Natural Childbirth Pioneer Elisabeth Bing Dies at 100
Natural Childbirth Pioneer Elisabeth Bing Dies at 100
Associated Press
The Guardian
May 16, 2015
http://www.theguardian.com/us-news/2015/may/17/natural-childbirth-pioneer-elisabeth-bing-dies-at-100
Elisabeth Bing, the Lamaze International co-founder who popularised what was known as natural childbirth and helped change how women and doctors approached the delivery room, died on Friday at 100 in her New York apartment, the organisation said on Saturday.
The German-born pioneer became interested in childbirth techniques in the 1950s, when women were often heavily medicated and dads were generally nowhere near the delivery room. The cause of her death wasn’t immediately known.
Trained as a physical therapist, Bing taught breathing and relaxation techniques to generations of expectant mothers, wrote several books about birth and pregnancy and encouraged women, and men, to be more prepared, active and inquisitive participants in the arrival of their babies.
“I was certainly considered a radical,” she wrote in Lamaze’s magazine in 1990. By then, she noted, childbirth education had become common: “This so-called fad has been proven not to be a fad.”
Born 8 July, 1914, in Berlin, Bing fled Nazi Germany with her family for England, where she got her physical therapy training. Working with new mothers got her thinking about delivery practices, an interest she brought with her to the United States in 1949.
She learned about ideas advanced by some doctors, including French obstetrician Fernand Lamaze, for using breathing and mental preparation to manage labor pain without medication. She and the late Marjorie Karmel established what is now Lamaze International in 1960 to spread the strategies.
Bing gave birth herself at 40, going into a fast labor during which she was given spinal anesthesia and nitric oxide. She told the New York Times in 2004 that she’d gleaned that childbirth training wasn’t about refusing drugs, but rather about teaching a woman “to help herself as far as she can go”.
Lamaze became a household word, woven into pop culture. Its signature classes involved both women and men, with the idea that fathers could provide emotional and mental support in the delivery room.
Over the years, the idea of refusing all painkillers during labor fell out of favor with many women, and some couples sought shorter birth preparation classes than Bing’s six-week program.
Still, “I feel we have changed the whole attitude toward obstetrics and pregnant women, not necessarily technical changes, but the psychological and practical approaches to pregnancy,” she told the New York Sun in 2004.
Lamaze International, which has about 2,000 childbirth educators around the world, now more broadly promotes healthy and natural birth practices and preparation. Bing’s influence lingers there, as in delivery rooms around the country, President Robin Elise Weiss said Saturday.
“Even if people haven’t heard her name,” Weiss said, “she’s impacted how they give birth.”
Paula A. Michaels
Oxford, Oxford Unversity Press, 2014, ISBN: 9780199738649; 264pp.; Price: £19.99
Over the last 100 years, childbirth has become increasingly synonymous with the hospital. Around 1900, hospital births were the exception; within less than three generations, it was almost unheard of for women in most industrialised countries to have their babies anywhere else. The same period saw a trend towards the professionalisation of maternity care, with state regulators across Europe and North America coming to define who was and who was not qualified to attend birthing women. Touching vast numbers of women and their families, these shifts have profoundly shaped attitudes to and expectations of health services, medical technology and professional power. A wealth of recent historical scholarship has documented how decision-making in birth both defined and was defined by gender, class and race, as well as identities as mothers, fathers and professionals. In her superb history of the Lamaze – or more accurately, the psychoprophylactic – technique, Paula Michaels shows how transformations in the management of childbirth also mediated the international and domestic rivalries of Cold War politics.
In the summer of 1951, Fernand Lamaze – a dapper, middle-aged and Left-leaning Parisian obstetrician – embarked on a tour of Soviet medical facilities organised by the National Commission of Communist Doctors, an affiliate of the French Communist Party. On a visit to a Leningrad maternity clinic, he witnessed a 35-year-old typist using patterned breathing techniques in place of pharmacological anaesthetics and analgesics to give birth to her first child ‘without pain and with joy’. This encounter with the Soviet state-endorsed psychoprophylactic method (PPM) would turn everything Lamaze had learnt about childbirth on its head. It also put him on the road to years of political and medical controversy that would make the international reputations of both psychoprophylaxis and Fernand Lamaze. Promoted by Lamaze with missionary zeal, the ‘Soviet method’ earned an enormous following in Western Europe and especially the United States, ironically at the height of the Cold War.
What exactly was psychoprophylaxis and how did it become both the ‘Lamaze method’ and an international movement? Answers to these superficially straightforward questions, Michaels so eloquently shows in this lucid, engaging and deeply informative book, can be found neither within the constraints of a single national history nor in the biography of one individual. This is instead a dynamic story of a method and a movement in transformation, of scientific and cultural traffic across borders and of meanings gained, lost and refracted through political agendas, social change and lived experience on both sides of the iron curtain.
