Penny Simkin, a former physical therapist who was inspired to redirect her training toward childbirth, helping spark the doula movement that offers assistance during delivery and afterward with postpartum care, died April 11 in Seattle. She was 85.
The death, at the home of one of her daughters, was announced by the doula group she co-founded, now known as Dona International. She had pancreatic cancer.
Ms. Simkin’s advocacy for the acceptance of doulas — a name derived from a Greek word for a female servant or helper — also made her a voice of change to expand U.S. medical insurance and call attention to childbirth trends, including a rise in caesarean deliveries. Doula services are now covered by many private insurers and in a growing number of state plans.
“Birth never changes,” said Ms. Simkin. “But the way we manage it and the way we think of it has. Right now, we’re in a culture of fear around birth.”
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Ms. Simkin’s interest in assisting in childbirth was kindled by watching physical therapists in Britain in the early 1960s use their techniques to help mothers through labor and delivery. When she returned to the United States, she answered an ad in Seattle seeking people to teach childbirth education classes.
She became one of the early proponents of reviving the ancient tradition of doulas, who see their role as different from that of midwives. Doulas focus on the immediate physical and emotional care of pregnant people, while midwives mostly manage the medical aspects of birth. In the United States, the group co-founded by Ms. Simkin (formerly known as Doulas of North America) has trained more than 5,000 doulas since the early 1990s, and other organizations have brought thousands more into the profession.
“Rhythm is everything in labor,” Ms. Simkin told NPR’s “Morning Edition” in 2002, “and so I’m trying to match her rhythm and help her maintain it.” That could mean providing massages, leading breathing exercises or helping with alternative positions, such as squatting, to ease delivery. After a birth, doulas’ work may include helping with the adjustment breastfeeding.
Ms. Simkin’s early promotion of doulas found a niche within the natural childbirth movement in the 1970s. Ms. Simkin, too, favored birth without drug interventions such as epidurals. Yet she was not dogmatic. If someone picked pain-curbing pharmaceuticals during delivery, a doula should support that call, she said.
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Where Ms. Simkin became strident was with doctors and other medical professionals. She believed that contemporary medicine often turned too quickly to surgical options such as caesarean births and was gradually losing older techniques such as how to turn a breeched baby.
“My specific concerns in this area,” she said, “include the escalating medical malpractice insurance rates and the effects of huge settlements on medical decision-making [such as] the rapidly rising caesarean birthrates.”
She also explored the potential emotional toll on women when “they can’t give birth themselves” and surgical teams step in. “I’m so sad that women think birth is impossible. … I want people to appreciate how well their bodies are designed to give birth,” she once said. “Every cell in your body knows how.”
Women helping women
Penelope Hart Payson was born on May 31, 1938, in Portland, Maine, and was raised in nearby Yarmouth. Her parents owned a hardware store.
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She graduated in 1959 from Swarthmore College in Pennsylvania with a degree in English literature. After receiving a certificate in physical therapy from the University of Pennsylvania in 1961, she moved to Britain with her husband while he advanced his medical studies.
At one point, she watched a group of physical therapists helping women through labor and childbirth. The simplicity impressed her. She returned to the United States — settling in Seattle — and considered ways to retool her physical therapy training for pregnancies and the birthing process.
“This role has not been filled since birthing moved into the hospital,” Ms. Simkin told the New York Times in 1992, the year she and four others founded Doulas of North America. “Before that, women always were helped by other women.” (The co-founders along with Ms. Simkins were Phyllis Klaus, a psychotherapist, and her husband, Marshall H. Klaus, a neonatologist; Annie Kennedy, a maternal-health advocate; and John H. Kennell, a pediatrician.)
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Phyllis Klaus later joined Ms. Simkin in researching the birth experiences of women who had been sexually abused in the past. Among their questions was whether hospital settings, including possible intimate interactions with strangers, could open feelings of vulnerability or uneasiness.
Their book, “When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on the Childbearing Woman” (2004), was among six books authored or co-written by Ms. Simkin. She also launched an organization called Prevention and Treatment of Traumatic Childbirth.
“Pregnancy, Childbirth and the Newborn: The Complete Guide,” first published in 1984 by Ms. Simkin and co-authors Janet Whalley, Ann Keppler, Janelle Durham and April Bolding, has sold more than 1 million copies.
Ms. Simkin’s husband, Dr. Peter Simkin, died in 2022. Survivors include four children; nine grandchildren; and five great-grandchildren.
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T-shirts worn by doulas trained by Ms. Simkin’s group have carried her motto — “How Will She Remember It?” — as a message to hospital staff in maternity wings. She also spoke of doulas’ extended responsibility to the infant and the mother’s partner.
“It’s a moment that I never am tired of witnessing,” she said, “and I feel that we’ve played a role in facilitating this relationship among the three of them.”
