Q&A; Birth Center vs. Hospital: Your Guide to Midwifery Care, Medicaid, and Water Birth in South Carolina

Choosing where and how to bring your baby into the world is one of the most sacred decisions you will make. If you are looking for a natural birth outside of a hospital setting, you probably have a lot of questions about how birth centers work, what insurance covers, and whether you qualify.

As the oldest freestanding birth center in the Upstate, we’ve gathered the most common questions from our inbox to help you determine if community midwifery care is the right fit for your family.

🏛️ Our Enrollment & Availability Policy

⚠️ Note on Availability: To maintain our high standard of personalized, safe, and intentional care, we strictly limit the number of expected due dates we accept each month. If you are certain you want to move forward with midwifery care, please don’t wait. Check Our Booking Calendar to Secure Your Due Date Month.

📋 Frequently Asked Questions

1. Does Carolina Waterbirth accept SC Medicaid?

Yes. We are incredibly proud to accept Medicaid for birth center deliveries. However, because licensed midwives operate under unique state guidelines, Medicaid has strict requirements you must follow:

• The Plan Requirement: You enroll in the Absolute Total Care (ATC) Managed Care Plan. If you are enrolled in a different Medicaid plan, you must contact Medicaid immediately to request a switch to ATC.

• Secondary Insurance Rule: Medicaid considers itself secondary to private insurance. If you have a private plan (like BCBS) and Medicaid, we cannot bill Medicaid as a secondary provider. You would need to drop the private insurance for us to utilize your Medicaid coverage. While it seems like having both types of insurance would be beneficial, reducing to just Medicaid can actually save you a lot of money.

• Out-of-Pocket Cost: While Medicaid covers the delivery, it does not cover all of our auxiliary facility services. The typical out-of-pocket expense for ATC clients is $750.

  
  

2. Is a freestanding birth center a home birth or a hospital setting?

Neither—it is the perfect middle ground. A freestanding birth center is a completely separate medical facility designed specifically for low-risk, healthy individuals who want a physiological, natural birth.

• Unlike a hospital, you won’t find routine IVs, epidurals, continuous fetal monitors, or rigid hospital protocols.

• Unlike a home birth, you are delivering in a specialized facility fully equipped with deep water birth tubs, resuscitation equipment, and emergency protocols, completely managed by Licensed Midwives.

• Carolina WaterBirth's facility is also in close proximity to a Regional Perinatal Center equipped with both maternal and neonatal advanced support in the rare cases when expanded care becomes necessary.

3. 3. Does CWB offer home birth care?

   Yes, but under specific guidelines. We love supporting home births for families in many of our local surrounding areas! To ensure the highest level of safety for both you and your baby, we have two firm requirements for our home birth clients:

   • Prior Birth Requirement: We only offer home birth services to mothers who have already safely delivered at least one baby biologically (multiparous). If this is your very first pregnancy, we would love to welcome you to deliver with us inside our beautifully equipped freestanding birth center instead.

   • Insurance Restriction: We cannot accept Medicaid for home birth services. South Carolina Medicaid covers

     deliveries that take place inside our physical birth center facility. If you are hoping to plan a home birth, it must be handled via private commercial insurance or our self-pay packages.

   
   

4. Can I use my private insurance (like BCBS)?

Yes, we gladly file claims with most major commercial insurance providers, including Blue Cross Blue Shield. Because many insurance companies do not routinely contract with independent midwives, your care is typically processed as out-of-network.

• We honor a prepayment negotiated rate (typically between $4,740 and $5,240 at the center) to keep your care affordable while we file your itemized requirements. Your final out-of-pocket amount will largely depend on meeting your family deductible.

  
  

5. What are the benefits of a water birth?

Water birth is one of our primary specialties. Laboring in a deep, warm custom birth tub provides profound benefits, often referred to as an "affinity epidural." The buoyancy of the water relieves pressure on your pelvis and abdomen, significantly lowering stress hormones and encouraging natural pain management. It also softens the perineum, which greatly reduces the risk of tearing during delivery.

6. How late in pregnancy can I transfer my care to a midwife?

We prefer to welcome families early in their journey—ideally starting around 9 weeks. While we do accept late transfers on a case-by-case basis, we cannot accept transfers that occur too late in the third trimester due to safety regulations and clinical history review requirements. Additionally, if our due date calendar for your month is already full, we will unfortunately have to turn the transfer away.

7. Do you offer VBACs (Vaginal Birth After Cesarean)?

While we wholeheartedly believe that many mothers who have had a prior cesarean are excellent candidates for a trial of labor, we do not currently offer VBAC services at our birth center.  While state regulations allow for birth center VBAC care, the South Carolina Department of Public Health's (DPH) overbearing enforcement policies prevent us from functioning to the full extent of our regulations. To protect our licensing and ensure your absolute safety, we happily refer VBAC clients to other trusted community-based providers.

🌿 Your Next Steps: Booking vs. Learning

To keep our midwives focused on direct patient care, we handle all scheduling directly through our website portal. Please choose the path that best fits your current situation:

• I am ready to commit to midwifery care: Skip the inquiry form entirely! You can securely register, input your medical history, and book your first clinical slot by visiting our CWB Initial Appointment Page.

• I am still deciding and want to see the facility: If you have unique questions or want to tour our beautiful birth suites, save a spot in our next free, virtual or in-person Meet-the-Midwife Orientation Class.