Lamaze, then, is an exemplary study of what historian of science James Secord has termed ‘knowledge in transit’. Too much of our work, he suggested in an influential paper published ten years ago, has focused on origins and producers, novelty and the places where novelty begins, all too often limited by un-conceptualised geographical and disciplinary boundaries. Calling for greater attention to processes of movement, translation and transmission, Secord appealed for historians to eradicate the distinction between the making and the communicating of knowledge; to understand science itself as a form of communication with receivers as well as producers.(1) Michaels – an expert on East European and Central Asian history of medicine and health – could justifiably have concentrated on the little-known Soviet origins of psychoprophylaxis. Broadening the geographical scope of this study, which looks in detail at the pre-histories, reception and afterlife of the method in France and the United States as well as the USSR, has resulted in a more richly textured and satisfying account. Lamaze is all the more valuable for its attention to the processes and media of communication, from the women’s magazines, radio broadcasts and educational films to the political unions and informal word-of-mouth exchanges that have shaped the practice and meaning of psychoprophylaxis since the 1950s.
The book is organised chronologically into seven chapters. The first half chronicles the development of psychoprophylaxis in the USSR, and then in France where it was more commonly known as l’accouchement sans douleur. The latter half takes a more explicitly transnational approach, crisscrossing the Atlantic in order to explain why and with what consequences the method gained traction, and how its practice adapted to different times and places. The United States, which has come to symbolise the trend towards what anthropologist Robbie Davis-Floyd has termed the ‘technocractic’ model of birth, necessarily serves as a touchstone.(2) It was in the United States that the ‘medicalisation of childbirth’ was defined as a historical phenomenon, largely by the second-wave feminist accounts that grew out of the women’s health movement of the 1970s. Other historians have touched on the significance of psychoprophylaxis in reshaping the management of childbirth in post-war America. But the particular strength of Lamaze is that Michaels encourages us to view both the American experience and transformation in childbirth in international perspective. This approach is particularly instructive not only because it allows us to appreciate how far present-day childbirth practices are products of transnational exchange, but also because it illuminates the contingency of the meanings and values that have been attributed to them.
Michaels uses the first chapter to orient the reader in the historical literature on childbirth, and also to introduce the best known precursor to the Lamaze method, advocated by the British obstetrician Grantly Dick-Read. In a 1933 book, Dick-Read proposed an alternative to the conventional, highly drugged, physician supervised way of birth common among Western women of privilege. ‘Natural childbirth’, also known as the Read method, hinged upon the premise that fear lay at the root of pain in labour. Through prenatal education and relaxation exercises in preparation for labour, Dick-Read insisted, women could conquer fear and thus give birth in comfort without resorting to anaesthetics. Natural childbirth made most impact in the Anglo-American context, particularly in the United States, where Dick-Read found an especially receptive audience. Michaels locates the popularity of natural childbirth among American women in the shifting gender ideologies of post-war consumer culture. Part of the appeal of the Read method was that it encouraged husbands’ participation in prenatal education classes, support that advocates considered essential for preparing expectant mothers to approach childbirth with joy rather than with anxiety. This aspect of natural childbirth spoke to the post-war American ideal of satisfying marital partnerships and emotional and physical security in the wake of wartime separation and under the shadow of the atomic bomb.
Grantly Dick-Read would later charge that Soviet obstetricians had plagiarised his work, refusing either to see any validity in psychoprophylaxis or to engage with Lamaze, a hostility framed by his vocal anticommunism. But Michaels convincingly argues that Soviet developers of psychoprophylaxis arrived at their method independently. Chapter two helps us to understand the conditions in which psychoprophylaxis could become, by 1951, the standard method of pain relief in all Soviet maternity wards. Grounded theoretically in physiologist Ivan Pavlov’s concept of conditional response, what became known as psychoprophylaxis was one of several psychological methods of pain relief to emerge from Soviet medicine during the late 1940s. The method offered an attractive alternative to pharmacological anaesthetics amidst medical personnel and pharmaceutical supply shortages in an immediate post-war era in which maternal care was a low priority for the central authorities. This was also an atmosphere in which science and medicine was highly politicised and scholarly research had to pass ideological muster. Psychoprophylaxis rode a wave of Soviet enthusiasm for Pavlov; around the centennial celebration of his birth in 1950, Pavlovian physiology became an essential component of medical teaching and research. Advocates of PPM found in Pavlov not just a theoretical framework for explaining how cortical function could be mobilised to suppress pain, but also a valuable rhetorical tool for promoting a method under the restrictive ideological conditions that governed science under Stalin. Psychoprophylaxis was materially feasible on a mass scale, Michaels explains, and thus fitted within a broader state strategy to present the Soviet government as a benevolent protector of proletarian women.
