A Challenging Time in the History of Lamaze International: An Interview With Francine Nichols

Abstract

Dr. Francine Nichols—President of Lamaze International from 1988 to 1991 (when the organization was known as “the American Society for Psychoprophylaxis in Obstetrics” or “ASPO/Lamaze”) and the founding editor of The Journal of Perinatal Education in 1990—is a woman with many skills that have contributed to her success throughout her career. Dr. Nichols is a knowledgeable leader in maternal-newborn nursing, a respected nurse and childbirth educator, a researcher, and an author. However, these skills were not the abilities she relied upon the most to lead the Lamaze organization through a challenging period in the 1980s; rather, Dr. Nichols's tenacity, business savvy, and willingness to face controversy helped guide Lamaze International back on track so that it was able to grow into the strong organization it remains today. This interview took place by telephone on June 12, 2006, when Dr. Nichols was in Washington, D.C., for the summer to coordinate the National Institute of Nursing Research's Summer Genetics Institute, a doctoral-level course cosponsored by Georgetown University.

Throughout the history of Lamaze International—from the association's early years, when it was known as “the American Society for Psychoprophylaxis in Obstetrics” or “ASPO/ Lamaze,” to the present—many dedicated individuals have shaped the growth of the organization and its mission (Zwelling, 1999, 2000, 2001a, 2001b, 2002). One woman who has contributed in numerous ways deserves special recognition in light of the 15th anniversary of The Journal of Perinatal Education (JPE), for she was the publication's founding editor. I feel honored to contribute to her recognition with this article, because I have been privileged to know Francine Nichols as my friend and colleague for many years. Although distance now prevents us from seeing each other often, we talked on the telephone for an hour in June 2006 about her involvement in childbirth education and Lamaze International.

Elaine Zwelling: Francine, you've had an extremely successful career in both nursing education and childbirth education. How did you first become interested in the field of maternal-newborn care?

Francine Nichols: In nursing school, I loved my labor and delivery rotations, but that was not where I thought I wanted to stay. I initially wanted to be a critical-care nurse. When I graduated, there was no opening in ICU, but there was an opening in labor and delivery; I took it and never left.

Zwelling: How long did you work as a staff nurse before you moved into nursing education? How did that evolve?

Nichols: It wasn't planned, that's for sure, because I always said I would never teach. But after I had been a staff nurse for about five years in labor and delivery, there was a head-nurse position open. Only two people applied for it: a person who was very senior and myself. I decided that if I got the position that would be fine, but if I didn't, it was time to leave. I didn't get the head-nurse position, but knew a position was open in the school of nursing at the hospital, working with students in OB. They were starting a baccalaureate program with St. Mary of the Plains College the following year. So I took on nursing education!

Zwelling: How long did you teach at St. Mary's?

Nichols: I started at St. Mary of the Plains in 1975. After a couple years, I went to the University of Texas at Austin [UT] for a master's degree in maternal-newborn nursing. I taught during the academic year, went to school in the summers, and graduated in December 1977.

Zwelling: Is that when you met Sharron Humenick?

Nichols: Right. I was at the huge UT nursing building for orientation, thinking, “What am I doing here?” I had looked in my ASPO directory and found the name “Sharron Humenick,” but I didn't know she taught at UT. As I was walking around the building trying to find my orientation session, I saw her name over her office door, and she was sitting at her desk. That's how we got to know each other.

Zwelling: And then you went back to school for your doctorate?

Nichols: Yes. By the time you get through the master's program at UT, you're programmed to get your doctorate. So, that was my goal. I went back in 1980 and graduated in 1984. When I finished, I went to Wichita State University and developed the maternal-child graduate program there.

Zwelling: How many years, then, did you teach maternal-child nursing?

Nichols: After Wichita State, I moved to Washington, D.C. I took a visiting professorship at The Catholic University of America for a year. Then, I did full-time consulting for about five or six years. I went to Georgetown University in 1998 to be the coordinator of the Women's Health program. So, probably from 1975 until I left Georgetown in 2001 to move to Hawaii. I taught maternal-child nursing for 20 years.

Zwelling: And you're still at Georgetown in the summers, right?

Nichols: Yes, I'm coordinating the NINR [National Institute of Nursing Research] molecular genetics summer program. The students in the course get 12 hours of doctoral-level credit for the course. I come two weeks in March to NIH [National Institutes of Health] to select the students for the next year's class. And then I'm at NIH for 10 weeks, from June to the middle of August. This year, I have 10 doctoral students, eight postdocs, and one advanced-practice nurse. They're a very dedicated group. We have about 40 faculty members that teach in the course, and they're the crème de la crème in genetics in the Washington, D.C., area. It's really a pleasure to be a part of it. I've been with the course since its development; I just happened to be in the right place at the right time.

