The History of Lamaze Continues: An Interview with Sunnye Strickland

Abstract

Although the most publicized beginnings of the Lamaze method in this country took place in the New York City area in the 1950s and 1960s, change was taking place even earlier in other parts of the United States as well, for women everywhere were eager to be educated and awake for their birth experiences. One of the early leaders of the “natural childbirth movement” in Colorado, Wyoming, and Oklahoma from the late 1940s through the early 1960s was Sunnye Strickland. Strickland began her career as a labor and delivery nurse, became a devoted advocate of prepared childbirth as a result of her own birth experiences, and embraced the philosophy of the psychoprophylactic method after visiting Dr. Pierre Vellay in Paris. She then became a faculty member with the American Society of Psychoprophylaxis in Obstetrics (ASPO/Lamaze, now Lamaze International, Inc.) and eventually a certified nurse-midwife. Her professional story spans five states, several countries, and 46 years, with a rich variety of experiences in which she was a change agent, educator, and active leader in the childbirth education movement.

Elaine Zwelling: You were one of the early pioneer childbirth educators in this country in the 1950s. How did you become involved with childbirth education?

Sunnye Strickland: I was a nursing student at two different schools of nursing, and so I had two clinical rotations in obstetrics and really loved it. When I graduated from St. Luke's Hospital School of Nursing in Kansas City, Missouri, in February 1949, I sought positions in what I believed to be the best part of nursing. At first, I worked on a surgical floor at Lawrence Memorial Hospital in Kansas and cared for postoperative patients and women who had D&Cs after miscarriages. At this same time, I was doing my undergraduate work at the University of Kansas. My husband, John, and I then moved to Denver where I got a job at General Rose Hospital in 1951. I just seemed to fall into the OB/L&D area, where the supervisor was a certified nurse-midwife who encouraged my interest in “natural childbirth” patients. There were enough at that time so I could support them during labor and birth. Many of those women had read Childbirth Without Fear (Dick-Read, 1951) and some enjoyed Cheaper by the Dozen (Gilbreth & Gilbreth, 1949). At this time, I also attended the University of Denver where I did a research paper for an English course, “Childbirth: The Natural Way.” So during these years of my work, I suppose you could say I was a monitrice, though at the time I did not know that word. I gave labor support to women who wanted to be awake for the birth of their babies. I was employed as an OB nurse, mainly working in L&D, but when a woman who wanted a “natural” birth arrived, I was able to work with her on the postpartum floor, only taking her to the labor room if she needed medication or to the delivery room if she was ready to push. Only on my shift was I able to work this way. I did know of a young intern at another hospital who offered support with fathers who were coaching their wives in labor.

During this time, I attended every lecture or workshop that I could, in and around Denver, that offered information on natural childbirth. I also did a telephone census of the area hospitals checking on the possibility of mothers being awake for the birth. It was not too positive. While doing the research for my paper, I studied many resources that were available at that time (Goodrich & Thoms, 1948; Heardman, 1951; Thoms, 1950), including the many by Dick-Read (1933, 1950, 1951). One reference I particularly liked was Introduction to Motherhood (Dick-Read, 1952), a small, red book that could give any woman knowledge and confidence.

Helping women during labor and birth certainly impressed me with the importance of support and how valuable it would be for women to have some education prior to the birth. So many women were completely unconscious just for the birth, if not before, and it seemed like they missed the reward for all the hard work of labor. When it came time for the birth of our firstborn at this same hospital, in September 1954, I knew what I needed to do for myself: I stayed out on the postpartum floor and only went to the delivery area when someone offered to let me sit by the desk. When I told them I was ready to push, I walked to the delivery room and climbed on the table (I'm not sure how graceful that was!). I had no medications and was able to push while awake and tell my student-nurse sister to be quiet—a woman was working! And that is how I really became involved in childbirth education.

So many women were completely unconscious just for the birth, if not before, and it seemed like they missed the reward for all the hard work of labor.