Turning to France, Michaels highlights the significance of the French Communist Party (PCF) and affiliated organisations, especially women’s unions, in spreading word of psychoprophylaxis as a symbol of the achievements of Soviet science. There are some fascinating passages in chapters three and four describing the entanglement of both national and international politics with efforts to promote the technique and its alternatives, notably the Read method. Lamaze and his supporters were ultimately more successful than Read in continental Europe, Michaels points out, because they were able to rely on the ready-made PCF networks to promote psychoprophylaxis. The Leftist internationalism implied by PPM, she suggests, perhaps also appealed more to French audiences than the virulent anticommunism of Dick-Read. In 1956, the French National Assembly adopted a PCF proposal to secure funding for psychoprophylactic preparatory courses through state social security. This accelerated the integration of the method into mainstream medical practice; by 1961, an estimated 30 per cent of French women chose to use psychoprophylaxis in labour. Michaels is nevertheless careful to show that the psychoprophylaxis popularised in France and elsewhere by Lamaze and his supporters was no direct replica of the Soviet method, but was constantly remade to suit local conditions. For instance, compared to their Soviet counterparts, French advocates of PPM stressed the benefits of more detailed and prolonged prenatal instruction and, more radically, aimed to give husbands enlarged roles as active members of the birthing team.
This core theme of the book, that psychoprophylaxis was never static, but a method constantly in flux, is brought out most evocatively in chapters five and six. These are largely concerned with the contrasting fortunes of psychoprophylaxis in France and the USSR, where it went into relative decline, and in the United States, where the method gained ground with remarkable speed. Michaels offers a fascinating analysis of the promotional strategies of the American Society for Psychoprophylaxis in Obstetrics (ASPO), which proselytised for the ‘Lamaze method’ amid fierce – and often anti-communist-inflected – criticism of psychological approaches to pain relief in the medical and popular press. ASPO built on foundations laid by the earlier success of the Read method, and so what ultimately emerged in the United States was a synthesis of natural childbirth and psychoprophylaxis quite different from what was practised in either the USSR or France. Perhaps the most enlightening section of the book concerns how new meaning was brought to psychoprophylaxis by the counterculture and feminist movements of the late 1960s and 1970s. As the rejection of obstetric anaesthesia became increasingly central to American second wavers’ vision of an empowered birth, the Lamaze method enjoyed considerable success even beyond the Northeastern cities where it had made its initial impact. In stark contrast, French feminists came to challenge psychological approaches, pushing instead for greater access to pharmacological pain management. The book is also excellent in general on the ways in which both the Lamaze method and what counted as a desirable birth experience were transformed through interaction with other approaches to pain management and medical technology, understandings of female psychology and the mind-body connection (especially those offered by Freudian psychoanalysis), consumer pressures and wider social shifts.
Another key strand in the book is Michaels’ exploration of women’s agency, a major concern of much recent historical writing on childbirth. She places women’s voices centrally, not only to paint a rich portrait of psychoprophylaxis as a lived experience, but also to recover women’s pivotal roles in the promotion and adoption of the method. Yet the international perspective offered by Lamaze allows us to appreciate the political, social and material constraints within which such agency could be exercised. As Michaels emphasises at the outset, the ‘typical’ woman who was drawn to the method differed markedly. In France, it was mostly working-class and Left-leaning women; in the United States, mostly well-educated, married and white women of the middle and upper classes. But in the USSR, she argues, women did not choose psychoprophylaxis but had it imposed upon them by a central government unable or unwilling to provide widespread access to alternative methods of obstetric pain relief. Michaels also attends closely to the contingency of concepts of agency and autonomy. For instance, even as some advocates in the 1970s found in Lamaze a means for labouring women to secure greater control over their bodies and faculties, others saw psychoprophylaxis as merely preserving physicians’ power unchallenged. Michaels returns to these issues in an overtly polemical, though nuanced, epilogue in which she enters into contemporary debates about maternity care in the United States. She is clearly sympathetic to the moderate present day position on the use of pharmacological pain relief by Lamaze International (formerly ASPO). Michaels advocates for a more empowered, care-driven way of birth, but is perhaps appropriately tentative in delineating what this would mean in practice.
