Real Midwives of D.C. In Washington, natural birth is big business

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Whitney Pinger, GW's director of midwifery services
Photo by Darrow Montgomery

The three dozen parents-to-be at the George Washington University Medical Faculty Associates building on a recent Tuesday night fill the lobby’s waiting room seats and overflow onto office chairs that have been dragged into the room for the occasion. By all appearances, it’s a high-end D.C. crowd: Suits and spectacles, ages that range from the middle years of childbearing to the late ones. There’s copious note-taking about birth outcomes, labor options, and this particular practice’s set of rules—No sugar! No processed foods! Daily exercise!—for natural childbirth.

Welcome to “Meet the Midwives” night at one of Washington’s newest, most talked-about labor-and-delivery operations, a place where the admissions process can be as coveted as that of the most pedagogically up-to-date preschool.

Midwifery once evoked images of giving birth at an organic farm, but GW’s Wisdom Midwifery works in a hospital setting—low-tech and high-touch, sure, but just steps away from cutting-edge medical expertise. In an age that fetishizes slow food and iPhones, it’s a potent combination.

In its 16 months at GW, the practice has grown from one nurse-midwife delivering 10 babies a month to four of them delivering 30, the maximum their time-intensive model can handle. There are plans to hire a fifth midwife. Meanwhile, there’s a waiting list out to July, and most months already have the maximum of 10 people on the list. Some women say they call Wisdom the day they find out they’re pregnant.

Tonight, the pitch is simple: Instead of being hooked to an IV in a hospital bed, Wisdom’s moms can labor in an aqua tub, take warm showers, receive massages, and move around into different birth-facilitating positions (one of the midwives pops into a squat to demonstrate). Rather than discussing epidurals, there’s talk of raising natural oxytocin levels through yogic heart-opening. And there’s a promise that the midwife—“birth provider,” in 2011 terminology—will be on hand through it all, rather than simply arriving for the big finale.

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“We’re in the business of giving women what they want,” says Whitney Pinger, GW’s director of midwifery services. “They don’t want to fight to get what they want. We are their birth plan.”

Among a network of holistic-minded mamas who chat in Washington’s yoga studios and childbirth education classes, Pinger doesn’t even need to use her last name. In online maternal message boards, her work gets described in capital letters. “I absolutely LOVE her. Whitney is amazing in every way,” gushed a member of DC Urban Moms in a recent comment. The 51-year-old certified nurse midwife is a veteran of the local scene. After running programs at Washington Hospital Center and Georgetown University Hospital, she came to GW last year, arriving like the LeBron of the up-market natural childbirth community.

You’d imagine Pinger’s practice appeals to those expecting mothers who admire her collaboration of crunchy and clinical. But at the Foggy Bottom medical center, she’s also demonstrated her standing among hospital administrators. They’ve come to see her as a practitioner who brings the sort of devoted following that allows a new practice to grow with little formal advertising.

Pinger is thus a pretty good example of how midwifery has become a significant business. She sensed the demand after she started Wisdom as a pilot project at Washington Hospital Center. It grew beyond what the facility could handle, so she looked for another home. GW bought in. (Since the move, the practice has officially been known as Midwifery Services at George Washington University Hospital.) In addition to the medical and teaching benefits, the logic went, a practice like Pinger’s also promised to bring new patients into the GW system—patients that are educated, privately insured, and likely to be making their family’s medical decisions for the next 18 or so years. That’s the sort of stuff that can make a calculator-wielding hospital administrator go all touchy-feely.

Pinger’s argument at the open house is simpler: “We have amazing outcomes,” she tells the expecting couples. “Among the best in the country.” About 95 percent of her clients deliver vaginally, 80 percent without any intervention. Wisdom’s cesarean section rate is approximately 5 percent, vastly lower than the nation’s rate of 33 percent.

It’s not just Pinger. Midwives across the area say they’re having a moment. Though the percentage of births they handle remains small—nationally, they do just 8 percent of the country’s annual 4 million births—midwives beyond Pinger’s cadre report a new interest in their service. Pinger’s former employer, Washington Hospital Center, didn’t have room to accommodate Wisdom last year, but has brought on two full-time and three part-time midwives since Pinger left; its new service can accommodate 30 women a month. “Midwifery has gone mainstream,” says Ursula Sabia Sukinik, a local doula, midwife assistant, and childbirth educator. (Full disclosure: I took a childbirth class with Sukinik earlier this year.)

In fact, demand right now seems to outpace supply. At the “Meet the Midwives” session, a woman asks about her chances of getting off the wait list. Her due date is March 30. But March, a popular time for births, has been full for months. “I’ll call myself April,” she says. It’s hard to tell if she’s joking.


Earlier in her career, Pinger used to wear a pin that read “Just Say No” and depicted a doctor standing over a supine woman in labor. It was her protest against the increasing technologization of birth. If that history makes her an unlikely choice for a chain-owned hospital, embracing her typical patients is a no-brainer.

In addition to promising to adhere to a set of diet and exercise guidelines that would please the most traditionalist doctor, the women in Pinger’s practice must be in excellent health and agree to hire a doula, a birth assistant whose services can run from $800 to $1,200 dollars in the Washington area.

It’s no surprise, then, that the group is largely composed of the highly educated and the professionally employed. Pinger says she sees lawyers, doctors, and even OB-GYNs. They are athletic women who have pushed their bodies before and will apply the same strength and endurance to preparing for labor.

