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.