During the years in Denver, while working at General Rose Hospital, a few private patients attended some of my very casual classes, mainly using some of the skills from Jacobson's books (1929, 1934, 1959). I had access to these books during nursing school and found them quite helpful in coaching laboring women. Quite a few books were written during the 1940s that pertained to relaxation for labor, despite the general practice in hospitals with standing orders by physicians to give a lot of medication during labor. Many times, if you were able to stay with a woman to offer support, you could help her give birth in a more natural way.

Since there was a shortage of graduate nurses, students had a lot of responsibility in the care of patients. By the time World War II was over in the summer of 1945, more physicians returned to their private practices with some new ideas about birthing babies. They were now interested in giving less medication and offering more support. I transferred to a different nursing school after my marriage in 1947 and was offered another clinical experience in OB in labor and delivery. This experience offered more interaction with students and nurses for the support of laboring women. Dads still were not generally allowed into the “inner sanctum,” but many were offered visitation. More information was being written for women wanting to take part in the birth process. By the early 1950s, Dr. Grantly Dick-Read was making tours of the United States, as well as Dr. Isiadore Bonstein from Geneva, Switzerland, who wrote Psychoprophylactic Preparation for Painless Childbirth(1958). I was in contact with a lot of the programs sponsoring the talks, which were primarily offered for physicians. By the time I applied for the job in Denver, Colorado, Dr. Frederick Goodrich, a professor at Yale University, had published A Manual for Expectant Parents(1950). Dick-Read published his little, illustrated antenatal book in England, known in this country as The Natural Childbirth Primer(1955). This was such a wonderful, enlightening time to be interested in birthing babies. It was okay now to help women have the kind of experience they wanted. I was a busy nurse and a new Mom when we were transferred to Casper, Wyoming, in the late summer of 1955.

Zwelling: Did you always teach the Lamaze method? How did you hear about it and make the change from the Read method?

Strickland: While in Casper, I took a part-time job at the local hospital on the weekends in L&D so my husband could care for our 18-month-old and I could check out the attitude there for natural childbirth. I did well with my second birth and had good support from my doctor who sent many of his clients to me for breathing lessons. So I started teaching small classes in my living room and used all and more of the training manuals available in 1956. I had patients/students who put me in touch with professors at Columbia University in New York City, so I had good input for materials to use. Since I also had access to the Childbirth Trust in London, I was able to receive materials on birth. Finally, Vera Keane from the Maternity Center in New York was the principal speaker at a seminar in Cheyenne, Wyoming, in October 1957. I was so excited to go to this meeting, as I had been invited to attend by the director of the Wyoming State Department of Health. At that time, I was the only nurse teaching prenatal classes in Wyoming. The director had attended a few of my classes to see what I was doing! So this was my transforming experience. Now, I not only wanted to teach more teachers/nurses, but I also wanted to become a certified nurse-midwife just like Vera. Vera Keane was the main character in the book, ABC's of Natural Childbirth (Gelb, 1954), a fun, very enlightening story which helped prepare me for my first labor and birth. I used it a lot and got more information on doing classes from the New York Lying-In Hospital. After the birth of my second baby and after starting those informal classes at my home, the word got out at the college level and a course plan was submitted for approval by the Casper College Board. So I started teaching an 8-week antenatal course, one at night and one in the afternoon for two hours, each.