To the women drawn to Wisdom, power is important. “They know what they want and know what their body can do,” Pinger says. “They want to be empowered, to be powerful.”

Tracey Mills, communications manager for George Washington Hospital, offers an identical characterization. “They know what they want and know how to find it,” she says. “They seem to want to embrace the whole experience.”

Cameron Rupprecht, a holistic health coach, is delivering with Wisdom in March. A dedicated CrossFit athlete, she liked Pinger’s emphasis on exercising during pregnancy. She also liked the idea of letting her body do what it was designed to do. “We’ve done this forever. We can do it. Why not try?” Rupprecht says. She says some people don’t understand why she’d want to experience pain. “I want to be present for the birth, fully feeling,” she says.

But for all the emphasis on natural, Rupprecht says she knew home birth wasn’t for her after seeing the Jennifer Lopez movie The Back Up Plan, which included a scene mocking home-birthers with a water tub and someone playing bongos in the background. Rupprecht also liked the idea of being at a hospital. “I can do the natural thing, but if something goes wrong, you’re right there,” she says.

Scholars who study birth say it’s hard to tell if more women are going the natural route. The overwhelming majority of births happen in hospitals, where epidurals and interventions are the norm. But Eugene Declercq, the assistant dean of doctoral education of Boston University’s School of Public Health, says anecdotal evidence indicates pockets of women interested in low-intervention births.

One pocket appears to be in the D.C. area. Pinger’s patients, who are typically over 30, represent the fact that educated women typically bear children later. This population, she says, has given more thought to the kind of birth experience they want.

Dr. John Larsen Jr., chairman of the obstetrics and gynecology department at GW, brought Pinger into his hospital. He says her hiring was partially a response to a demand he’d seen in the market. “Many women in Washington, D.C. are very interested in having a completely normal birth without medication, and vaginal delivery,” Larsen says.

Susanna Montezemolo, a vice president of legislative affairs for a non-profit organization, says she became interested in natural childbirth several years ago via prenatal yoga training (she’s also a yoga teacher). As a 36-year-old first time mother, she wanted the access to immediate medical backup that a home birth would not provide. Montezemolo did her homework. “Wisdom gave the best probability of having a natural childbirth,” she says. The day she found out she was pregnant, she emailed Pinger. “I got the positive test at 6 a.m.. At 6:20, I emailed her to get a spot.”

Montezemolo’s labor this fall was not an easy affair. She arrived at the hospital almost ready to deliver her baby, and describes it the most painful thing she had experienced. But, she has no regrets. “It was really such an amazing, empowering experience.”

Our definitions of “amazing” and “empowering,” of course, change with the times. And from diets to drugs, ours is a moment of a certain suspicion of the expert in the white coat. In the maternity industry, that means a backlash against practices that aren’t medically necessary and don’t benefit both mom and baby. The number of home births, while still tiny, has been rising. That’s true especially among educated white women, according to a 2011 Centers for Disease Control report. Talk show host Ricki Lake has become a front person for this trend with her documentary The Business of Being Born and her new book Your Best Birth. A glance at the latter’s cover is telling: Rather than depicting the kind of shaggy 1970s types whose images adorned prior natural-birth guides, the tome is illustrated with a cover shot of stylish, beautiful, and expensively made-up expectant mothers. In August, a prominent doctor published an editorial in the Obstetrics and Gynecology medical journal about how to stop the “relentless rise” in cesarean deliveries.


That’s not just a concern for the natural-process obsessive. The prospect that cesareans could reach 50 percent of births also sparks cost concerns by public-health types. Wisdom Midwifery boasts a cesarean rate of approximately 5 percent—and takes women who’ve previously had c-sections and want a vaginal birth, a group some practitioners deem too risky.

Regan Nelson, who delivered her son at GW last week, believes her birth would have gone much differently if she hadn’t delivered with the midwives. After her water broke without going into labor, they gave her time to try delivering her son naturally. She went to the hospital 24 hours later, where she spent the night before receiving an oral medication to kickstart labor. Twelve hours after that, she gave birth to her son—a “very primal, sacred moment.”

“I knew I was at the beginning of what in a traditional hospital setting could very easily lead me down the slope to a cesarean section,” says Nelson, so pleased with her experience that she offered to be interviewed the next day. “For ten months you work so hard toward a natural birth. It’s so great it was able to happen to me.”

Besides health trends, one less quantifiable factor also helps explain Pinger’s lengthy waiting lists: It’s human nature to want something not everyone can have. With a small number of slots, Wisdom has “exclusivity cachet,” Larsen says. He’s seen patients who wouldn’t be candidates try to re-describe their health history, making themselves sound healthier than they are. He’s seen influence peddling, women calling the executive offices of the university to ask if there are ways they can jump the waiting list—and never knows what he’ll hear when the phone rings.

“Tell a lawyer, lobbyist, or top-level bureaucrat she can’t have something and suddenly she’s hungry for it,” he said.


GW wasn’t looking to add midwives when Pinger first approached Larsen. Her goal at the time was to simply deliver to doctors and residents a presentation called “Pearls of Midwifery,” highlighting best practices and outcomes. GW hadn’t had midwives in 20 years.

“If she hadn’t walked through the door, it wouldn’t have happened,” Larsen says. “Whitney can sell.”