Zwelling: When, along that pathway of your teaching nursing, did you get involved with childbirth education and with Lamaze?

Nichols: At the time I was working in labor and delivery, there was a person in Wichita, Kansas, who taught Lamaze classes. But when her students came to the hospital in labor, they were very argumentative; they believed we were going to do everything “wrong,” and it was all very negative. So, I went to St. Louis and did the ASPO/Lamaze training with Pam Schrock because I wanted to be able to start Lamaze classes at the hospital to provide more than just one option for classes in Wichita. I became certified in 1974.

Zwelling: How long did you teach childbirth classes?

Nichols: I taught classes until I moved to Washington, D.C., in 1990. So, I taught Lamaze classes for about 25 years.

Zwelling: You also started one of the ASPO/Lamaze childbirth educator certification programs in your area. Tell me about that.

I just happened to be in the right place at the right time.

Nichols: Sharron Humenick had the Texas program where she was doing teacher training. She talked with me and helped me develop the program for St. Mary of the Plains College. And then I eventually moved the program to Wichita State. While I was in Kansas, I did one teacher-training program a year. When I started the program there, we had three or four teachers who were teaching childbirth classes. Some were certified, some not; some taught Bradley and some taught Lamaze. When I left, we had Lamaze-certified teachers in every populated county that had a hospital in Kansas. Then, when I moved to D.C., I was fortunate to become involved with Fairfax Women's Hospital. I did teacher-training programs through the New York City Lamaze Chapter. The people who attended were primarily from D.C., Maryland, and Virginia. The candidates were excellent, and most of them scored very high on the certification exam.

Zwelling: How did you become involved in the leadership of Lamaze International, back when it was known as “ASPO”?

Nichols: I was a state coordinator when ASPO had those positions…the only one in Kansas. And once again, Sharron Humenick kind of shepherded me along the way. I believe it was because I was a member of the ASPO faculty that I became interested and ran for the board of directors.

Zwelling: And then you became an officer of the organization. How did that evolve?

Nichols: I was vice president for two years in 1986–1988, when Dr. Steve Silverman was the president. During that time, money became a more critical issue every year. Steve and I and other board members pushed to have an audit of the ASPO/Lamaze organization done…not just a financial audit, but an organizational audit as well. And then, after I became president, the board finally voted to have an audit done. About the first thing I did as president was go out to interview potential firms that might do this audit.

Zwelling: Your years as president were very challenging, to say the least.

Nichols: Yes, I still have scars. It's not an experience I would want to repeat!

Zwelling: Many of the current readers of JPE may not know about the challenges the Lamaze organization faced during that time. What would you like to share about that? Why did you feel there should be a total audit of the organization?

Nichols: Some members of the board began to question the budget that was presented to us at our quarterly meetings by the executive director at that time. It was very disconcerting that the numbers didn't add up…the numbers just didn't come out right, and you could never project the budget. I took past quarterly P&L [profit-and-loss] sheets, and when I would enter them in my computer into a bookkeeping program, they never matched. And so, that was one thing of concern. The other concern was that we were supposed to have $3 million revenue a year in ad money from Lamaze Parents magazine, but we didn't seem to be making any headway financially. You just couldn't pin down anything. We never suspected mishandling of funds or anything like that, but some of the board members felt an audit was needed. But the board was really divided on that issue.

Zwelling: I remember that difficult time and the soul-searching you went through before going ahead with having an audit done.

Nichols: Yes, it was a difficult decision, but I went out and interviewed potential firms that might do the audit. That's how I met Carol Lively, who was the vice president at SmithBucklin and Associates, the association management company that has managed Lamaze International ever since.

Zwelling: After the audit, as I recall, it was discovered that there was a problem.

Nichols: Well, I got a call in Kansas—I think it was on a Tuesday—from Carol Lively, at six o'clock at night. It's one of those times you never forget. She said, “Francine, I need you to come to Washington, D.C., tomorrow!” I said, “I've got to teach class. There's no way I can come. What is the problem?” And she said, “Well, I really can't discuss it over the phone, but I need to see you in Washington as soon as you can get here.” So, I got there on Thursday. When I walked in the room, there was the CFO [chief financial officer] from SmithBucklin in Chicago; the room was filled with people. But the bottom line was that ASPO/Lamaze was facing bankruptcy, and we owed over $1 million that was either past due or due in the next 30 days!

Zwelling: In the next 30 days…oh, my goodness!

