Florida has become the first state to allow doctors to perform C-sections outside of hospitals, backing a group of doctors at private equity organizations who say the change will reduce costs and offer pregnant women the more home-like environment than many. they want to give birth.
But the hospital industry and the nation's leading obstetricians association say that while some Florida hospitals have closed their maternity wards in recent years, performing C-sections in doctor-run clinics will increase risks to women and babies when complications arise. .
“A pregnant patient who at one point has a low-risk prognosis may suddenly need vital care,” Cole Greves, an Orlando perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to . New birth clinics, “even with greater regulation, cannot guarantee the level of safety that patients would receive within a hospital.”
The Florida Legislature passed a law this spring allowing “advanced birth centers,” where doctors can deliver vaginal or cesarean births to women considered at low risk of complications. Women could spend the night in the clinics.
Women's Care Enterprises, a privately held medical group with locations in Florida, California and Kentucky, 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 that breaks our hearts,” said Stephen Snow, who recently retired as an OB-GYN at Women's Care and testified before the Florida Legislature advocating for the 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 quality obstetric care that is effectively billed as giving people more options,” said Alice Abernathy, assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania. “This seems like a precarious solution to a chronic problem that will make outcomes worse rather than better,” Abernathy said.
Nearly one-third of U.S. births occur by cesarean section, the surgical delivery of a baby through an incision in the mother's abdomen and uterus. Doctors usually use this procedure when they believe it is safer than vaginal delivery for the mother, the baby, or both. These medical decisions can be made months before birth or in an emergency.
Florida Republican state Sen. Gayle Harrell, who sponsored the birthing center bill, said performing a C-section outside a hospital may seem like a radical change, but so was the opening of outpatient surgery centers in the late 2000s. 1980s.
Harrell, who ran her husband's obstetrics and gynecology practice, said birth centers will have to meet the same strict standards for staffing, infection control and other aspects as outpatient surgery centers.
“Given where we are with the need, and the maternity deserts across the state, this is something that will help mothers have the best care,” she said.
Seventeen hospitals in the state have closed their maternity units since 2019, with many citing low insurance reimbursement 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 outpatient surgery centers because of the multiple risks associated with C-sections, such as bleeding.
Florida law requires advanced birthing centers to have a transfer agreement with a hospital, but does not dictate where they can open or their proximity to a hospital.
“We have serious concerns about the impact of this model on our collective efforts to improve maternal and child health,” Mayhew said. “Our hospitals do not see this as the best option to provide quality and safety during labor and delivery.”
Despite its opposition to the new birth centers, the Florida Hospital Association did not oppose passage of the bill as a whole because it also included a significant increase in the amount Medicaid pays hospitals for birth care. maternity.
Mayhew said birthing centers are unlikely to help alleviate the shortage of care. Hospitals are already struggling with a shortage of obstetricians and gynecologists, she said, and it's unrealistic to expect birth centers to open in rural areas with a large share of people on Medicaid, which pays the lowest reimbursement for birth care. and lighting.
It's unclear whether insurers will cover advanced birth centers, although most insurers and Medicaid cover care at midwife-run birth centers. Advanced birthing centers will not accept emergency visits and will only care for patients whose insurance companies have a contract with them, making them in-network centers.
Snow, a retired obstetrician-gynecologist with Women's Care, said the group plans to open an advanced birthing center in Tampa and Orlando.
The advanced birth center concept is an improvement on midwifery care that allows for birth outside of hospitals, she said, as the centers allow women to stay overnight and, if necessary, offer anesthesia and cesarean sections.
Snow acknowledged that the fact that a venture capital firm has invested in Women's Care plays into the idea that birth centers are also about making money. But she said hospitals have the same profit motive and, like midwives, are likely to oppose the idea of centers that could offer C-sections because it could reduce hospital revenue.
“We are trying to reduce the cost of medicine, and this would be more profitable and more pleasant for patients,” he said.
Kate Bauer, executive director of the American Association of Birth Centers, said patients might confuse advanced birth centers with free-standing birth centers for low-risk births that midwives have run for decades. There are currently 31 licensed birth centers in Florida and 411 freestanding 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 risks for mother and baby.
No other state allows C-sections outside of hospitals. The only center that offers similar care is a birth clinic in Wichita, Kansas, connected by a short walkway to the Wesley Medical Center hospital.
The clinic has “hotel-type” maternity suites where the staff attends to about 100 births a month, compared to 500 a month at the hospital itself.
Morgan Tracy, a maternity nurse at the center, says the concept works largely because the hospital and maternity suites can share staff and pharmacy access, plus patients can be quickly transferred to the main hospital if complications arise.
“The good thing is that there are team members on both sides of the street,” Tracy says.
This story was produced by KFF Health News, a national newsroom focused on in-depth coverage of health issues, which is one of the main programs of KFFthe independent source for health policy research, polling and journalism.