Pinger does so well beyond the confines of medical establishments. On July 4 of this year, she and other midwives marched in the Palisades parade wearing signs that said “Where’s Your Midwife?” She carried a placard of those same clinical “pearls,” which she says maximize the chance that women will have a natural, normal labor: eating and drinking during labor, allowing labor to start on its own rather than inducing it, and changing positions rather than lying on a bed.

Pinger’s presentation to the GW doctors was postponed by the early 2010 blizzard. As Pinger and Larsen tried to find another date, they began talking. At the time, she was working at Washington Hospital Center. The practice had grown rapidly, and it didn’t have a neat place on the center’s organizational chart. Might GW have the capacity to give it a better home? “Your patients are leaving you to come to me,” she recalls telling him. “Why don’t you bring me there?”

The decision, Pinger wrote in a paper this year, helped “attract an educated insured population of women to [GW] for maternity care and delivery.” This was good for the hospital. Pinger, for her part, loved the idea of training residents, physicians, medical students, and nurses who once looked at her peers with suspicion.

What makes Pinger so dynamic, Larsen says, is a combination of competence, character, and chemistry. Pinger is an expert in natural, normal birth; she continually works to improve her patient outcomes; and she’s got a innate quality that draws people to her. Her expansive personality is the extra element that has made her so attractive to so many pregnant women, he says.


Pinger was born in San Francisco, a fourth-generation Californian; you can still see her West Coast proclivities, even after two decades in Washington. She wears her blonde hair long and sports flowy skirts and silver jewelry. At the open house, she was chewing gum and swiveling her hips, looking younger than her 51 years. She says her energy comes from following the same exercise and diet Wisdom asks of its patients. (That gum, incidentally, was sugar-free.)

Pinger says she was first exposed to the idea of natural birth in a high-school biology class and apprenticed with local midwives. At the University of California-Berkeley, she wavered between medical school and midwifery school until visiting the Frontier Nursing Service in rural Kentucky, one of the country’s first midwifery practices. “I really didn’t like the operating room,” Pinger says. “My tribe was the midwives.”

Pinger got a nursing degree at Yale University, where she also studied midwifery, and practiced in Connecticut while her husband finished his law and business degrees. In 1990, when his parents offered to help them buy a home, they moved to D.C. with their first child. They settled in Cleveland Park and had three more children, all natural births with midwives.

Pinger worked as a midwife at Prince George’s Hospital, then spent ten years at the Washington Free Clinic providing prenatal care for low-income women. In 2000, she went to Georgetown University Hospital to become their director of midwifery. When that practice closed (the hospital says it wanted to focus on high-risk births instead), she went to the Washington Hospital Center.

Nowadays, Pinger says, her vision for maternity care is bigger than GW: She wants to see what has happened there go national. “The model is definitely replicable,” she says. “Doctors, nurses, midwives—we can do it all, high-risk and low-risk women, all together.”

This may be the moment to go forth. Concern of a workforce crisis in obstetrics, combined with a new swell of activism around birth issues, spurred by The Business of Being Born and the book Pushed, present a political climate ripe for collaboration. Those involved in promoting this kind of maternity care say they see an awakening among consumers about what kind of birth they want to have.

“There is more excitement about working on birth issues than there has been in 20 years,” says Declercq.

This excitement spreads for free, which is no mean feat in an age when hospitals must advertise their cardiac-care centers on bus stops. Typically, GW would roll out a marketing campaign with a new division, says Lisa McDonald, head of marketing and business strategy for the hospital. In the case of the midwives, the hospital is holding back because the practice already fills quickly. Besides, the informal advertising makes the formal kind—like a recent cover story in the hospital’s magazine—seem redundant. (GW would prefer we use the hospital-branded “Midwifery at George Washington Medical Faculty,” but the Wisdom name, which came with Pinger from Washington Hospital Center, is how the practice is best known.)

Pleasance Lowengard Siliki says Pinger was “literally the first person I called” upon learning she was pregnant with her second child. Siliki, a yoga studio owner who had a traditional hospital birth with her first child, wanted something different for her second. Even before her son was born in July, she became another voice in Wisdom’s word-of-mouth network. She’s talked up the practice to her yoga students and blogged about it on her studio’s website.

“It’s pretty amazing to be in the hands of such a birthing powerhouse in D.C., and to learn from her,” Siliki wrote. It’s a good bet that sort of devotion and publicity doesn’t attach itself to all of of Washington’s more traditional providers.


High-profile hires notwithstanding, midwifery practices are not a great economic model for hospitals out to maximize short-term profits. All the same, having someone like Pinger on board can help a hospital differentiate itself from competitors and develop long-term loyal customers, says Declercq.

In 2009, the average charge by a hospital for a vaginal delivery without complications (not including anesthesia services, newborn care charge and provider charge) was $9,617, according to information from Childbirth Connection’s “Transforming Maternity Care” project. A vaginal delivery with complications averaged $12,532. A hospital c-section with no complications was $15,799 and with complications, $21,495.

But for GW, the addition of Pinger and the other midwives have brought in additional patients for prenatal care and delivery: Women who may have gone to other practices and delivered at one of the city’s other hospitals.


Wisdom enrolled 200 women for prenatal or gynecological care in its first six months at GW. The hospital’s total number of births has gone up from 1,465 last year to an expected 1,800 this year. In pure numbers, Washington Hospital Center and Sibley Hospital dominate the D.C. birth market, with more than 4,000 and 3,456 births last year, respectively. Pinger’s practice, though, helps win her hospital a very attractive niche.

