In Florida, doctors can deliver babies by cesarean section in “advanced birth centers.” That’s the only state that allows the surgery, typically called a C-section, to take place outside a hospital. And the controversial law has triggered some concerns from people who are worried about complications.
While Florida lawmakers said it will give expectant mothers more birthing options, “We worry about harm to patients,” Dr. Judette Louis, department chair of obstetrics and gynecology at the University of South Florida, told Fox News. “In the scenario where you have an unexpected hemorrhage, will you have the right resources on hand?”
She added that many in her profession have had to call in other surgeons to deal with an unexpected complication.
Her concerns were countered by the bill’s sponsor, Republican state Sen. Gayle Harrell, who said in a statement, “Free-market principles show us the private sector can innovate in ways government could never imagine. What government can do is facilitate the exploration and implementation of innovative technologies and delivery models that increase efficiency, reduce strain on the health care workforce, improve patient outcomes, expand public access to care and reduce costs for patients and taxpayers without impacting the quality of patient care.”
The statement hailed the bill, which passed unanimously this spring, saying it “grows Florida’s health care workforce, removes regulations to increase workforce mobility and expands access to quality, efficient health care.”
Fox News reported that the advanced birth center bill had been tabled numerous times since it was first introduced in 2018, but passed when Harrell tied it to a healthy living initiative.
KFF Health News reported that “despite its opposition to the new birth centers, the Florida Hospital Association did not fight passage of the overall bill because it also included a major increase in the amount Medicaid pays hospitals for maternity care.”
The advanced birth centers
The bill, SB7016, allows certified OB-GYNs working in authorized advanced birth centers to perform prescheduled C-sections for women considered low risk. They cannot do the surgical delivery for women who are high risk or in an emergency. Instead, they need to have a written transfer agreement with a hospital nearby to accept patients in an emergency. It doesn’t define nearby. Women can stay overnight at the centers after delivering.
The advanced birth center can deliver babies at 37 to 41 weeks vaginally and it can also perform vaginal deliveries for women who have previously had a C-section.
An advanced birth center must have two medical directors — one a board-certified obstetrician and the other a board-certified anesthesiologist. It also has to have a written agreement for emergency blood bank services, written protocols for managing obstetric hemorrhage and follow other state facility rules.
In passing the bill, lawmakers said they hoped it would help women living in rural parts of Florida who often have to drive nearly an hour to reach a hospital for pregnancy-related care.
According to The Independent, “Florida’s maternal death rate was 40.2 per 100,000 births in 2022, nearly twice as high as the national average of 22.3 per 100,000 births. The state’s C-section rate was 35.9% in 2022, also slightly higher than the national average of 32%.”
KFF Health News reported that lawmakers were “siding with a private equity-owned physicians group that says the change will lower costs and give pregnant women the homier birthing atmosphere that many desire.”
The article noted, “Women’s Care Enterprises, a private equity-owned physicians group with locations mostly in Florida along with California and Kentucky, lobbied the state legislature to make the change. BC Partners, a London-based investment firm, bought Women’s Care in 2020.”
Worried watchers
“A pregnant patient that is considered low risk in one moment can suddenly need lifesaving care in the next,” Cole Greves, an Orlando perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, 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.”
Per The Independent, “So far, no advanced birth center has opened in Florida but at least one facility, Women’s Care Enterprises, is exploring the option. The facility helped propose amendments to the new legislation.”