Lamaze raises questions it cannot reasonably be expected to answer and it would be unfair to ask such an ambitious and thought-provoking work to do much more. However, the transnational scope of the book did lead me to reflect on the slippage between the terms ‘international’ and ‘global’. The former performs work as an actors’ category, capturing something of both the internationalism evident in Leftist efforts to promote psychoprophylaxis in the post-war USSR and in France and to a slightly lesser extent in the American women’s health movement. It is also relevant to the international ambitions of the various organisations and congresses set up to facilitate discussion among the physicians, childbirth educators and psychologists who favoured the method. When Michaels describes Lamaze as ‘going global’ in chapters five and six, she is largely referring to the success of psychoprophylaxis in the United States. The book offers the occasional glimpse of the reception of psychoprophylaxis beyond its core strongholds; for instance, in the illuminating discussion of one French-Algerian doctor’s contention that psychoprophylaxis was more successful among Arab women than Europeans because of their supposed ignorance and suggestibility. This passage did lead me to wonder whether the long-term fortunes of Lamaze could be sketched on a more genuinely ‘global’ canvas. With this in view, there are perhaps comparisons to be drawn between the global circulation of the ‘bible’ of the women’s health movement, Our Bodies, Ourselves, and the more limited reach of psychoprophylaxis.(3) Was Lamaze’s appeal, as Michaels implies, largely confined to affluent women of the ‘global North’? More parochially, it would also be interesting to learn more about how Lamaze fared in Britain where, as in the United States, it was in closer competition with the Read method.
In showing us how expectations about safety, dignity, control and power in maternity care have been reconfigured by both national and international influences, Michaels has succeeded in producing an innovative, refreshing and insightful book. Lamaze tells us much not only about the history of childbirth, but also Cold War politics, the communication of knowledge across borders, and social change in three very different post-war settings. It deserves a wide readership.
Notes
- James A. Secord, ‘Knowledge in transit’, Isis, 95 (2004), 654–72.Back to (1)
- Robbie Davis-Floyd, ‘The technocratic body: American childbirth as cultural expression’, Social Science and Medicine, 38 (1994), 1125–40.Back to (2)
- Kathy Davis, The Making of Our Bodies, Ourselves: How Feminism Travels Across Borders (Durham, NC, 2007).Back to (3)
Elisabeth Bing—physiotherapist, childbirth educator, and cofounder of the American Society for Psychoprophylaxis in Obstetrics (now Lamaze International)—is well known to most childbirth educators in the United States. She has been a true pioneer in the education of parents for pregnancy and birth. Her book, Six Practical Lessons for an Easier Childbirth, served to guide many parents and childbirth educators in the use of the Lamaze Method for labor and birth. She has prepared a countless number of parents for their birth experience in both her hospital classes in the 1950s and 1960s and in her private classes in the “studio” of her New York City apartment building, where she began teaching in the 1960s and continues to teach today. Elisabeth is beloved by all those who have had the opportunity to meet her or work with her. She has created a legacy that will continue for decades to come.
I remember clearly the first time I saw her. I believe it was in the spring of 1968. As I walked into the auditorium in Dayton, Ohio, where I had traveled to attend her workshop, I was immediately fascinated with her appearance and her warm manner. When she spoke, I was mesmerized—she was delightful, her accent so charming, and her message everything I believed about childbirth. I had heard about Elisabeth Bing because I owned her original training manual in psychoprophylaxis (“the red manual”) that had been the “bible” for many childbirth educators at that time (Bing, Karmel, & Tanz, 1961), followed by Elisabeth's well-known book, Six Practical Lessons for an Easier Childbirth (Bing, 1967). By the end of the workshop she had become my idol, the role model for what I wanted to become as a childbirth educator. I could not believe that I was actually seeing this pioneer “in person.” I wanted to be “just like her”—to teach pregnant women the techniques of the Lamaze Method just as she had taught the techniques to those attending the workshop. I wanted to stimulate and motivate others as she had motivated me. I had just begun teaching childbirth classes in Columbus, Ohio, and was pursuing my certification through ASPO. Elisabeth's workshop was to serve as my “training seminar” and, thus, Elisabeth was my “trainer.” That day, I had no idea that we would become professional colleagues and develop a friendship that has lasted 31 years, and I feel so blessed. And despite the fact that I have developed my own career and have learned that none of us can be “just like” another, Elisabeth continues to be my mentor and inspiration, just as she is for many of you who will read this article. I am so pleased to have the privilege of sharing our conversation with The Journal of Perinatal Education. This interview took place in October 1999 during the Lamaze International annual conference in Toronto.
The Interview
Elaine Zwelling: I know people will be interested to know about your background. Describe your early years and your family life. Where were you born? When and why did you come to the U.S.?
Elisabeth Bing: I was born in a beautiful house in a suburb of Berlin. It was a home birth, as were all my mother's births. I was the fourth of five siblings—three girls and two boys. Apparently I came so fast, being the fourth birth, that the doctor didn't make it. But the midwife was there. I was born the month before the first World War broke out. Because my father volunteered to go, I really didn't see much of him the first 4 years of my life. On the whole, I think I had the most wonderful childhood imaginable. My parents were absolutely marvelous. They did an enormous number of things with us—bicycle trips, boating trips, and skating on the river in the winter. They helped us with our homework. So it was a very stimulating childhood.