Pinger, meanwhile, says showing off GW’s status as the home of evidence-based midwifery could yield more benefits to come.

That, of course, could mean fighting more battles. Robbie Davis-Floyd, a medical anthropologist who studies birth, says a midwife would have to be a strong leader and an astute politician to overcome traditional resistance in hospitals, where her research shows midwives tend to get kicked out when doctors feel their business is threatened.

Pinger, though, is able to articulate the scientific and financial benefits of working together. For example, the women coming to GW to have their babies with midwives are increasing patient volume for nurses, the nursery, and other medical departments such as genetics. “The downstream effects are enormous,” she says, using a term associated more with business suites than birthing rooms.

Larsen says the decision not to compete was a deliberate one. “Each of us has lived enough years, seen enough in our years. We’ve seen doctors and midwives compete against each other.” He calls working with Pinger “just one of the happiest developments in my life,” while Pinger tells potential patients that Larsen as a wizard with forceps, an expert hand who can manipulate the tool so skillfully that a woman can have a vaginal birth and the baby can emerge without a mark.

“Everyone at the hospital is on our team,” Pinger tells people at the “Meet the Midwives” event. Without Larsen, GW’s anesthesiologists, and other doctors and nurses, the midwifery practice wouldn’t have the kind of outcomes they do, she says.

Extraordinary effort is needed to make collaborative birthing practices sustainable after the people who have established collaborative relationships move on. “The challenge is to be able to institutionalize it,” Declercq says.

At any rate, it makes sense for a hospital to make sure women’s maternity experience is emotionally positive as well as medically sound. Maternity care is one of the few services in a hospital that is typically joyful. Women make many of a family’s health care decisions, and providing great maternity care is a wise move if a hospital wants to provide them future medical care, says Trish MacEnroe, head of Baby-Friendly USA, an organization that promotes breastfeeding best practices in hospitals. “They have the business of the family for the long haul,” she says.


In the America that worships scientists but suspects science, we are of two minds about childbirth.

One places all importance on the end result. As long as the baby comes out with no complications, how mom experienced the birth is not that important. When I was pregnant, one doctor at the large practice I used compared childbirth to a wedding. That single day is insignificant compared to the marriage, which comprises all the days that come after.

Others see the experience of childbirth itself as transformative. “The process affects the product,” is how Davis-Floyd, the medical anthropologist, puts it. In this view, how a child is born affects the physical and mental health of baby and mother.

For every Ricki Lake who is selling an argument (and book, and film) advising women to demand the kind of birth they want, there is someone like Élisabeth Badinter, the French philosopher, selling a different argument (and book) that slams our fascination with “natural” motherhood—with its drug-free births, long breast-feeding periods, and cloth diapers—as setbacks for equality.

Pinger and other midwives believe the tide is starting to turn in their favor, and that the culture is changing as evidence builds that the their model is the best approach for low-risk women. The D.C. market, which gives women dozens of choices for their maternity care, is full of examples of institutions appealing to desires. Sibley Hospital, a much bigger player than GW, offers a combination spa/childbirth education weekend for parents-to-be: just $1,200 for two nights at the Ritz Carlton in Tysons Corner and four sessions of childbirth education (plus facial or prenatal massage!). Shady Grove Adventist Hospital now offers the area’s first “birth advisor,” who gives personal consultations to mother’s-to-be about what they want. (The hospital’s tagline sums it up well: “Everything Mom Wants, Everything Baby Needs.”)

Pinger’s October “Meet the Midwives” event wound up drawing 100 people and was relocated to the hospital auditorium. That’s quite a feat for a practice that just delivered its 200th baby. “We’re not doing hoochie choochie midwifery craziness,” she says.

That’s what you’d expect Pinger to say, of course. Even as she’s moved into a prominent institutional setting, she remains an advocate. What’s more interesting about our current midwife moment is how her line is echoed by hospital administrators, whose jobs typically involve balancing a professional obligation to focus on healthy outcomes with a fiduciary obligation to cater to the customer. In Pinger’s Washington, losing out on the business of empowered maternity consumers is a bad call on both counts.

“Seeing a midwife is a revolutionary decision for a woman,” says Lorel Patchen, head of midwifery at Washington Hospital Center. “It’s also a revolutionary decision for a hospital.”

And, for that matter, it may also be a non-negotiable choice: “If we don’t create this model, the chance of natural birth moving out of the hospital are very possible,” Pinger says.

Our Readers Say

On the other side of the district the Family Health and Birth Center (http://www.yourfhbc.org/) is providing birth center and hospital based midwifery care for the women who don't have the resources to be Whitney's clients.

As a doula I've seen the good work that Whitney and her practice have done, and I'm very glad they're here doing what they do, but the midwives of FHBC deserve some attention, too.
I am so happy that people are realizing that midwifery clients have great outcomes. I also agree with Jennifer that great outcomes are needed no matter how well lined your pocket is and the Family Health and Birth Center (http://www.yourfhbc.org/) have been doing AMAZING work long before this practice came along.
All four of my children (born between 1992 and 2010) were delivered by midwives, two at home. To me the most surprising thing is that it isn't a bigger business.
There are lots of doulas that cost less than $800, and some doulas-in-training do not charge while they attend births to gain experience. Natural childbirth,midwifery, and doula services are not just for the moneied elite!
I'm so glad to see comments raising the issue of the tone of this article. I wrote a long-ish response to the piece over breakfast this morning, if anyone, including the author of this snarky article, is interested in reading.

