Florida Allows Doctors To Perform C-Sections Outside of Hospitals – KFF Health News

Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals. The private equity-owned physician group says the change will reduce costs and give pregnant women the homelike atmosphere many desire during childbirth.

But the hospital industry and the nation’s leading obstetricians’ association say that although some Florida hospitals have closed their maternity wards in recent years, performing C-sections in clinics run by doctors who do not have them would increase the risks to women and babies if complications arise.

“A pregnant patient who is considered low-risk at one moment may suddenly need life-saving care the next,” said Cole Greaves, MD, a perinatologist in Orlando, in an email to KFF Health News. New birth clinics, “even with increased regulation, cannot guarantee the level of safety patients receive in a hospital.”

This spring, a law It was enacted to allow “advanced birth centers” where doctors can deliver babies vaginally or by C-section for women at low risk of complications. Women would be able to stay overnight at the clinics.

Women Care Enterprises, A private equity owned physician group Women’s Care, based in Florida as well as California and Kentucky, lobbied the state legislature for this change. London-based investment firm BC Partners purchased Women’s Care in 2020.

“We have patients who don’t want to deliver in the hospital, and that makes us very sad,” said Stephen Snow, who recently retired as an OB-GYN at Women’s Care and who testified before the Florida Legislature in 2018 advocating for the change.

Brittany Miller, vice president of strategic initiatives for Women’s Care, said the group would not comment on the issue.

Health experts are worried.

“It seems like a poor substitute for quality obstetric care that’s effectively being presented as something that gives people more choices,” said Alice Abernethy, assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine. “It seems like a poor bandage on an old problem that will make outcomes worse rather than better,” Abernethy said.

About one-third of babies in the U.S. are born via C-section, which involves surgically delivering the baby through an incision in the mother’s abdomen and uterus. Generally, doctors use this procedure when they feel it is safer than a vaginal delivery for the parent, the baby, or both. Such medical decisions may be made months before birth or in an emergency.

Gayle Harrell, a Republican state senator from Florida who sponsored the birth center bill, said having C-sections outside of a hospital may seem like a revolutionary change, but so was the opening of outpatient surgery centers in the late 1980s.

Harrell, who has been an obstetrician-gynecologist (OB-GYN) for her husband, said birthing centers must meet the same high standards for staffing, infection control and other aspects as outpatient surgery centers.

“Given our needs and the obstetric issues across the state, this is something that will help us and help mothers get the best care possible,” she said.

Seventeen hospitals in the state have closed their obstetrics units since 2019, according to the Florida Hospital Association, with many citing low insurance reimbursements and high malpractice costs.

Mary Mayhew, chief executive officer of the Florida Hospital Association, said it’s inaccurate to compare birthing centers to ambulatory surgery centers because C-sections carry many associated risks, such as hemorrhage.

Florida law requires advanced birthing centers to have a transfer agreement with a hospital, but it does not specify where these facilities may be opened, nor how far away from the hospital they must be.

“We are deeply concerned about the impact of this model on our collective efforts to improve maternal and child health,” Mayhew said. “Our hospitals do not believe this is in the best interest of providing quality and safety in labor and delivery.”

Despite its opposition to the new birthing centers, the Florida Hospital Association did not oppose passage of the overall bill, because it also included a large increase in the amount Medicaid pays to hospitals for maternity care.

Mayhew said it’s unlikely that birth centers will help solve the care gap. Hospitals already struggle with a shortage of OB-GYNs, she said, and it’s unrealistic to expect advanced birth centers to open in rural areas, where a large number of people rely on Medicaid, which pays the lowest reimbursements for labor and delivery care.

It is unclear whether insurers will cover advanced birth centers, although most insurers and Medicaid do cover care at midwife-run birth centers. Advanced birth centers will not accept emergency walk-ins and will only treat patients whose insurance contracts with the facilities, making them in-network.

Dr. Snow, a retired obstetrician and gynecologist at Women’s Care, said the group plans to open an advanced birthing center in the Tampa or Orlando area.

He said the concept of advanced birth centres is an improvement in midwifery care that makes deliveries outside hospitals possible as these centres allow women to stay overnight and also provide anaesthesia and C-section facilities if required.

Snow acknowledged that, with private equity firms investing in women’s care, the birth center idea is also about making money. But she said hospitals have the same incentive to make a profit and, like midwives, they may oppose the idea of ​​centers providing C-sections because it could cut into hospital revenue.

“We are trying to bring down the cost of the medicine and it will be more cost effective and more palatable for the patients,” he said.

Kate Bauer, executive director of the American Association of Birth Centers, said patients may confuse advanced birth centers with existing, independent birth centers for low-risk births that have been run by midwives for decades. She said there are currently 31 licensed birth centers in Florida and 411 independent birth centers in the United States.

“This is a radical departure from the standard of care,” Bauer said. “It’s a bad idea, because it could increase risks to mother and baby.”

No other state allows C-sections to be performed outside of a hospital. The only facility that offers similar care is a birth clinic in Wichita, Kansas, which is connected by a short walkway to a hospital, Wesley Medical Center.

The clinic offers “hotel-like” birthing facilities, where staff deliver about 100 babies per month, compared to 500 babies delivered per month at the hospital.

Morgan Tracy, an obstetric nurse navigator at the center, said the concept works largely because the hospital and delivery room can share staff and access to the pharmacy, plus patients can be quickly transferred to the main hospital if complications arise.

“The beauty is that there are team members on both sides of the street,” Tracy said.