I left Germany when I was through high school at age 18 because Hitler had taken over the country. Before I left, my mother sent me to a “household school” because she felt I should learn something about how to keep a house. (I remember I got a failing grade in ironing or something like that!) Soon after that, in September 1933, I left for England and was the first one of the family who managed to get out of Germany. My father had died in 1932, but my mother and older brother had the foresight to see that trouble was brewing, and since my parents were of Jewish descent it was best that we all get out. My parents had converted to Protestantism years earlier and I was raised as a Protestant, but of course that didn't matter to the Nazis. We were fortunate, for none of my immediate family lost their lives. So I went to England with the idea of becoming a physical therapist.
Zwelling: Did you always want to be a physical therapist? Describe your early professional training and what you did in your early career.
Bing: I actually had the idea to become a physical therapist while still in Berlin. Right after high school I tried to join the university there and start the course, but I was asked to leave after 3 days because of my Jewish heritage. So I went to England, but because it was very difficult to take any money out of Germany at that time, I first had to take a job as a student nurse in a hospital for rheumatic diseases in the Midlands of England. If you were a student nurse for a year, your physical therapy training was much cheaper. While I was there I fell ill and had to have some surgery. I was told that because of this I had to leave. I went to London and by this time my family managed to get enough money out of Germany to enable me to apply for a school of physical therapy there. My training took about 3 years and I became a member of the Chartered Society of Physical Therapy. After that I had several jobs with doctors in their offices and with hospitals. My patients were paraplegics, hemiplegics, or had such things as Bell's palsy, fractures, and multiple sclerosis. I had nothing to do with obstetrics at that point and in fact had not even had reproduction or obstetrics included in my training course.
Zwelling: When did you begin working in obstetrics? How did that become an area of interest?
Bing: My introduction to obstetrics came because in one hospital where I worked we had to go to the maternity floor the first thing in the morning when we came on duty, to give exercises to women who had just given birth. At that time they were keeping postpartum women in bed for 10 days and they were not allowed to even put their feet on the floor. So the physical therapists had to give them exercises and massage. I also had a part-time private practice in my apartment at that time, and I had a patient who was an elderly lady who I loved very much and I always told her about my work. She then told me about a book that she'd just come across that she thought might interest me. It was Grantly Dick-Read's Natural Childbirth (Dick-Read, 1933). When I read it, I thought it really made a lot of sense for women to learn more about their birth before they delivered and to be given exercises during pregnancy as well as afterwards. So I wrote to Dr. Read and asked if I could come and learn from him. This was in 1939 and the second World War had just broken out. Dr. Read wrote back saying he would love to have me come, but he had just been called up to serve in the war. But he suggested I get in touch with a physiotherapist who had been working with him, named Helen Herdman. She had written a little booklet on natural childbirth. Unfortunately, she was in the North of England, and at that time it was not possible to travel because the bombs were falling. So I had no way of getting to her. I therefore decided to teach myself. I got some obstetric books and studied. I also asked at the hospital where I was working if I could observe some births. I was given permission if I would do it on my own time. What I saw I disliked intensely and I thought there must be better ways. It was very frightening and upsetting to me. The women either had very heavy anesthesia or nothing at all. They were entirely out of control. And they were treated very roughly. But I couldn't do very much more about it at that time because of the war, which took all one's energy. I had to do some community jobs like fire watching and ambulance driving and that kept me very busy.
What I saw [when I observed my first births] I disliked intensely and I thought there must be better ways…. The women either had very heavy anesthesia or nothing at all.
After the war in 1949, my eldest sister, who had married an American and moved to the United States, wrote and asked me to come and look for jobs in the U.S. I came and stayed with them in Jacksonville, Illinois, where she and her husband were teaching at a college. I got a job working with handicapped children. One day we were invited to a party at someone's home. I met an obstetrician that evening and asked him if he knew anything about natural childbirth. He said, “No, not much. Do you?” I said, “Not much.” Then he replied, “How would you like to try it?” I was almost speechless and I said, “Yes, please!” He sent me all his patients and he allowed me to train them in the Read method and coach them through labor. I was doing this with individual women, not in group classes, and fathers were not involved yet at this time. So I learned by doing it. I enjoyed it and learned an enormous amount. I did that for a couple of years.
Zwelling: When did you begin teaching group classes? How did you get involved?