I mention FHBC and also BirthCare in Alexandria as examples of midwifery care that is not catering to Washington elites. FWIW, I don't necessarily believe that GW's Midwifery Center is - I am inclined to think this article is extraordinarily editorialized.

http://woahbaby.wordpress.com/2011/11/10/midwives-the-louboutin-of-birth-experiences/
Thank you for covering this. Increasing the birth options for women in our area is extremely important. I also recommend expecting parents to look at Midwifery Care Associates in Rockville (Shady Grove Adventist Hospital Affiliation) and if they are interested in a CNM but a home or birth center location - BirthCare in Alexandria. They have a waiting list also so keep that in mind in your planning.

What a great story!! Congratulations to the mothers, to the physicians, nurses and administrators at GW Hospital, and of course to Whitney and the midwives who have joined with her to create this wonderful option for childbearing families. WOW!
This is a terrific and informative article, but I'll reiterate what several other commentators have said - Family Health and Birth Center at 801 17th Street,NE should REALLY have been covered in this article, too. FHBC is a local non-profit midwifery practice serving ALL residents of the District, including low-income women and the uninsured. They offer options to deliver at the Birth Center or at Washington Hospital Center with a midwife. Doulas' services and lactation consultants are included in their care, and they accept most types of insurance. If you read this article and liked the sound of delivering your baby with a mid-wife in a hospital, please check out FHBC. They don't have a waiting list, their care is exceptional, and you can feel good knowing that your patronage is directly helping to support low-income families.
I'm glad to see a positive article about midwifery. It would have been nice to read about the other midwife practices available. I had BirthCare and attempted a homebirth, but ended up transferring to WHC for a complication. Once there, I had the pleasure of not only keeping my midwife from BirthCare, but I also had an AMAZING midwife (Erika) from Family Health and Birth Center attend me. Now I'm torn between the two providers for the next baby--how great is that?!
How nice the educated and insured women can get great care. Meanwhile poor women, minority women, women on Medicaid are still getting sub-standard care, abuse during labor and sectioned at alarming rates. Did they mean to sound so "elitist"? It's nice they have an article written about them but if they already have a wait list, why do they need the publicity? Why not write about the DC birth center and the great work they do?
We are so happy to see Whitney continue to lead and support the option of choosing a midwife and a natural delivery. It's exciting for us to know back in November, 1987 in CT, we were going to be part of a very important movement. I still like to tell people our perfect baby girl was delivered by a real California girl in a lovely jade silk blouse and long flowing blonde hair!! It was the best experience of our lives. It was the best choice for me. Good luck to All!
I have mixed feelings about this article--while on the one hand I applaud City Paper--and GW hospital--for bringing attention to the incredible popularity of Whitney's hospital based midwife practice, I found the stress on the "elite" and financically attractive nature of the collaboration to be misplaced, and felt the author could have done more to explore what midwifery care is about, how it differs from traditional OB care (besides its low intervention goal), and also what the midwives and doctors are learning from each other in this place. Yes, it is probably good business for GW (and Wisdom) and yes, a lot of the parents tend to be older, educated, financially stable--but have you looked at the maternity ward of Sibley? It seemed like a reunion of harvard law grads! What should have been the focus of this article is that Wisdom provides a model of collaboration that is highly desirable--midwife based care but in a hospital setting should things not go according to plan--and yet has been elusive until now. The exciting thing about this collaboration is getting beyond the antagonism and mutual suspicion--if doctors and midwives collaborate on obstetrics, and can get hospital administrators to see the value in their collaboration, and women have more choices they feel good about, this is a terrific thing. FWIW, I am a current patient of the practice, was not told that I "have" to have a doula, and am fairly middle class. Moreover, when i sit in the waiting room at GW, its mixed regular OB and midwife patients--you don't know who is whom, wisdom takes the same insurance as the regular docs--and I have to say that it is MUCH more diverse (age wise, racially, probably economically) than the practice was at my former OB's office, where natural delivery was looked upon as a kind of "yuppie fantasy" that I'd get over once I got to Sibley and had some sense talked into me. And yes, the DC Birth center got short schrift--midwifery care is not only for the elites!
There are two things important n this arfticle:
1.) change most often comes from the top down when informed, powerful women get involved in making the change. This article highlights that and will increase the momentum to make this care avaialble to all women.
2.)Whitney Pinger is an incredible, savvy, change agent who has contributed enormously to assisting in bringing about the paradigm shift needed to establish a team approach to care that is safe, satisfying and affordable - regardless of setting. She is defining midwifery as a specialty different, but compatable with obstetrics and putting it on the organizational table of the institutions that care for 99% of the women in America.

Brava! Brava!

NOw we have to open up the flow of tax payer money that supports hospital residency programs to include midwifery. 80 years of demonstration has produced more than enough solid evidence on the benefits of the midwife as part of the team providing care. If we contiue to primarily suport the training of sugeons to control the care of childbearing women, we should not be surprised at a rising cesarean section rate. It is time to step up the production of this missing provider in our health care system. Midwives cannot be part of the solution if they are denied access to the clinical teaching sites caring for the 99% of childbearing women.