Nichols: Yes. One thing SmithBucklin could do, and did do, was that the CFO developed a budget. They told me what we could do, step by step, and how we could at least make a go of it. They assigned us a member of their staff to serve as ASPO/Lamaze's executive director. About 21 people had been working for ASPO, and one of the first things I had to do was to fire 12 of them because we couldn't afford to pay that large a staff. That was very hard. Some of them were people who had been with ASPO for 15–20 years. That was really hard…really hard. I wrote letters of reference, and our SmithBucklin director helped me find good jobs for everyone at other places. Fortunately, in D.C., that's not too hard to do because of the opportunities there.

Zwelling: You experienced a lot of criticism because of these decisions, as I recall. There were members of the organization who did not agree with the concept of being managed by an association management firm.

Nichols: Yes, there was definite concern! Partly because, as a board member, I could not tell people some of the things that were happening.

Zwelling: Was that the most challenging thing that happened during your term as president?

Nichols: Well, fiscal security was one. The second challenge was developing corporate partnerships to bring the organization to a state of fiscal stability while, at the same time, not “selling out,” I guess is the best way to say it. If we had not taken that approach, the organization would not be here today…or most likely wouldn't be here. Along with trying to secure the organization's fiscal security, one of the first things we explored was selling Lamaze Parents magazine. I happened to know a fellow from New York who I'd worked with on another project who always thought the magazine was great. I worked with him until the company he worked for was ready to buy it, and then Carol Lively with SmithBucklin came in and closed the deal. And so, we got $1 million for the magazine in that first year.

Zwelling: Would you say that saved the organization, financially?

Nichols: Well, certainly that made a big difference. Before that sale, ASPO/Lamaze would not have lasted long. We had a printing bill of, I think, $800,000, as well as some other bills. I remember calling my dad—he had his own business and a lot of business sense—and he said, “Well, you just need to go to the bank and ask for a loan.” I said, “How can you go to the bank for a loan if you're facing bankruptcy?” He said, “Oh, but you're about birthing babies! That's a good thing. Some bank will give you money.” And so, we found a bank…actually, it was about the third bank I went to. Our SmithBucklin executive director went with me, but I had to do all the speaking. This bank had been doing some Lamaze business and was willing to take the risk. They sat down with the printing company and talked them into taking terms on the printing we owed, as well as printing the next Lamaze Parents issue, which was due. I don't remember the payment terms, but the bank paid it out in installments. The banker basically told the printing company, “You know, if you say ‘No,’ you're not going to get your money at all.” And so, the printer agreed. And then, by cutting back and not spending anything, we brought some stability to the ASPO/Lamaze organization. But when we really turned the corner was when the magazine was sold. And that was a real issue with many people. We tried to retain as much control as we could. We did retain all the editorial rights and the content. But it's always a potential problem when you try a blend of corporate and nonprofit, you know. I think most people looking at the magazine today would not see it as just a corporate endeavor. They see it as having excellent content.

Zwelling: Yes, but at the time members were worried….

Nichols: Right, right. And then the other thing was that, about the time we sold the magazine, the board contracted with SmithBucklin to manage ASPO/Lamaze. And our offices moved over to the SmithBucklin office.

Zwelling: I remember apprehension about that decision to be run by an association management firm!

Nichols: Definitely! At least you have accountability. It was certainly by far the best approach for what ASPO/Lamaze needed at that time. Nothing like what happened to us as a stand-alone association financially would ever happen with SmithBucklin.

Zwelling: What was the timeline on what you've just described? How much time passed from that fateful Tuesday night call from Carol Lively until the organization was out of bankruptcy?

At least you have accountability. It was certainly by far the best approach for what ASPO/Lamaze needed at that time.

I was president for three years because nobody wanted it! Looking back, I learned a lot and, so, I guess you could say it was a good experience. But I still have scars from the conflict. I would not want to repeat that presidency!

Nichols: Well, we never did declare bankruptcy. It took about a year to become stable. After we sold the magazine, we had some security the following year. I would say it was the third year before the organization really turned around. Usually, the president's term is only two years; I was president for three years because nobody wanted it [laughs]! Serving that third year turned out to be a very good experience for me because things were settling down and we were making progress. The board was also very supportive. I think if I had left before that time, I would have had some very, very hard feelings about the experience.

Zwelling: Do you mean hard feelings on your part or from others?

Nichols: You have to make decisions that are looked on as not being the right ones, you know; and then I'm sensitive, as most childbirth educators are. Anyone who disagreed with what we did at that time really believed they were taking the right stand. So, it was…it was a difficult time, and not an experience I'd ever want to repeat.