During this time, I managed each week to attend about two to three Moms in labor as their special duty nurse. In order to do this, my close friend and neighbor was on call to care for my children. In May of 1959, after sending fan mail to Marjorie Karmel and receiving her personal copy of Painless Childbirth (Lamaze, 1958), it was easy just to incorporate the psychoprophylactic method (PPM) into the classes. In the fall course, we obtained the French film Naissance1 from Elisabeth Bing and Marjorie Karmel for a film festival offered at Casper College. The film needed to be back in New York City for their own film showing and it was touch and go. A big snowstorm in the Midwest had slowed everything down, so after many phone calls and a frantic search, the film made it back by special mail in time! Thank You, Dr. Lamaze (Karmel, 1959), published the same year, also became a part of our course plan after we gained permission from the publisher and, I suppose, from Marjorie Karmel. We also used the Manual of Information and Practical Exercises for Painless Childbirth (Rennert & Cohen, 1959) as our main impetus in the course. Even though the college had gained permission to copy and use this material, we did not run up flags or change our terminology in the labeling of the program. We were walking a fine line. However, the director of the Wyoming Health Department had visited my course and wanted us to share this information with the larger maternity departments in different Wyoming cities. So by 1959-1961, it was, “Have PPM, will travel!” Being pregnant with our third child seemed to make all of this more believable, or so it seemed in the many workshops held during that year. I gave birth again on December 29, 1960, to our third child, a second son, using the Lamaze method. The health department ordered the famous “red manual” (Bing, Karmel, & Tanz, 1961) from the newly formed American Society of Psychoprophylaxis in Obstetrics (ASPO/Lamaze, now Lamaze International, Inc.) in New York City. This may have been the time I joined as a “support member,” for nurses were not really allowed to be official, voting members at first.

Sunnye Strickland (center) attending an ASPO/Lamaze seminar in Lake Charles, Louisiana, in 1980.

Zwelling: What were those times like? Did you encounter much opposition from established medicine?

Strickland: I was very fortunate in gaining a lot of approval, possibly because I had a supportive obstetrician in Casper as my own physician and he was also chief of staff at the hospital. He was the one who sent me the first clients. As another “bee in my bonnet,” he also would call me out anytime—day or night—during these years to come to L&D if he had a patient who was “stuck.” I was not known as Sairey Gamp2 for nothing, and so I worked my “magic” in getting these ladies to deliver within the hour. As you well know, if you get a woman up into a rocking chair, give her a nice warm bath or sponge, wake her up, and explain what her progress is obstetrically, you could then go on from there, and … “Voilà, a baby!” These were not even necessarily PPM class members.

Now the only real problem area was with the hospital administration, who were mainly trying to figure out just what my role was when I attended a woman in labor. So, I was called on the carpet a time or two to explain my role. Because fathers were not allowed in L&D (except doctor Dads), I was a threat to some of the staff as an outsider nurse or private duty nurse (“Oh, that teacher person”). But with the good outcomes, this kind of thing did not ruffle my feathers. A few of the doctors really were a bit unnerved by the mother's looking at them when pushing during second stage! Many had not seen women awake for a birth except as a mistake, either a precipitous delivery or their own late arrival at the hospital. So, attending women with no shave prep or enema caused some raised eyebrows!

I was not known as “Sairey Gamp” for nothing, and so I worked my “magic” in getting these ladies to deliver within the hour.

Zwelling: I know you had an opportunity to meet Dr. Pierre Vellay (Dr. Fernand Lamaze's associate) in Paris. Tell us about that.