This is the advocacy that these powerful women experiencing midwifery care need to take on. Disadvantaged women facing the problems daily survival can help but strong leadership by powerful, connected women and men who know how to navigate the system will be essential.
I, too, applaud Whitney for her success in establishing a hospital-based practice with such amazing outcomes, and also the excellent care provided by FHBC (disclosure - I am a member of the birth center's advisory board). I also urge the women of DC to consider the option available right across the Potomac in Virgina - licensed and regulated Certified Professional Midwives. CPMs, who are specifically educated to provide birthin services in the home and birth centers, would further expand the birthing options for DC families, and at a reasonable cost. Last year, Congress enacted legislation that requires all state Medicaid plans, including DC, to cover birth center services, including the services of all licensed midwives -- CNM or CPM -- in birth centers, and a bill is currently pending in the House of Representatives (HR 1054) that would extend Medicaid coverage to home birth services provided by CPMs. CNM services, in any location, are already mandated by federal Medicaid law. It is time for the DC Council to expand options for DC women of all income levels by adding CPMs as a category of licensed health professional under DC law. The more birthing options --at all price point -- the better for moms and babies.
Having delivered in dc twice- once at fhbc in 2008 and just recently through Whitney Pingers practice I have to say both had their strengths and few weaknesses. From my personal standpoint the sacred nature of birth was better respected at the birth center. At the hospital although the midwives have your back, there is still the invasive monitoring and vitals taking that is generally intrusive and that I found off-putting. Full disclosure I am a physician assistant and familiar with hospital settings and how annoying they are. I did have to threaten to sign out AMA (against medical advice) to let them let me gome home when I was ready- also not a problem at fhbc.
However,the midwife that delivered me at fhbc moved and is one of the partners at the the GW practice so I was going to GW more for her than anything else. I missed the sweet, quiet and the lovely family aesthetic of fhbc but I loved my choice to see my midwife again. Both were great natural births and I liked having the choice to see a midwife in both settings. I guess that the beauty of it; the choice. Also, I am no gym-buffed amazon lawyer and none of the women I met were either so I think that's a bit of a mis-representation and maybe just represents dc ( at least NW) and not an author or practice bias.
I agree with what a few of the other ladies had to say... Where is the love for Family Health and Birth Center. I commend any midwife don't get me wrong but I feel like there are a lot of midwives/birth centers in the area that have paved the way for these new programs at "elite" hospitals to even happen. Everybody deserves great care so I hope to see a part 2, 3, and 4 praising some of the other area midwives and birth centers! Congratulations to all the midwives for what you do and the strides you make to better educate women on birth and labor!
Kitty,I agree and would have LOVED to read a piece about Whitney as a change agent. I feel this particular piece fell far, far short of that, and even, frankly, had an almost mocking tone at times, highlighting her wardrobe and sugar-free gum and really skipping over the substance of her her obvious passion for her work. (By that I mean that the quotes from Whitney were great, but the article kept pushing the elitist angle and the financial benefit to the hospital.)

Susan - thanks for that information on the political side of things! I didn't know about HR 1054.

Kea, I think I'd like to see your parts 2,3 and 4 written by other authors.
Speaking from a different standpoint, Whitney and Wisdom have provided the model for beautiful natural births to medical students,residents and physicians--something that they have needed to witness as "normal". In a world where historically a majority of laboring women receive epidurals, foley catheters and pitocin, it has been refreshing to see physicians placing warm compresses on perineums, allowing women to express discomfort and allow women to deliver in positions other than in lithotomy position because of the influence of these amazing midwives. As the medical world embraces the midwifery model, what is birthed is an amazing philosophy where the best of both worlds can be provided to the patient. As these residents become new attending physicians, they are able to provide to women the freedom to birth-- with increased skills in helping women deliver naturally. People want to have midwife care in a high risk center where, in the event of an emergency situation, the physicians can work hand-in-hand with midwives and collaborate towards better births. America needs this model...this is the only way that change can happen so that America's numbers in cesarean sections and maternal/ infant morbidity can decrease. Thank you, Whitney for the work that you are doing...and slowly but surely...we will see the change that your heart is pursuing happen in this nation.
When my ob/gyn retired while I was pregnant with my second child, I set out to look for a solo practitioner to replace her. I was not having much luck when a friend from Pittsburgh (who delivered at Forbes with a mid-wife) suggested that I try looking into a mid-wife. Thank goodness I did because that is how I found Whitney. I hope this article raises awareness that a mid-wife might be the right way to go for most pregnancies. Both my pregnancies and labors were healthy and uncomplicated, yet I never considered using a mid-wife before I met with Whitney. Furthermore I wasn't 100% sure I wanted to go drug free (I had an epidural with my first). Whitney was open to my wishes but strongly suggested I try and go without the medication. I'm so glad that I did, my recovery was very quick. I was clear headed and ready to take on the challenges of having a newborn almost immediately. Whitney was amazing, though the first thing she said to me after my daughter was born was that I was amazing. Thanks for reporting such a positive piece.
So wonderful to finally see such a successful nurse-midwifery program at GW again. To give you some historic perspective on midwifery at GW I worked with many other nurse-midwives in the late 1970's at Group Health Association. We provided full midwifery prenatal care, delivery & postpartum care. Then in 1979 I was asked to join the private practice of Drs. McKelway, Titus & Heintze. As far as I know I was the only nurse-midwife in private practice to have ever worked at GW. So it is a thrill to see your practice doing so well, Whitney! Please, give my best to Dr. Larsen. I commend him for making the decision to incorporate midwifery into GW's ob/gyn program.
Bravo to Whitney and GW. This is a model that should be replicated in all hospitals to improve outcomes, lower costs, and produce healthy, happy children for the future.
It is wonderful that this article was published, and it made a lot of really great points. It painted Whitney as very special and powerful and gifted, all of which are true. She is a special woman who has balanced home and work, she is a powerful change agent, and she is a gifted diplomat and advocate of women and birth. She has many unique gifts, but what is NOT unique is that she is an advocate of natural childbirth and an expert in the care of healthy women having natural childbirth--ALL midwives are experts in that! All midwives care for the whole woman, take an interest in their diet, stress level, sleep patterns, exercise, sex life, and everything else that makes them who they are and forms their health picture. All midwives spend time with their clients, getting to know them and forming a relationship with them, being "with women." That Whitney does these things does not make her unique. It makes her a midwife. I point this out not to diminish anything about Whitney, who deserves all the praise in the world, but to point up the fact that she represents an entire profession dedicated to providing diligent, respectful, empowering, evidence-based care in hospitals, birth centers and at home. Brava, Whitney!
It is great to see Whitney and the women of WISDOM getting attention, but I disliked the articles implication that well-educated, professional, women would not have considered natural childbirth without the GW practice. The women I know who are passionate about natural childbirth come from all walks of life. It makes it sound like natural childbirth is something normally reserved for someone's idea of a "hippie." I had a VBAC which was attended by Whitney, Nora, and Marcia, and they were all amazing.
What a delight to come across this link this morning, having worked with Whitney in the early 1990s at the Washington Free Clinic, serving low-income refugee women with free prenatal care & support. It was an absolute privilege learning with and from her then, the very beginning of my career in the birth world, and impressive to see where her career as a midwife has led her. Whitney, if you read this - thanks for your guidance and mentoring as I began my own path in birth work. Many blessings to you & your family.