Zwelling: After all is said and done, would you say your greatest accomplishment as president of ASPO/Lamaze was saving the organization?

Nichols: Actually, the board of directors as a group were the ones responsible for “saving” the organization. I don't exactly like the word “saving” [laughs]. I've always had a good sense of business, and that skill served me well as president. And that's because I grew up in a family where my dad was in business and my mother kept the books for him. I think I was in the right place at the right time. I think the Lamaze accomplishment I'm the most proud of is spearheading development of the first certification exam, because that's a professional thing. Prior to having that exam, we didn't really have certification. If a Lamaze candidate got through the educational process, she got a certificate. The work of the certification committee during my presidency in developing that exam and cleaning up the files of all the past candidates who had been in the certification program is definitely what I would be most proud of. We were able to get the certification files computerized and, for the first time, knew how many people we had certified and where they were.

I think the accomplishment I'm the most proud of is spearheading development of the first certification exam.

Zwelling: I remember that, for years, we never had an ability to statistically analyze the certification exam and the candidates' scores.

Nichols: No, we didn't. And in reality, those early exams were not really certification exams. We hired a psychometrician who became our exam consultant and did the analysis. The work laid the foundation for NCCA [National Commission for Certifying Agencies] accreditation.

Zwelling: Tell me about The Journal of Perinatal Education. When was it launched? Was that during or after your presidency?

Nichols: It was during my presidency that we developed the idea for the journal. Because ASPO/Lamaze had to make some financial cutbacks at that time, we cut back on all our publications. Then, after we turned the corner financially, we had time to think about what we might want to do regarding a professional publication. I had always thought that Lamaze should have a peer-reviewed journal, and Steve Silverman and the other members of the board at that time were very supportive of that idea. I worked with Jones and Bartlett Publishers and was the editor for the first five years. Then, Sharron Humenick became the editor and has had it for 10 years.

Zwelling: So, this is the 15th anniversary of The Journal of Perinatal Education.

Nichols: Yes. It was tough going at first, because at the time I started it I'd never know if I was going to have enough copy for the next deadline. And then there were some real challenges working with the publishing house, and I didn't have a full-time assistant with any editorial expertise. We were really still tight in terms of money. When Sharron took it over, she made a lot of changes in terms of how the journal is done—who does the proofs, and the process it goes through—which made it so much smoother.

Zwelling: So, in those five years that you were the editor, what do you feel were your accomplishments? You started it from nothing. What was the status when you turned it over to Sharron?

Nichols: At the end of five years, I pretty much knew that when I put one journal to bed I already had the copy for the next journal. By that time, I had an assistant with some editorial background, and that really helped. And then, both Sharron and I really worked with people in terms of revising their articles, and I was beginning to get filler [copy that can be used to “fill” pages, if needed] for each issue as well. I was the start-up person, and Sharron was then able to take it over, secure better funding to support it, and facilitate its growth. It's really astonishing what has been accomplished in 15 years.

Zwelling: It's amazing…all the things you did during those years: being president of the organization at a very difficult time in its history, facilitating the improvement of the certification process and development of the exam, and starting the professional journal. And this was all in addition to keeping up your own academic teaching career as well!

Nichols: Well, I guess I was just in the right place at the right time.

Zwelling: That may be true, but I wonder what would have happened to the organization had you not been “in the right place”?

Nichols: It is always possible that the organization would have claimed bankruptcy. I think other people would have banded together and started another organization. But I think when you claim bankruptcy like that, you have to deal with the fallout from that action. It's very damaging to the name of the organization, too. I will always be eternally grateful for Carol Lively and her support and guidance.

Zwelling: I'd like to shift gears a bit and talk about your perspective on the status of maternity care and childbirth education today. Every decade, there seem to be new challenges. What do you view as the current ones?

Nichols: I've not been real involved in the frontline of maternity care in the past few years like I once was, but I think we have some of the same issues that we've been fighting all along. The technology is one issue. But also, so many women today do not see the benefit of a normal childbirth. It's a cultural philosophy—if you have pain, you just get rid of it—and that's hard to change.

So many women today do not see the benefit of a normal childbirth. It's a cultural philosophy—if you have pain, you just get rid of it—and that's hard to change.

Zwelling: I agree with you. The childbearing women of today are known as the “Echo Boomers,” the children of the Baby Boomers. They're the generation that has grown up having everything in their lives quick, fast, and easy. They've never known a time when there was not easy access to communication and information, fast food, drive-through pharmacies, dry cleaning, banking, et cetera. And that's what they want for their birth experiences.

Nichols: No muss, no fuss.