Strickland:In February of 1962 we moved to Dublin, Ireland, because my husband, who is a geologist, was sent there to help locate the drill site for the first oil well in Ireland. While in Ireland, I found it very interesting investigating maternity care in the Emerald Isle. I continued my pursuit of information about the psychoprophylactic method and offered it to several pregnant American women there who were interested in preparing for their birth. At one point in 1963, John was working in Germany for several weeks and we made arrangements to meet in Paris. By coincidence, it was a very sad time leaving Dublin for Paris, as President Kennedy had just been assassinated. I left on the Irish day of mourning, and the next day the French declared a day of mourning. I had already been in contact with Dr. Pierre Vellay, Dr. Lamaze's associate, and we were trying to coordinate our work and play schedules so that we could meet. It was hard for me to concentrate on this, but we could not change this sad event in history, and so I tried to focus on my original agenda. Paris was a very exciting experience for me. I met Madame Rennert, a peer of Madame Cohen's, Dr. Lamaze's monitrice (Zwelling, 1999). Unfortunately, I did not have the opportunity to meet Madame Cohen at that time. She may have been at a different clinic. I was royally treated by both the doctor and the monitrice at the clinic I did see. Madame Rennert gave me a lot of the materials that she used in her training sessions. Her office was so interesting; there were actual photographs of pregnant women in all trimesters of pregnancy. It was not at all like the offices we see in the United States. I listened to lectures at the Rothchilds Hospital; attended the private hospital for a delivery with Dr. Vellay, along with Madame Rennert; had a very special luncheon at the doctor's home (a real treat); and was even driven from one clinic to the hospital to the private clinic with Dr. Vellay in Paris traffic (a real thrill!). To say I was in a whirlwind of a tour, lasting several days, is putting it mildly. It was a kind of supertraining seminar conducted by the most gracious professionals I had ever had the pleasure of meeting. My brain was overwhelmed—I was living a dream!

Helping with the coaching and delivery of a Vellay-Lamaze-trained mother was so rewarding. It helped me to really understand the impact that this trained woman had received from all those in attendance and how she had given us so much in return. These days were my intensive training program, validating all of my previous attempts at childbirth education in Wyoming. Despite the sad time of that year, I knew my visit had been well spent and I had learned so much. We had to return to our children in Dublin the next week, and I did help a few other ladies prepare for their births there. I even checked out The Rotunda Hospital for possible training as a midwife. But time was passing and it took over two years of training for midwifery there, as I would be required to take nursing courses even though I had already obtained my Irish nursing license. We were transferred back to Ponca City, Oklahoma, in January 1964, and my midwifery training was again placed on hold.

During this time, I kept in touch with both Marjorie Karmel and Elisabeth Bing in New York and they kept me updated on developments. By this time, I was a member of ASPO and was receiving the newsletters in Ireland. My connection with Marjorie is one of the special reasons that my visit in Paris was so enjoyable and enlightening; she had put in a few good words for me. We were pen pals; we never actually met in person, just communicated with books, many letters, and phone calls.

Sunnye serving as monitrice for her daughter, Julie, in Denver, Colorado, in 1987.

Zwelling: How did you learn about ASPO (Lamaze International), and what was your involvement with the organization?

Strickland: Psychoprophylaxis was a part of my life after writing to Marjorie Karmel and Elisabeth Bing in 1958 to request use of Dr. Vellay's film, Naissance, and to get permission to use the training manual in the back of Karmel's book, Thank You, Dr. Lamaze(1959), for the course I was teaching at Casper College. I believe the organization really got off and running in May 1960. This was just about the time Marjorie had her third child and she turned over the films to ASPO to handle, for it was becoming a real task to keep up with the demand for their use.

In the early days of ASPO, only physicians were members; all others were supporting members. From the beginning, my main involvement was as a teacher and supporting advocate, paying the fee for that level of membership because only MDs had voting rights. Nurses and parents came on board later, when the physicians found they needed more grassroots support—they could not spread the word alone!

Our fourth child was born in July 1964, just before I received my ASPO certification from Dr. Heinz Luschinsky and Dr. Alfred Tanz. I had completed all the necessary requirements that the ASPO national office had sent me early on, so that I could continue with my teaching in Oklahoma as a prepared teacher of PPM. I was so happy to have my “diploma.” I had been teaching at home in small or private sessions, going to the hospital with clients, speaking to the hospital administrator, and doing all that advocacy—“knock-down-the-barriers stuff” we all have had to do—just as I had already done in Wyoming. It seemed that I had gained some finesse in dealing with administrators and physicians by this time. Even my husband was permitted to stand by the delivery room door for Michael's birth! Viva Lamaze!