Bing: After a couple years in Illinois I wanted to get back to England … I was homesick. When I came to the U.S. I had bought a return ticket, just to make sure I could get back. But I also wanted to see a bit of the country first. I had good friends in New York, so I stopped there to spend some time with them. While there I met Fred, my husband, and we were married about a year after that. And I'm still there! Jobs in New York were poorly paid at that time, so I decided to specialize in teaching childbirth education. I went around from one obstetrician to another to introduce myself, and tell them about what I had been doing the past 2 years training pregnant women, and I asked them to send me their patients. And one by one they began to come to me. Then I got terribly lucky, for one of the doctors recommended me to Mt. Sinai Hospital, which had just opened their first maternity department. The Chief of Obstetrics, Dr. Alan Guttmacher, hired me. He was a very prominent obstetrician and a great Jewish scholar. So that's when I became “respectable.” I taught at Mt. Sinai for 8 years. The doctors there sent their patients to my class and I also worked with clinic patients in large groups.
Zwelling: How did you hear about the Lamaze Method? What training did you have in psychoprophylaxis? And how did you develop the course of “six practical lessons” that we have all become so familiar with?
Bing: Even though I was teaching Read's method, I had been hearing about the Psychoprophylactic Method (PPM). I read the book on PPM by the Swiss doctor Isidore Bonstein, who was in Cleveland for 3 months (Bonstein, 1958). I asked Dr. Guttmacher if I could go to France to learn more about the method, but he said they did not have the money to send me there. Then I came across Marjorie Karmel's book, Thank You, Dr. Lamaze (Karmel, 1959). I called her publisher to get in touch with her because her book inspired me. The book had just been out for 2 weeks when she called me and said, “You're the person I need, because since my book has been out I've been overwhelmed with demands from women asking where they can learn the method. You're going to teach it!” Marjorie taught me the psychoprophylactic method just as she had learned it from Dr. Lamaze and Madame Cohen in Paris. It wasn't too hard for me to learn it, for I'd had almost 10 years of experience teaching the Read method by this time. I went to Dr. Guttmacher and asked if I could switch to teaching the psychoprophylactic method and he said, “Yes … If you think it's better, then you should teach it.” He had met Dr. Lamaze at a conference in Paris. I thought it was really wonderful of him to say that. So, I began teaching it.
One time, though, I was called on the carpet at Mt. Sinai Hospital. They made me appear at grand rounds before 150 people—the whole obstetric staff—because some of the doctors had complained about me. Dr. Guttmacher tried to arrange a private meeting in his office, but these doctors would not hear of it—they wanted it to be public. I called the doctors that I knew were on my side and I asked them to be at the meeting, because I felt they were going to attack me. And they were there! When the meeting started, Dr. Guttmacher said that the question of prepared childbirth would be discussed, but if anyone attacked Elisabeth personally they would have to deal with him. And so I was not personally attacked and prepared childbirth classes were discussed in a lively debate, and I was in the end allowed to continue to teach.
Zwelling: How was ASPO born as an organization and how did you become one of the founders?
Bing: In 1960, the doctors we'd been working with met with Marjorie and me in her apartment and we founded the American Society for Psychoprophylaxis in Obstetrics. I think the people who attended that first meeting were Dr. Heinz Luschinsky and his partner Dr. Jean Anderson, Dr. Benjamin Segal, Dr. Irving Avelow, Dr. William Rashbaum, Dr. Alfred Tanz, and Dr. Irwin Weiner. It started as a physicians' organization, a medical society. Marjorie and I were allowed to be there, but we could not vote. The other original nonphysician members at that time were Ellie Rakowitz and Cecilia Worth. Then it eventually became a tripartite organization with three divisions. The idea for this came when Khruschev came to the United States for the meetings at the United Nations. He talked about three divisions of the Russian government. Dr. Luschinsky said, “This is what we need for ASPO—three divisions: Physicians, Parents, and Professionals.”
Zwelling: How was it that at that time you were able to find this many physicians in New York City who were willing to become involved in this? Why were they interested?
Bing: It was amazing. These doctors were prepared to stick their necks out even though there was a lot of opposition from their colleagues at that time to “this crazy fad” and probably because of the climate of the times as well. I think they were uneasy about the overmedication of women and they probably had the same feeling that we had—that there must be better ways. One also has to understand that it was probably the times as well. It was a time when there were many changes going on—women's lib, the Vietnam war, the “flower children,” the freedom rides, etc. People seemed to say, “We have to change things; things are not good enough.” Prepared childbirth was easy to introduce in a way because the atmosphere was right.
Zwelling: It must have been an incredibly exciting time.
Bing: It was. I was constantly stimulated and motivated. It was all very new to me. I did not plan anything like that. Life just sort of took me into it. It wasn't that I had decided once I was in this country that this was what I was going to do. Things just happened, and I was there at the right moment, and I stayed with it.
