"I want midwifery services to be accessible to any woman who is diligent with her personal care and qualifies for a midwife," says Sandy Glenn, South Carolina Licensed Midwife and owner of Carolina WaterBirth since 2005.
Midwife, Sandy Glenn, had her first baby straight out of college in 1989. At that time, a private obstetrician fee was $2500 (a fee far beyond their ability to pay), so she became a Medicaid clinic patient. Sandy did not realize that midwifery was still practiced in South Carolina nor did she realize what it meant to participate in the clinic system of care.
Although Sandy attended childbirth classes and followed the physician's advice, when labor began, the situation went poorly. One intervention let to another and after only a few short hours at the hospital, Sandy was wheeled into a surgery room. Her hands were strapped to the gurney which was standard procedure for a cesarean section, but at no point was Sandy informed that surgery was being considered; she was just strapped down and her consent was "assumed." Thankfully, Sandy kept pushing while everyone waited on the doctor to arrive and a healthy baby boy was birth vaginally in the surgery room.
By the time Sandy had her third son, she had private insurance and had finally found a midwife. Although she happily prepaid for the midwifery services, she was unprepared for the battle that occurred with Blue Cross Blue Shield to get reimbursement.
"I battled with Blue Cross for almost a year and although the reimbursement was small, I thought that my battle might be helping other women who were planning a midwife-attended birth."
Sandy's third birth was surreal and she knew immediately that she wanted to offer this service to women. Within months she was enrolled in midwifery school.
It had taken Sandy 6 years to find her own midwife so when she finally received her license in 1999, she wanted to make midwifery more accessible to others.
"It was funny. In the early days, people thought midwifery was so unusual that I kept getting approached by newspapers, local magazines and even the local news for interviews. But today it's common and accepted by most women as an alternative for healthy pregnancies."
Being able to accept Medicaid has been a long hard battle for Carolina WaterBirth. Some claims would go unpaid while other claims could take over a year to get reimbursed, but CWB continued to fight for each payment and appealed every denied claim.
South Carolina Medicaid has private Managed Care Organizations that require excessive medical malpractice coverage which usually makes it impossible for a midwife to obtain "in-network" status, but each state is also required to have one "open-network" plan. Although homebirth coverage is still difficult, CWB has been able to keep their non-covered charges low and take members who can get enrolled with only open-network plan (Absolute Total Care).
"I remember my disappointment when I couldn't afford the care that I wanted for my pregnancy and I feel like all women deserve the opportunity to try midwifery as long as they are healthy."
CWB currently accepts the South Carolina state Medicaid plan and Absolute Total Care. Participants pay for non-covered services with a $200 initial appointment fee and then $100 a month until they are paid in full.