After getting my official designation as a certified teacher of PPM, I could then offer more volunteer speaking engagements and film showings, and I always tried to recruit more parent members. Besides being pregnant, birthing my own children, teaching childbirth classes, and helping others birth, I did find time to do engagements in schools (sex education) and for women's groups and to teach postpartum/baby care. Also, the Red Cross always needed swim instructors for mother/baby classes and so that was a big item for my time. Relax and breathe (PPM from the beginning)!

As usual, just about the time teaching and monitricing were getting on track in Oklahoma, we were transferred to Princeton, New Jersey, in June 1966. Now there was another hill to climb! We drove across the country in June, with four kids, one cat, two adults, and arrived in good shape for country living. I signed up for the teacher training course with Elisabeth Bing in 1967, attending the required eight weeks of practice and theory, as well as participating at the parents' childbirth education course offered at Flower and Fifth Avenue Hospitals, New York Medical College. I had also been a syllabus reader and had attended seminars for trainers at the ASPO national office in New York City. By 1968, I was given permission to conduct teacher-training programs in New Jersey. The course I offered was patterned after the 8-week program. I offered it to hospitals that embraced family-centered care and needed prepared teachers for the childbirth education programs being offered throughout the state. I still conducted classes in Princeton, New Jersey, and volunteered and attended film showings and programs to promote parents' classes in New York City.

The Princeton Chapter of ASPO eventually became a reality. I was the cochair with Paula Bartow. We, along with other volunteers, worked to encourage fathers to be in labor and delivery with their wives for birth, and we “adjusted” the attitude of a lot of caregivers. Princeton was a wonderful town and New Jersey a wonderful state to live in at that time. On May 17, 1971, the Princeton, New Jersey, ASPO Chapter and the seminary wives hosted a wonderful surprise dinner for me, prior to my leaving for midwifery school. My mentors, friends, and family, along with other childbirth educators, parents, and several physicians attended this exciting evening. Well, I was overcome! It was such an outpouring of energy and love. This was very significant for me because this day was also the birthday of the Princeton Chapter's chairman, Paula Bartow.

By 1970-1971, a lot of growth and development of ASPO was taking place. There were many changes in the national office as well as with regional chapters, and training programs for childbirth educators were underway. A number of teacher training seminars had been scheduled for the northeastern part of the country prior to 1972. ASPO's national office had relocated from New York City to Washington, DC, and needed to honor these commitments. Cash flow was very tight for National ASPO, but we all pitched in and helped the organization grow. Somewhere during this time, I had another hat besides teacher trainer, syllabus evaluator, and chapter coordinator. I was appointed chairman of the certifying committee.

[I incorporated] psychoprophylaxis every way that I could, besides in parent classes. It is not just for labor, but for life!

When we transferred to Connecticut in June 1972, ongoing teacher training activities continued and I was close enough to New York City to attend seminars there and the National Certification Committee meetings in Washington, DC. I became more active in the local International Childbirth Education Association and Lamaze groups and met with RNs to teach labor and delivery support, incorporating psychoprophylaxis every way that I could, besides in parent classes. It is not just for labor, but for life! At the 1976 ASPO national convention, I was presented with the Marjorie Karmel Award (another peak life experience)! In July of 1976, we moved to Houston Texas, where I continued all these activities. I tried to be a mentor as I had been mentored.

In 1985, I continued reading course syllabi and teaching seminars. However, the one I did in 1985 was the last, as I became ill with chronic fatigue syndrome or, as it was labeled then, Epstein-Barr Virus. It affected my vocal cords, so it was very difficult to really give my all to the responsibility and vocalization needed as an ASPO faculty member. So, many of my former activities were limited, but I still offered support whenever needed.

Resting between contractions, Sunnye and Susan Melnikow, CNM, assist at a home birth in 1988.

Zwelling: I know you are a certified nurse-midwife (CNM). When and how did you achieve that long-awaited goal? How did you incorporate that into your professional career?