It wasn't that I had decided once I was in this country that this was what I was going to do. Things just happened, and I was there at the right moment, and I stayed with it.
Zwelling: What made you stick it out? There must have been times when you wanted to give up.
Bing: Oh, yes, there were! I would feel “What's the good?” On the other hand, the doctors that were in on it from the beginning never let me down. They stayed in it—they continued working with us, and eventually physicians from all over the country joined our group. So the whole movement grew, and soon it wasn't just a group in New York City, but there were groups in Los Angeles and then all over the country.
Zwelling: How did your career evolve then? You have become known as the “Mother” of the Lamaze Method in this country. How did that happen?
Bing: I began to travel a great deal lecturing, as you know. I wrote articles and appeared on TV shows like Barbara Walters and Phil Donahue and others. I also gave talks on radio. Whenever I gave a talk in a community, I was always asked to be on radio or TV. The publicity at the time was very good. At that time prepared childbirth was really news. It was fun and I enjoyed it. One day I had a father in my class who was an editor with Bantam Books. He told me I should write a book describing my classes, but I said “No!”, that I couldn't write. He said, “You're going to write it and we'll call it Six Practical Lessons for an Easier Childbirth.” And that's how the book came about. And it's still in print, which I find unbelievable (Bing, 1967). But I must mention also that I had a husband who supported me, baby-sat after my son Peter was born in 1955, and encouraged me in every aspect of my work.
Zwelling: I want to talk about challenges. What were the challenges in those early years? What do you see as the greatest challenges for childbirth education in the 40 years you've been involved? What are the challenges today?
Bing: The challenges early on were that both the physicians and nurses felt very threatened. Not by me so much, but by parents who were suddenly very knowledgeable, who were asking questions, and who were demanding certain things in regard to their birth experience. This was the big difficulty at first. Also, because there were other emerging organizations that called prepared childbirth such names as “Childbirth Without Pain” or “Natural Childbirth” and so we were accused of causing a lot of anxieties and feelings of guilt if anyone accepted medication. In my lectures, I made a special point of saying that there should never be feelings of guilt if a woman accepts medication. I really had to cope with this within myself. I hope I never made anyone feel guilty.
Today, the challenges are different. In former times, we fought for humanizing obstetrics and we have been quite successful. We raised the conciousness of care givers and made them realize that every woman giving birth is a tremendous human experience. The new challenges are that the medical profession seems to want us out of the picture. The epidural, even the so-called walking epidural, are viewed as wonderful ways of taking away pain. As one of the doctors said to me, “Elisabeth, all of our patients are smiling now.” This has brought me personally to ask the questions, “Who am I to say that they shouldn't have that crutch? Why should they have to work so hard?” I was looking for some very good reasons why somebody should not accept help that is comparitively safe. But then I came to the point that it isn't just the epidural—it's the attitude towards childbirth which is, even more than it used to be, that it's a disease from which women have to be cured. Everyone is viewed as high risk. There is nothing accepted anymore by the medical profession that childbirth is part of a woman's life, of her inner experience, or of her development. Even with regard to the pain—there is no satisfaction achieved because the woman does not have to work for anything. We've minimized the sense of achievement one obtains when mastering a difficult experience. Now I think it's not the method that is at issue, but it is to be allowed to trust one's body and work with one's body.
We've minimized the sense of achievement one obtains when mastering a difficult experience. Now I think it's not the method that is at issue, but it is to be allowed to trust one's body and work with one's body.
Zwelling: What do you see as your greatest accomplishment? What would you like people to remember about you and your work?
Bing: I personally get satisfaction when people stop me on the street and say, “Hi, Elisabeth! I was in your classes 29 years ago.” It does show me that, as the psychiatrists say, childbirth is a peak experience, and it stays with you no matter what else happens to you in your life. If I have helped people feel good about birth and about themselves, then I'm satisfied. Surely they must feel that way if they still remember me 29 years later and want to say hello. This happens often enough that I feel that perhaps I have really done something meaningful. I'm sure they wouldn't stop me on the street if they saw me and thought, “Oh, there is that awful woman who made us learn those breathing techniques!”
Zwelling: What is your greatest frustration?
Bing: The greatest frustration at the moment is due to my physician colleagues and myself not working as a team anymore. We seem not to be talking to the medical profession at all. We're not really talking to the parents either. Communication among the key people who are involved in the childbirth experience has almost disappeared.
Zwelling: When we talk to parents, what they tell us is that they want an epidural. Is this disappointing or discouraging to you?
