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With Greenville Midwifery Care ending deliveries at its birth center soon, Upstate moms who want a more natural approach to childbirth may be looking for other options.

But there aren’t many. And those that do exist may struggle with insurance reimbursement.

Greenville Midwifery said it’s ending its birth center deliveries and transitioning all births to the hospital because insurance reimbursements aren’t enough to sustain the center, according to its owner Prisma Health-Upstate, formerly Greenville Health System.

“I’ve been doing this for 20 years and had the birth center for 11,” said Linda Weaver, a licensed midwife and owner of Labors of Love Midwifery and Birth Center in Spartanburg, whose midwives attend deliveries all over the Upstate.

“Insurance companies are reluctant to pay for birth center deliveries,” she told The Greenville News. “But you have to turn a profit to stay in business.”

Midwife births a growing trend

Birth center and midwife births have been growing in popularity in recent years.

According to the U.S. Centers for Disease Control and Prevention, nearly all births took place outside the hospital in 1900. That dropped to 44 percent by 1940 and to 1 percent by 1969.

Beginning in 2004, the number started to increase again. And the percentage of those births increased from 1.26 percent 2011 to 1.36 percent in 2012, CDC reports.

That year, 53,635 babies were born out of a hospital, including 35,184 home births and 15,577 at birthing center births.

If the trend continues, it could affect “patterns of facility usage, clinician training, and resource allocation, as well as health care costs,” the agency said in a report.

Most major health insurers contract with birth centers for reimbursement, including Aetna/US Healthcare, Blue Cross/Blue Shield, TriCare and Humana, according to the American Association of Birth Centers.

But because it can be hit or miss, Labors of Love has opted to run an all-cash practice with help for clients who seek to be reimbursed by their insurers, Weaver said.

“We’re working with some insurance companies, but insurance is not easy. It takes a lot of time and effort,” she said. “Some pay well. Some don’t pay at all.”

In addition, Weaver said, so many people have high-deductible plans these days and the cost of the birth doesn’t meet the limit.

“Our cash pay price is $4,000,” she said. “And they’ll come in with deductibles of $6,000 or $10,000, and deductible on the new baby.”

Why moms like birth centers

Ashley Heringa, a new mom from Pendleton, said she opted to have her baby girl Karis a week ago at Greenville Midwifery’s birth center because it felt so natural and normal, not like she was sick.

“It’s just a totally different atmosphere and a lot less invasive,” she said, adding her first child, son Kellin, was born in the hospital.

“It’s so much more homey. And I felt so much more supported and cared for,” she added. “The hospital to me is more anxiety-ridden. People are constantly coming in and checking vital signs and things.”

Though both births were covered by her insurance, the birth center delivery was covered only because it was affiliated with the hospital, Heringa said.

“It would only cover certified nurse midwives and would not cover freestanding birth centers,” she said.

Certified nurse midwife Amy Leland has been operating Blessed Births Family Wellness and Water Birthing Center in Greenville since 2000, offering deliveries and related care as well as women’s health care.

While most patients go home within four to six hours, Blessed Births offers a 24-hour stay for clients who come from as far away as Atlanta or the coast, or for nervous first-time moms, she said.

Most major insurers cover her services, except BlueCross BlueShield, Leland said. But she’s hoping to change that, saying her BlueCross patients haven’t gotten the same benefits as other patients.

“But we take a lot of their patients,” she said, “because the prices are reasonable enough to be able to afford it even not using insurance.”

Patti Embry-Tautenhan, spokeswoman for BlueCross BlueShield of South Carolina, the state’s largest insurer, said the company covers services at birthing centers that meet its credentialing standards.

“This is one of the ways we ensure our members are accessing qualified providers and centers with the appropriate focus on patient safety and health outcomes,” she said.

Providers and insurers

Birth centers are licensed and inspected by the state and must conform to standards, such as having an arrangement with hospitals for transporting patients who need medical intervention, Leland said.

Embry-Tautenhan said BlueCross was unaware of Prisma’s decision to end deliveries at its birth center.

“Nevertheless, the cost challenges in health care are real and everyone in the health care space — providers and insurers — have to continually evaluate how to best allocate resources to meet the greatest needs,” she said. “It appears this is what Prisma is doing.”

Birthing centers are generally covered by insurance depending on the company, the plan the person selects, and the provider network within that plan, said Cathryn Donaldson, spokeswoman for America’s Health Insurance Plans, which represents health insurers nationwide.

But state laws vary regarding midwives and birthing centers, which could impact coverage, she added, such as requiring the pregnancy be low-risk and setting limits to labor and delivery only.

Midwifery is really a calling, said Sandy Glenn, a licensed midwife who has run Carolina Waterbirth in Simpsonville for 15 years. Like other midwives in the area, she attend—s at-home births as well as deliveries at the birth center, and related care.

Her services are covered by most insurance, though she’s working to improve that. 

"But," she said, “we all struggle with the same problem — insurance reimbursement.”

Personal birthing choices limited

Out-of-hospital birth is a valid and popular option, though it’s not always easy, said Christina Szrama, a doula in Greenville.

While women can use local services, some drive to Asheville, where there is a medical doctor willing to attend those births, or to other areas in North Carolina or Georgia where certified nurse midwives will see them, she said.

Some rent Airb&bs for weeks before and after their delivery, she said, or drive to these locations for their weekly checkups as the due dates near.

“Women should have to the right to have a baby the way they want to, in whatever setting they want,” said Weaver.

“We are already getting some calls from (Greenville Midwifery patients) who say they want to do a home delivery or a birth center delivery," she added. "When we take away a birth center that is busy and active, that’s sad for women in the Upstate.”

Out-of hospital birthing options

Birth Centers

  • Blessed Births Family Wellness and Water Birthing Center in Greenville - www.blessedbirths.com
  • Carolina Waterbirth in Simpsonville - www.carolinawaterbirth.com 
  • Labors of Love Midwifery and Birth Center in Spartanburg — www.laborsoflovebirthcenter.com

Midwives

  • Hatched at Home — www.hatchedathome.com 
  • Labors of Love — https://scmidwife.net/midwives-associates
  • New Life Homebirth — www.newlifehomebirth.com 
  • Smart Pregnancy — www.smartpregnancy.net 

 

Related: Greenville birth center to stop delivering babies, much to the dismay of Upstate moms

 

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