Zwelling: That's right. Do you think childbirth education can sustain an influence in view of these desires? How can childbirth educators deal with this?

Nichols: I think back in the 1970s when I was first teaching, people came with a mission and a goal, and they knew exactly what they wanted. Then, we went to the era where they didn't come motivated. They came because they felt the “right thing to do” was to go to a class. And so, you hoped to send them out motivated. I don't know exactly what the answer is today. People still go to Bradley classes and Lamaze classes, but today you have a large group of women looking for something different. That “different” might be yoga for pregnancy or something like that. I do know that, whatever the needs of the woman and her family are, childbirth educators have got to meet them where they are, because you can't do much more than that. That's where you have to start.

Zwelling: I think this has been a real challenge for many childbirth educators. It's hard to change one's own beliefs and philosophies.

Nichols: It is difficult, but you have to find out what women's needs are, and then meet them where they are. Today, you know that 90% of them want an epidural. So, you might start in classes by discussing what the benefits might be if they got an epidural later in labor and what they could do to achieve that. And then, the other thing is that classes are not all about the birth of the baby. Parents need a lot of important information, such as managing the discomforts of pregnancy, newborn care, and parenting. I just had a call the other day from a friend whose daughter is 7 months pregnant with her fourth baby who is breech. The doctor has already scheduled her for a C-section, and my friend wondered what her daughter could do. So, I called the daughter and gave her the breech exercises and sent her the information. I think childbirth educators have to look beyond just the birth experience and see the value of all the other information that parents need.

Zwelling: You're right. I think expectant parents need childbirth education more than ever today because of all the technology choices they're faced with, such as elective induction, elective cesareans, epidurals on admission, et cetera. They need to be informed so they can make educated decisions.

Nichols: Right. If there's one thing I would tell childbirth educators—actually, perinatal nurses as well—it's that when you say something, make sure you can say, “The research shows that X, Y, and Z…,” so that parents are hearing the research evidence, rather than just stating it as a fact. I think that makes a lot of difference.

Zwelling: You have a very different, rather exciting life these days. Let's talk about that.

Nichols: Yes, it's very different [laughs]. I'm living in Hawaii, and I just built a new home there. Actually, one of the constant things in my life has always been alternative, complementary medicine. And Hawaii is the place to be for that. So, in my home I have a steam room and a beautiful outdoor shower with pebble tile from Bali on the floor. There is a warm pond on the property. The pond is really lovely. It's 91 degrees at low tide and 89 degrees at high tide; it's half saltwater and half springwater. I've been working with women who had been very ill or are in transition, using complementary, alternative approaches, which any childbirth educator uses. I'm doing my certification in imagery this year, and my goal is to have small retreats. Last year, I had 10 people come for a Qigong retreat. [Author's note: Qigong is a component of Chinese medicine and primarily consists of meditation, relaxation, physical movement, mind-body integration, and breathing exercises.]

Zwelling: How do people hear of your work and your place?

Nichols: Primarily, by word of mouth. They come mostly from the mainland and stay for about a week. Some are going through a divorce, an illness, or a death, or they just need to be away in a different area. I have a couple of massage therapists who are just great, one who does hot-lava-rock massages. Two people in my area do watsu. I don't know if you're familiar with that. It's shiatsu massage in water and it's wonderful. I have another person who does cranial-sacral therapy, which is just wonderful. We also have Qigong and yoga classes in my area, so they can either do them privately or go to a class. And, of course, the pond is very healing. And there's a very good acupuncturist who will come. So, I individualize the program for what each person needs.

Zwelling: This must be really rewarding!

Nichols: Yes, and uses some of the skills that I developed as a childbirth educator. The other thing I want to do is get certified in journal therapy. There is a retreat twice a year in Boulder, Colorado. I'd really like to do that because I encourage women to keep a journal. In fact, there's a computer program called “LifeJournal,” which makes journaling very easy.

Zwelling: Francine, is there anything else you'd like to share with the JPE readers about your wonderful career?

Nichols: Yes, the professional accomplishment I'm most proud of is the textbook, Childbirth Education: Practice, Research and Theory(2000), which Sharron Humenick and I wrote together. It is used widely in all different types of instructor-training programs for childbirth education. Also, I really appreciate the opportunity to share with the readers some of the challenges the Lamaze organization faced in its past, as well as the growth we made in relation to certification and the journal. It's a very stable organization, today.

Zwelling: And I appreciate your sharing, Francine! You have been one of the leaders of Lamaze International who will go down in history for demonstrating courage during difficult times and helping to make the organization what it is today—a voice for all who work to make birth a normal, positive experience for women and their families. Thank you!