Bing: Of course they want an epidural. They were born into the computer age and they accept being wired up. This does not look as crazy to them as it does to you or me. They take this absolutely for granted. They believe it's safer and, if not used, perhaps the baby wouldn't be OK. And yes, this is very discouraging. If I think about it very much, I do get discouraged. But then I have my classes and I teach the parents, and I get enthusiastic again and I forget about it. And of course the interest in the epidural depends on the group you're teaching—some are far more interested in it than others.
Zwelling: What do you see for the future? In view of the epidural and the interventions, does childbirth education still have a place?
Bing: I don't know what I see for the future … I know I've been asked that a number of times, but I can't look into the crystal ball. All I know is that the parents I'm teaching now have the same anxieties they had 40 years ago, and my feeling is that they will have the same anxieties 40 years from now. So the childbirth educators who we are training now will have the same responsibility and I feel they should have the same dedication to helping women through this wonderful, but often quite difficult, period in their lives. I don't think this is something terribly new, because if you think of women in more primitive societies, they never had to do it just on their own—there was a tradition there. There were unwritten rules of behavior and laws. I think no matter how much we hook people up to machines, the anxiety will still be there.
Oh, yes, childbirth education still has a place! There's no question about it. And there are so many new areas for us to be involved in—breastfeeding, postpartum, and parenting. I think our whole field has enlarged tremendously, and obviously it's become very interesting that way. But, even though we've widened our horizons, we must not forget to teach the relaxation and breathing techniques to help women cope with pain. Women still need to know what to do with their bodies during pregnancy, labor, and birth. It's wonderful to go off in all these other directions, but we should not forget these basic needs. I'm sad when I see that this is happening.
Oh, yes, childbirth education still has a place! There's no question about it.
Zwelling: Tell me about your family and your life today. What are your leisure-time pleasures?
Bing: My son, Peter, who is now 44 and an Assistant Professor of Classics at Emory University, is in Cambridge, England, for the academic year doing research and writing. His wife, Mary, is a doctor with the CDC in Atlanta in the Department of TB Research. And my little granddaughter, Anna, is now 4 3/4 and is just starting preschool. She is taking cello lessons because she thinks every grown-up plays the cello. Both her grandmothers and her aunt play the cello, and her mother plays the trombone. I play in a string quartet every other week where we are coached. And of course I'm still teaching my Lamaze classes once or twice a week in my studio. I also go to exercise class twice a week. And I travel extensively—I go to England twice a year, as well as take other trips. And I love to read, read, read!
Reflection
Although I already knew much of what Elisabeth shared with me that sunny, fall afternoon in Toronto, several things had particular meaning as we talked and have continued to stimulate my thinking as I've contemplated Elisabeth's role in this history of childbirth education and what her example might mean for us today.
The dedication of Elisabeth and the other women who started ASPO (Lamaze International) was incredible. Their experiences were very similar to what many of ours have been—balancing the multiple roles of professional commitments while, at the same time, nurturing marital relationships and raising young children. And yet they volunteered countless hours to starting an organization that would champion a cause that has endured for 40 years—the education of childbearing women, the advocacy of women's rights to have the childbirth experience they desire, and the reform of the maternity care system in this country. Elisabeth and her colleagues set the stage for what so many childbirth educators have continued to this day. Lamaze International remains successful because of the countless hours of dedication and work by women who share the same passions as its founders did.
Even though discouraged at times, Elisabeth has never given up. She remains positive, upbeat, and enthusiastic. In a 40-year span, there have been many challenging issues, any one of which might have induced her to say, “Oh, what's the use? I give up … it's just not worth it!” And how many times have each of us had those same thoughts and frustrations? I wonder … is it possible to work for any “social cause” and not be discouraged at times? Probably not. So, what is it that keeps us going? Perhaps those of us who have endured are somewhat stimulated by the challenges and the roadblocks. Or perhaps we are all just stubborn! And, of course, we are committed to our mission of creating positive pregnancy and birth experiences for families. So, thank you Elisabeth, for the example you have set for all of us! If we can all remain committed to this mission until we are in our 80s, there will no doubt continue to be challenges, but think of the progress that will also be made! I feel so grateful to have had Elisabeth in my life as a teacher, role model, and friend!
References
- Bing E, Karmel M, Tanz A. 1961. A practical training course for the psychoprophylactic method of childbirth. New York: American Society of Psychoprophylaxis in Obstetrics.
- Bing E. 1967. Six practical lessons for an easier childbirth. New York: Grosset & Dunlap, Inc.
- Bonstein I. 1958. Psychoprophylactic preparation for painless childbirth. London: Heinemann Medical Books.
- Dick-Read G. 1933. Natural childbirth. London: Wm. Heinemann Medical Books.
- Karmel M. 1959. Thank you, Dr. Lamaze. New York: J. B. Lippincott Co.