Strickland: The year 1971 was a great time for me, as I was accepted into the midwifery program at SUNY Downstate Medical School, Kings County, Brooklyn, New York. On April 28, 1972, graduation was held for 14 new nurse-midwives and I was so excited and proud to be one of them. By June 1972, we were transferred to New Canaan, Connecticut. There I worked as a nurse practitioner in a local clinic where I did a lot of well-woman teaching. This included health education: breathing skills, touching/massage, importance of nutrition, and exercise. I was now using my newfound skills as a certified nurse-midwife.

In the spring of 1981, while living in Houston, Texas, I was offered a nurse-practitioner position with an OB/GYN physician. I still taught childbirth classes and supported pregnant couples in L&D as a monitrice but also did more antepartum care and postpartum visits for the physician's clients. However, I did not do any births at this time. Nutrition was one of my interests for pregnancy and beyond. I also managed well-women health care for clients and particularly enjoyed working with young girls and women having their first exams. I still did a lot of health education and sex education lectures as well, for schools and women's groups.

By 1983, homebirths and birth-center births had developed a more positive image and were viewed as good places to be for childbirth. After working at five different birth centers in Houston, Texas, with six CNMs over a period of six years, I found my niche at Women's Health and Birth Care Center with Pat Jones, CNM, owner and director. It is the only birth center still offering homebirth as well as birth at the center by CNMs. So in addition to taking calls and doing childbirth classes, I continued with all of my former activities. Now I was truly using all of my skills as a Lamaze-oriented health care provider. The last baby I caught as a CNM was a homebirth six years ago. The last birth I attended as a monitrice was my own granddaughter's, now age three! I was with our daughter-in-law for her birth in a hospital birthing room, her legs were on my shoulders, the baby was appearing, and I said, “I need a pair of gloves, please!” The nurse said, “I'd better call the doctor.” The doctor caught the baby—no episiotomy, no stitches. “What a wonderful birthday,” we all said.

I still continued my learning, and before our youngest son graduated from high school in May 1983, I graduated with my bachelor's degree in health care and administration from Ottawa University in Ottawa, Kansas. I had finally finished all the loose ends of my formal education!

Zwelling: How long did you teach childbirth classes? What made you decide to “retire” and move on to other things?

Strickland: I'm not sure that I have actually moved on to other things, as I still continue with my one-to-one teaching about childbirth whenever I get a captive audience, sharing some of my library whenever the moment presents itself. I also still do sex education and speak at small group meetings for local organizations on topics such as PMS, well-woman health, and menopause—all with a psychoprophylactic approach. All together, I've been teaching childbirth education or women's health classes for 46 years.

Sunnye in 1997, on one of her many camping trips that she and her husband enjoy taking out West.

Zwelling: Tell us about your life today. What are your current interests and what occupies your time?

Strickland: My husband and I travel often, mostly in the U.S. now, not like the world trips we used to take in past years when John was involved with worldwide oil exploration. But we do enjoy camping in the mountains of Wyoming, where John enjoys fly-fishing each summer. I write a lot of postcards and just enjoy the scenery. We visit our four children and their families who are widely scattered throughout the States or see them here in Houston at holiday times, so I keep busy with those preparations. Everything seems to take longer and time really does seem to fly by. Swimming and teaching swimming to grandchildren and other kids keeps me fairly limber and healthy. I believe that babies need to learn breathing skills and water safety early on, so I offer psychoprophylactic-breathing preparation in the bathtub or the swimming pool.

I keep in touch with a lot of the graduates from my Lamaze classes and longtime Lamaze teachers. I try to offer help whenever I'm asked. I know that I did not always give everyone what they wanted, but I did try to give them what was most useful. I know you can't please everyone all the time and it's not always possible to please some of the people part of the time, but you do hope that, in the process, you learn to appreciate their needs and provide a mutual understanding of the other's views. In the process of doing this interview, so many fond memories have popped into my head—it's been a wonderful ride down memory lane!