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.