Florida allows doctors to perform C-sections outside hospitals

Florida became the first state to allow doctors to perform C-sections outside of hospitals. The change should reduce costs and create a more comfortable environment for pregnant women during childbirth, reports CNN.

Photo: iStock.com/Natalia Kuzina

But the hospital industry and the country's leading association of obstetricians argue that such innovation will increase the risks for women and children if complications arise.

"A low-risk pregnant patient may need life-saving care at some point in time," said Cole Greves, an Orlando-based perinatologist.

On the subject: What important new laws took effect in Florida in 2024?

New maternity hospitals, he said, “even with increased regulation, cannot guarantee the level of safety that patients will receive in a hospital.”

"Birth Centers"

This spring, a law was passed allowing advanced birth centers. There patients can give birth to naturally or by caesarean section. This is allowed for women with a low risk of complications. Women in labor can stay there overnight.

“We have patients who do not want to give birth in the hospital. It breaks our hearts,” said Steven Snow, a former OB/GYN at Women's Care. He testified before the Florida Legislature advocating for changes in 2018.

Health experts are wary

“It seems like a poor substitute for quality obstetric care, which is actually being marketed as something that gives people more choice,” said Alice Abernathy, an assistant professor of obstetrics and gynecology at the Perelman School of Medicine at the University of Pennsylvania. “It feels like a bad Band-Aid for a chronic problem that will worsen rather than improve outcomes.”

Nearly a third of births in the United States occur via Caesarean sections. It is a surgical procedure to deliver a baby by making an incision in the uterus and anterior abdominal wall of the pregnant woman. Doctors typically use this procedure when they believe it is safer than vaginal birth. Such medical decisions may be made months before birth or in emergency situations.

Seventeen hospitals in the state have closed their maternity units since 2019, according to the Florida Hospital Association. Moreover, many of them cite low insurance compensation and high medical malpractice costs.

Mary Mayhew, CEO of the Florida Hospital Association, said it is wrong to compare birthing 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 an agreement to transfer women in labor to a hospital if complications arise, but it does not specify where those facilities can open or regulate the distance between them.

“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 believe this is in the best interest of ensuring the quality and safety of childbirth.”

The Florida Hospital Association did not fight passage of the entire bill because it included a significant increase in the amount Medicaid pays hospitals to care for pregnant women.

It's unlikely that birth centers will help solve the health care shortage, Mayhew said. She believes hospitals are already suffering from a shortage of obstetricians and gynecologists. It is unrealistic to expect advanced maternity hospitals to open in rural areas.

Profitable idea

Snow, a retired OB-GYN with Women's Care, said the group plans to open an advanced birth center in the Tampa or Orlando area.

The concept of advanced birth centers represents an improvement in obstetric care, he said. It allows births to take place outside of hospitals. The centers allow women to stay overnight and offer anesthesia and caesarean sections if necessary.

Snow admitted that the maternity hospital idea is about making money. And at the same time, he noticed that hospitals have the same incentive to make a profit. New maternity hospitals could cut into hospital revenues.

No other state allows C-sections outside of hospitals. The only facility offering this type of care is a birthing clinic in Wichita, Kansas.

It is connected by a short walkway to Wesley Medical Center Hospital.

The clinic has hotel-style maternity wards where staff see about 100 babies a month, compared to 500 a month at the hospital itself.

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Morgan Tracy, a nurse at the center, explained that the concept works largely because the hospital and delivery rooms can share staff and pharmacies.

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 aisle,” Tracey concluded.

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