Florida Becomes First State to Permit C-Sections Outside of Hospitals

Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals, siding with a private equity-owned physicians group that says the change will lower costs and provide pregnant women with the homier birthing atmosphere that many desire. However, the hospital industry and the nation’s leading obstetricians’ association warn that this move could increase risks for women and babies when complications arise.

New Legislation and Concerns

The Florida Legislature passed a law this spring allowing “advanced birth centers,” where physicians can deliver babies vaginally or by C-section to women deemed at low risk of complications. These centers will also allow overnight stays for new mothers. The move was lobbied by Women’s Care Enterprises, a private equity-owned physicians group with locations in Florida, California, and Kentucky. BC Partners, a London-based investment firm, bought Women’s Care in 2020.

“We have patients who don’t want to deliver in a hospital, and that breaks our heart,” said Stephen Snow, a recently retired OB-GYN with Women’s Care, who testified before the Florida Legislature advocating for the change in 2018.

Despite the potential benefits, health experts remain skeptical. Cole Greves, an Orlando perinatologist and chair of the Florida chapter of the American College of Obstetricians and Gynecologists, expressed concerns about the safety of these birth centers. “A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next,” Greves said in an email to KFF Health News. “The new birth clinics, even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.”

Divergent Views on Safety and Quality

Alice Abernathy, an assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine, echoed these concerns, calling the new model a poor substitute for quality obstetrical care. “This feels like a bad band-aid on a chronic issue that will make outcomes worse rather than better,” Abernathy said.

Nearly one-third of U.S. births occur via C-section, generally when doctors believe it is safer than vaginal delivery. These decisions can be planned or emergent, underscoring the need for immediate access to comprehensive medical care.

Historical Context and Legislative Background

Florida state Sen. Gayle Harrell, the Republican who sponsored the birth center bill, compared the new legislation to the opening of outpatient surgery centers in the late 1980s. She assured that birth centers would meet the same high standards for staffing, infection control, and other aspects as those at outpatient surgery centers.

“Given where we are with the need, and maternity deserts across the state, this is something that will help us and help moms get the best care,” Harrell said.

Since 2019, seventeen hospitals in Florida have closed their maternity units, citing low insurance reimbursement and high malpractice costs, according to the Florida Hospital Association. Mary Mayhew, CEO of the association, stressed the many risks associated with C-sections, such as hemorrhaging, arguing that birth centers are not comparable to ambulatory surgery centers.

Operational and Financial Considerations

The new law requires advanced birth centers to have a transfer agreement with a hospital but does not specify proximity requirements. This raises concerns about the timeliness of emergency care. Additionally, it is unclear whether insurers will cover advanced birth centers, though most insurers and Medicaid cover care at midwife-run birth centers. Advanced birth centers will not accept emergency walk-ins and will treat only patients whose insurance contracts with the facilities, making them in-network.

Industry and Public Response

Snow acknowledged the financial incentives behind the birth center model, noting that hospitals have similar profit motives. However, he emphasized the potential benefits for patients, including reduced costs and a more pleasant birthing experience. Kate Bauer, executive director of the American Association of Birth Centers, warned that patients might confuse advanced birth centers with existing midwife-run centers, which have been safely operating for decades. “This is a radical departure from the standard of care,” Bauer said. “It’s a bad idea because it could increase risks to mom and baby.”

No other state allows C-sections outside of hospitals. A similar facility in Wichita, Kansas, provides “hotel-like” maternity suites connected by a walkway to a hospital, ensuring immediate access to comprehensive care if needed.

Looking Ahead

As Florida pioneers this new model of care, the debate continues over the balance between cost, convenience, and safety in childbirth. The outcomes of this legislative experiment will likely influence future healthcare policies and the organization of maternal care across the United States. The state's decision underscores the ongoing challenges and discussions about how best to provide safe, affordable, and accessible obstetrical care in a changing healthcare landscape.

Comparative Models and Future Implications

The Wichita, Kansas facility, which combines hotel-like maternity suites with immediate access to a hospital, offers a potential model for the advanced birth centers proposed in Florida. However, the Kansas facility’s close proximity to hospital resources highlights a key difference. Florida's law does not mandate such proximity, raising concerns about emergency response times and patient safety.

Economic and Ethical Considerations

The involvement of private equity in Women’s Care raises questions about the influence of profit motives on healthcare decisions. While proponents argue that these centers can reduce healthcare costs, critics worry that financial incentives might compromise patient safety. The balance between cost efficiency and high-quality care remains a contentious issue as Florida navigates this new terrain.

Broader Healthcare Impact

The establishment of advanced birth centers in Florida could set a precedent for other states grappling with maternity care deserts and hospital closures. If successful, this model could provide a blueprint for expanding maternal care options nationwide. Conversely, any negative outcomes could reinforce the importance of hospital-based deliveries and stringent regulatory standards.

Conclusion

Florida’s decision to allow C-sections outside of hospitals marks a significant shift in maternal healthcare policy. As the state embarks on this new approach, the healthcare community will be closely monitoring the outcomes to assess the viability and safety of advanced birth centers. The implications of this policy change extend beyond Florida, potentially shaping the future of maternal care across the United States.