Florida has become the first state to allow doctors to perform C-sections outside hospitals, backing a privately owned doctors' group that says the change will cut costs and give pregnant women the more comfortable birth setting many desire.
But the hospital industry and the nation's leading association of obstetricians say that although some Florida hospitals have closed their maternity departments in recent years, performing C-sections in physician-run clinics will increase the risks to women and babies when complications arise.
“A pregnant patient who is considered low-risk one moment could suddenly need life-saving care the next,” Cole Graves, an OB-GYN in Orlando who heads the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to KFF Health. next”. News. New maternity clinics, “even with increased regulation, cannot guarantee the level of safety that patients will have inside the hospital.”
this spring, Law A law was passed allowing “advanced birth centers,” where doctors can deliver babies vaginally or by cesarean section to women deemed to be at lower risk of complications. Women will be able to stay overnight at the clinics.
Women's care institutions, A private equity owned physician group With locations mostly in Florida along with California and Kentucky, it lobbied the state legislature to make the change. BC Partners, a London-based investment firm, bought Women's Care in 2020.
“We have patients who don't want to give birth in a hospital, and it breaks our hearts,” said Steven Snow, who recently retired as an OB-GYN with Women's Care and testified before the Florida Legislature calling for change in 2018.
Brittany Miller, vice president of strategic initiatives at Women's Care, said the group would not comment on the issue.
Health experts are cautious.
“This seems like a poor substitute for good obstetric care, when it's actually being touted as something that gives people more choices,” said Alice Abernathy, MD, assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine. “This seems like a bad bandage on a chronic problem that will make outcomes worse rather than better,” Abernathy said.
Nearly one-third of births in the United States are by cesarean section, which is the surgical delivery of the baby through an incision in the mother's abdomen and uterus. In general, doctors use this procedure when they believe it is safer than vaginal delivery for the parent, baby, or both. Such medical decisions may be made months before birth, or in emergency situations.
Florida State Sen. Gayle Harrell, the Republican who sponsored the birth center bill, said performing a C-section outside a hospital may seem like a radical change, but so did the opening of outpatient surgery centers in the late 1980s.
Birth centers must meet the same high standards for staffing, infection control and other aspects as those at outpatient surgery centers, said Harrell, who ran her husband's obstetrics and gynecology practice.
“Given where we are in need, and the maternity deserts across the state, this is something that will help us and help mothers get the best care,” she said.
Seventeen hospitals in the state have closed their maternity units since 2019, with many citing low insurance costs and high malpractice costs, according to the Florida Hospital Association.
Mary Mayhew, CEO of the Florida Hospital Association, said it's a mistake to compare birth centers to ambulatory surgery centers because of the many risks associated with C-sections, such as bleeding.
Florida law requires advanced birth centers to have a transportation agreement with the hospital, but it does not specify where the facilities can be opened or how close they are to the hospital.
“We have serious concerns about the impact this model will have on our collective efforts to improve maternal and child health,” Mayhew said. “Our hospitals do not see this as being in the best interest of providing quality and safety in labor and delivery.”
Despite its opposition to new birth centers, the Florida Hospital Association did not oppose passage of the overall bill because it also included a significant increase in the amount Medicaid pays hospitals for maternity care.
Birthing centers are unlikely to help address the lack of care, Mayhew said. Hospitals already have a shortage of obstetricians and gynecologists, she said, and it is unrealistic to expect advanced birth centers to open in rural areas with a large percentage of people on Medicaid, which pays the lowest reimbursement for labor and delivery care.
It is unclear whether insurance companies will cover advanced birth centers, although most insurance companies and Medicaid cover care in birth centers run by midwives. Advanced Birthing Centers will not accept emergency walk-ins and will only treat patients whose insurance contracts with the facilities, keeping them in-network.
The group plans to open an advanced birth center in the Tampa or Orlando area, said Snow, a retired obstetrician-gynecologist with Women's Care.
He said that the concept of the advanced birth center is an improvement to midwife care that enables births outside hospitals, as the centers allow women to stay overnight and, if necessary, provide anesthesia and caesarean sections.
With a private equity firm invested in women's care, the idea of a birth center is about making money, too, Snow admitted. But hospitals have the same profit incentive, he said, and are likely, like midwives, to oppose the idea of centers that can provide C-sections because it might reduce hospital revenues.
“We are trying to reduce the cost of the drug, and this will be more cost-effective and more pleasant for patients,” he said.
Patients can confuse advanced birth centers with freestanding birth centers for low-risk births that midwives have managed for decades, said Kate Power, executive director of the American Association of Birth Centers. She said there are currently 31 licensed birth centers in Florida and 411 free-standing birth centers in the United States.
“This is a radical departure from the standard of care,” Bauer said. “It's a bad idea,” she said, because it could increase the risks for the mother and baby.
No other state allows C-sections outside of hospitals. The only facility offering similar care is the maternity clinic in Wichita, Kansas, which is connected by a short corridor to Wesley Medical Center Hospital.
The clinic offers “hotel-like” maternity suites, where staff deliver about 100 babies a month, compared to 500 babies a month at the hospital itself.
Morgan Tracy, a maternity nurse at the center, said the concept works largely because the hospital and maternity wards can share access to staff and the pharmacy, plus patients can be quickly transferred to the main hospital if complications arise.
“What's nice is having team members on both sides of the street,” Tracy said.