sarah (lewis) juliusson
The article barely touches on the dichotomy between hospital vs home birth. The GW midwifery practice is not unique within the US medical system in providing midwidery services. It does represent a middle ground for families who feel reassured by having the security of a hospital setting yet want natural childbirth on their own terms with a CNM. Homebirth with a CNMs and CPMs is an equally valid option for mothers with low risk factors (I'll let the hospital administrators keep their calculators to themselves thank you). In fact, any number of midwives referenced in the article and its comments serve the bulk of their patients via homebirth rather than a medical setting (hospital or birth center). The article is misleading on this point.

I'll second the above commenters criticism of elitism. The out of pocket cost was higher for a homebirth than the out of pocket cost of a hospital birth (midwife or not), even though the overall real cost was significantly lower. The real cost savings was for my insurer. We chose that option not to save our insurer $$ but because it was our preferred birth experience and fortunately for us we could afford it. All the "powerbrokers" and "Crossfit" moms referenced here just had the bulk of the cost billed to their insurers, who sadly will pay hospitals perfuntorily yet often place obstacles for midwives to get fairly reimbursed for their services
The Midwifery Care Associates, at Shady Grove, has the same model (midwives in hospital) and it precedes Witney's. I had my first baby with the Midwifery Care Associates and my second one with WISDOM I was not required to have a doula with WISDOM, and I did not really follow that strict diet. Both births went great and I would recommend the Shady Grove practice just as much as WISDOM. The article is good, but I agree that it focuses too much on Witney's practice when there are other practices in the area that provide the same services.
I was excited to see midwifery on the cover of the City Paper, but disappointed that the article was one, long hagiography of Whitney Pinger. I saw Pinger for a preconception consultation when she was still at Washington Hospital Center. She kept me waiting two hours after my appointment time, offering no explanation or apology. Worse, she was harsh and snarky. When I told my friend who referred me to her my impression, she said, "Yeah, she's mean until you're officially pregnant and her patient." Huh? I found Pinger's bedside manner very off-putting, and she is just as dogmatic as the traditional OBs I was trying to avoid! There are other more laid back, reasonable midwives (like Midwifery Care Associates in Bethesda) who won't play God and dictate every area of your life. They are also more open to women who are interested in midwifery services but who haven't made up their minds about using pain meds during birth.
Why were there no statistics in the article about the actual outcomes of birthing centers vs. hospital birth or hospital birth vs. home birth? I suspect it's because the perinatal death rate is nearly three times as high for home birth vs. hospital birth. But it seems most of the commenters here feel that their own personal birth experience is more important than that pesky issue of whether it's safer for the child.
Before attacking a wonderful midwife and a great practice we all must remember that the last time midwives were in the news in DC it was tragic and horrendous. Any publicity for midwifery is great for all of us who believe in 'natural' childbirth. While the article was not written keeping all practices in mind and there were some false facts, the premise behind the article is wonderful. We should all be grateful to people like Whitney (as well as others, of course) for making midwifery accessible to a wider population. Washington Hospital Center is by no means a privileged place and it is not the fault of the patients that insurance companies charge so much to deliver in a hospital. Moving to GW was not a choice for Whitney.

If people had a united voice instead of bickering about which practice was first and who qualifies as elitist then maybe more people would understand the advantages of midwifery. It is the author's voice that people should be commenting on - not Whitney's.
We were among the first to sign up with Wisdom at WHC and moved with Whitney to GW. We consider ourselves so lucky to have found her -- our first two babies were delivered in hospitals by midwives, but we could not go back to them because they had been driven out of business (first Georgetown Hospital, then Takoma Women's Health, which delivered at Sibley).

