Florida has turn into the primary U.S. state to permit doctors to perform C-sections outside hospitals, siding with a personal equity doctors’ group that claims the change will reduce costs and provides pregnant women the more comfortable birthing environment many want.
But the hospital industry and the nation’s leading obstetrician association indicate that although some Florida hospitals have closed their maternity wards in recent times, performing cesarean sections in physician-run clinics increases the danger to women and babies within the event of complications.
“A pregnant patient who is considered low-risk one moment may suddenly require life-saving care the next,” Cole Greves, an Orlando-based perinatal medicine specialist who heads the Florida chapter of the American College of Obstetricians and Gynecologists, said in an email to KFF Health News. The latest maternity hospitals “cannot guarantee the level of safety that patients would enjoy in a hospital setting, even with increased regulation.”
This spring, a law A law was passed allowing “advanced birth centers” where doctors can deliver babies vaginally or by Caesarean section for ladies who’re at low risk of complications. Women can stay overnight within the clinics.
Women’s care corporations, a personal equity-owned medical group with locations primarily in Florida, but in addition in California and Kentucky, lobbied the state legislature for 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 a gynecologist at Women’s Care and testified before the Florida state legislature in 2018 to advocate for the change.
Brittany Miller, vp of strategic initiatives at Women’s Care, said the group wouldn’t comment on the problem.
Health experts are suspicious.
“This looks like a poor substitute for high-quality obstetric care, which is actually touted as something that will give people more choices,” said Alice Abernathy, assistant professor of obstetrics and gynecology on the Perelman School of Medicine on the University of Pennsylvania. “This feels like a poor Band-Aid on a chronic problem that will worsen outcomes rather than improve them,” Abernathy said.
Nearly one-third of all births within the United States are by cesarean section, which involves making an incision within the mother’s abdomen and uterus. Doctors generally use this procedure once they consider it’s safer for the mother, the infant, or each than a vaginal delivery. Such medical decisions could also be made months before birth or in an emergency.
Gayle Harrell, a Republican state senator from Florida and a sponsor of the maternity care center bill, said performing cesarean sections outside of hospitals may appear to be a radical change, but that was also the case when outpatient surgery centers opened within the late Eighties.
Harrell, who ran her husband’s obstetrics and gynecology practice, said birth centers must meet the identical high standards as outpatient surgery centers by way of staffing, infection control and other features.
“Given the current need and maternity deserts across the state, this is something that will help us and help mothers get the best care,” she said.
According to the Florida Hospital Association, 17 hospitals within the state have closed their maternity wards since 2019. Many of them complain of low insurance reimbursements and high medical malpractice costs.
Mary Mayhew, executive director of the Florida Hospital Association, said it’s mistaken to match birth centers with outpatient surgery centers because there are a lot of risks related to cesarean sections, comparable to bleeding.
Florida state law requires advanced obstetric centers to have a transfer agreement with a hospital, but doesn’t dictate where the facilities may be opened or how close they needs to be to a hospital.
“We are seriously concerned about the impact of this model on our collective efforts to improve maternal and fetal health,” Mayhew said. “Our hospitals do not see it as the best way to ensure quality and safety in labor and delivery.”
Despite its opposition to the brand new birthing centers, the Florida Hospital Association didn’t oppose passage of the bill since it also proposed a big increase in the quantity Medicaid pays hospitals for obstetric care.
Mayhew said it’s unlikely the birth centers will help address the shortage of care. Hospitals already face a shortage of gynecologists, and it’s unrealistic to expect modern birth centers to open in rural areas, where a big portion of individuals are on Medicaid, which pays the bottom reimbursement for obstetric care.
It is unclear whether insurance firms will cover the prices of the trendy birth centers, although most insurance firms and Medicaid will cover the prices of the midwife-led birth centers. The modern birth centers don’t accept emergency cases without an appointment and only treat patients whose insurance company has a contract with the facilities, making them a part of the network.
Snow, the retired Women’s Care gynecologist, said the group plans to open a contemporary birthing center within the Tampa or Orlando area.
The concept of a contemporary birth center represents an improvement in midwifery care and enables deliveries outside of hospitals, he said. The centers allow women to remain overnight and offer anesthesia and caesarean sections when needed.
Snow acknowledged that the concept of maternity clinics can be about creating wealth, as a personal equity firm has invested in Women’s Care. But he said hospitals have the identical profit incentives and, like midwives, would likely oppose the concept of centers that may perform C-sections since it could cut into hospital revenue.
“We are trying to reduce the cost of medicines. This would be more cost-effective and more convenient for patients,” he said.
Kate Bauer, executive director of the American Association of Birth Centers, said patients may confuse modern birth centers with the prevailing, freestanding, low-risk birth centers which have been run by midwives for a long time. There are currently 31 licensed birth centers in Florida and 411 freestanding birth centers within the U.S., she said.
“This is a radical departure from the standard of care,” Bauer said. “It’s not a good idea,” she said, since it could increase the risks for mother and child.
No other state allows cesarean sections outside of hospitals. The only facility that provides similar care is a maternity hospital in Wichita, Kansas, which is a brief walk from a hospital, Wesley Medical Center.
The clinic has “hotel-style” delivery rooms where staff deliver about 100 babies a month, in comparison with 500 babies a month on the hospital itself.
Morgan Tracy, a nurse and midwife at the middle, said the concept works primarily since the hospital and delivery room can share staff and pharmacy access, and patients may be quickly transferred to the principal hospital in case of complications.
“The nice thing is that there are team members on both sides of the street,” Tracy said.
