980s that she learned how much she was helping. That was when eminent pediatricians John Kennell, MD, and Marshall Klaus, MD, published their studies proving that having a woman’s support throughout labor led to fewer perinatal problems, shortened the length of labor, and improved interaction between the mother and child.
Could Simkin prove the same thing with her own experiences, she wondered?
“I began seeing my own role in birth differently after this study came out, and I even did my own study on women’s long-term memories of their birth experiences,” Simkin says.
She asked her former students to share their birth stories with her and to rate their satisfaction, and she found that the women who felt well cared for during their births rated their satisfaction higher than those who had bad memories of how they were treated, regardless of how the actual birth went.
“Those with the highest satisfaction felt the birth had given them a sense of achievement,” Simkin said. “One said: ‘I knew after that I could do anything. It was like climbing Mt. Everest.’”
For Simkin, the results proved that her childbirth classes as well as her presence in the birthing room had helped these women. They also showed her that more needed to be done.
“When I found out that it’s more important how these women were cared for than whether they had a difficult or complicated birth, I realized what a difference support in the birthing room can make,” she says. “We can control that. We can’t control whether it’s going to be a long or complicated birth, but we can control whether we treat the mother with respect and care.”
“That’s what made me begin focusing more on training other labor support providers.”
But in order to start teaching more doulas to follow in her footsteps, she had to define the profession, which she did with help from Dr. Kennell, Dr. Klaus, Kennedy and Phyllis Klaus, CSW, MFT.
Together they adopted the term doula (doo’-luh), a Greek word referring to an experienced woman who helps other women; and formed Doulas of North America (DONA), the birth and postpartum doula professional association that now has a global reach as DONA International.
“We’ve Got to Get People Caring More About Childbirth”
Since then, Simkin has attended more than 800 births, and she’s also trained more than 5,000 doulas around the world.
“I care so much about all of those women I’ve helped over the years,” says Simkin, who is known by many as the mother of modern childbirth education. “We’ve got to get people caring more about childbirth.”
Simkin has been doing her part to further that goal with her Seattle practice that has been offering childbirth education and other classes for new families since 1968. But she started focusing more on helping new doulas get started with the 1988 creation of Simkin School, a program of the Seattle Midwifery School.
Both reached out to an even bigger student base in 2009 when the Seattle Midwifery School merged with Bastyr University, which offers science-based degree programs that complement the birth vocations fields, including naturopathic medicine, acupuncture and Oriental medicine, nutrition, psychology, herbal sciences and human biology.
“Bastyr University is fortunate to have someone with Penny Simkin’s stature and experience in modern childbirth,” said Bastyr University President Daniel K. Church, PhD. “Whenever the foremost leader of any industry is a part of your community, as Penny is, it is a great honor and one for which we feel very privileged to have.”
“When Survivors Give Birth” a Groundbreaking Issue
In her fourth decade of dedication to childbearing women, Simkin is still breaking new ground.
She teaches When Survivors Give Birth, which focuses on understanding and healing the effects of childhood sexual abuse and rape on childbearing women. Simkin and Phyllis Klaus teach the class together through a collaboration that started in 1987, resulting first in the book When Survivors Give Birth.
Simkin explains that she had become interested in how birth trauma affects abuse survivors after she discovered that abuse survivors often spoke about birth experiences similar to rape.
“When I got started in this,” she says, “there was nothing in the literature about any kind of connection between birth and sexual abuse.”
Even now, there is little beyond the 2004 book Simkin and Klaus wrote, and Simkin says women who have suffered sexual abuse and rape are among the least understood of pregnant clients.
Stay tuned for other groundbreaking classes from Simkin, who says her latest area of interest is an outgrowth from her work with abuse survivors: Birth trauma.
How to Enroll
Simkin Center courses at Bastyr University are open to the public and would be of interest to practitioners and anyone who works with childbearing women. Most classes take place on weekends and evenings to accommodate busy schedules.
To learn more about upcoming courses or to register, go to the Simkin Center Course Calendar. Classes include:
- Birth Doula Skills Workshop
- Postpartum Doula Skills Workshop
- Foundations for Best Practice in Lactation Care
- Childbirth Educator Training
- Pre- and Perinatal Massage Therapy Certification Course
- Infant Massage Educator Certification Training
- When Survivors Give Birth
- Perinatal Support Group Facilitator Training