Midwifery should not be dismissed as some weird backwards fad, or an option reserved for the privileged (or as "Lonnie B" seems to think, the selfish). We had amazing birth experiences that were positive for me AND my babies, who were all born healthy with no complications. Whitney was very supportive throughout my pregnancy, and trusted my intuition and experience as a third-time mom throughout the delivery process. And why is it bad or selfish to want a wonderful birth experience? Birthing does not have to be a scary, surgical, highly medical ordeal, and by pushing midwives out of hospital settings, hospitals and doctors unfairly leave women with a choice between home or center births and hospital births with OBs who opt for the scalpel 1/3 of the time (or more). Not everyone is a good candidate for a midwife birth, but I am so grateful the option was there for us. I hope midwifery is here to stay.
I am dismayed by the misguided portrayal of Whitney Pinger in the comments above. Shame on the less-than-compassionate view for one of our hardest working birth workers in America. Whitney has done an incredible amount to advance responsible, safe midwifery for all women in the DC area and this country. Her standards are now being used to teach other midwives and medical students across the country what it takes to achieve normal birth. Building successful midwifery practices in hospitals -- as Whitney has done -- is one way to turn the tide toward normal birth being the norm in this country. She is showing that it IS possible to have a less-than 5% C-Section rate in a hospital -- where the majority of women have their babies.

She is human, just like the rest of us. Instead of slandering her, consider that she may have been up all night helping a woman achieve a natural birth before seeing patients the next morning. Or she may have had a woman in labor at the same time she was seeing patients. Or she was booked with 20+ appointments in 3 hours. I know from my own experience, and from talking with so many women who have worked with Whitney, that 99.9% of us had a good experience with her.

I agree with Lyla: It is the author’s voice people should be taking issue with. The slanted portrayal of midwifery in general, and Whitney specifically, is divisive. Whitney and other midwives in DC and across the U.S. are all working hard to make normal birth an option -- even a standard of care -- for all women. Let’s applaud them and ask how we can make normal birth a right for more women, no matter their income or healthcare setting.
There is room for more than one midwifery practice in DC and we should celebrate the fact that Whitney's hospital based hybrid model is successful at giving families the choice that meets their needs. Positive coverage of Whitney and Wisdom doesn't come at the expense of other midwives in town who may have a different model. The fact that hospitals and insurance companies are finally beginning to see that it is in their interest to bring women a more authentic birth experiences gives talented midwives like Whitney the opportunity to innovate and bring this service to a much broader audience. Instead of commenting on their perceived appearance and perceived class, focus on the fact that 100 people packed an auditorium to learn more about natural birth, many of whom otherwise likely would have contributed to the unfortunately high elective C section rate at other area hospitals. Having given birth twice with Whitney I have to disagree, though, with Dr. Larsen's quote in the article: Whitney doesn't "sell." She is. The fact that she has a waiting list is not a function of a competitive, type A desire for exclusivity. It's because she's talented and dynamic and very, very smart. And she has the ability to inspire you to want the most authentic experience for yourself and your child. And anyone who meets her knows it within 5 minutes.
I second what others said about the family health and birth center, I had an incredible birth for my first child with Ericka as midwife. I am French so I started to research about what giving birth look like in the US. When I discovered the FHBC, I switched from an ob/gyn practice and this is the best decision I ever made. I felt totally relieved and knew that it won't be a fight on the D day. I didn't even need a birth plan as the midwives were already doing what i wanted! I am so happy i had delivered my baby in the us and in a birth center! This is truly a chance to have the choice, but you have to "make your homework" and be aware of those choices.
I started as a patient at Wisdom/GW last year for well-woman care. They are the ONLY practice in my 11 years of seeing doctors in DC who actually listened to my concerns and made me feel safe. Everyone involved in my appointment was amazing, and my first appointment was an hour long. I cried through most of it, probably with relief, as my last routine pap smear in a different clinic had been so dismissive and traumatic that I hadn't been back for routine care in three years. They took it all in stride and I was never made to feel embarrassed. For the record, I was not pregnant or planning to become pregnant at the time, and I was still treated in an absolutely respectful and compassionate manner.

As others have stated, I'm not sure why the author chose to portray Wisdom's clientele as exclusive. I am self-employed (and was low income at the time) with a crappy individual insurance plan, but I had no issues with access. Wisdom's place at GW allows them to use the hospital's infrastructure and consequently accept a wide range of insurance plans. Some may criticize them for not being accessible to the uninsured but it sounds like there are other services in the area that serve that purpose.
I had been with my previous OB/GYN for a number of years and the same practice (CWC) for even longer. It was a gradual build-up to deciding to look elsewhere for a variety of reasons, but my last appointment was beyond uncomfortable (ie dismissive, rushed, etc.). I was actually more interested in enrolling with FHBC for well-woman care (I was pre-TTC) because I really liked the sense of community they seemed to promote, but they weren't accepting any new patients for well-woman care :( Ironically, enough, I'm now a new patient with GW Midwifery, with a CNM who works with FHBC as well.
While the media attention for this hospital and the midwifes is great, I say shame on you Whitney for taking credit and boasting about your great outcomes and low C/S rate. Whitney this was your one chance to tell people reading this article what the midwifery theory was about.
Your hospital is not the first to model this care. What is your epidural rate? Have you looked into the IHS statistics? Did you know that many hospital in Denver have been modeling this care for 5 plus years? You should have made clear that while your model is new at that hospital,the concept is not. That there are many facilities and midwifery groups around the country that have worked very hard to establish their practices.

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