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.