In March, Florida became the first state in the nation to enact a law allowing doctors to perform Cesarean sections outside of hospitals. Under the law, physicians can deliver babies vaginally or by C-section for women at low risk for complications at free-standing “advanced birth centers,” where women could stay overnight. Lawmakers said the legislation aims to reduce the cost of giving birth and to increase access to care in rural areas and maternal care deserts.
“Complications can arise quickly during childbirth and having centers that are driven by profit-centric private equity rather than patient care is a recipe for problems.”
Details of Florida’s New Law Regarding Birthing Center Access
The new law establishes requirements for advanced birth centers concerning operating procedures, staffing, equipment, laboratory and surgical services, and anesthesia administration.
The new advanced birth centers are different from traditional birth centers, which are staffed by midwives and have operated in the state for decades. Those traditional birth centers can only deliver low-risk babies vaginally. They are not authorized to perform C-sections. Generally, birth center births cost about the same or less than hospital births, although more than home births.
Private Equity Influence
In passing the law, Florida sided with the private equity-owned physicians group Women’s Care Enterprises. The group lobbied the state legislature to make the change, claiming the legislation would lower costs, give women a more comfortable birthing atmosphere, and increase patient satisfaction.
However, private equity firms generally focus on maximizing profits over the short term, which could lead to financial peril for both the new advanced birth centers and traditional hospitals. Studies have shown that a profit motive negatively impacts outcomes, as private equity-owned hospitals often seek to cut costs by reducing staff and supplies. Additionally, the rates of adverse events like surgical site infections are higher at hospitals acquired by private equity.
The Florida Hospital Association has opposed the new birth centers but didn’t fight the bill’s passage because it also included a major increase in the amount Medicaid pays hospitals for maternity care. Mary Mayhew, the association’s CEO, has said that the new advanced birth centers will unlikely help address care shortages since the state is already short on OB-GYNs.
Risks Associated with Non-Hospital C-Sections
The hospital industry and leading obstetricians’ groups say performing C-sections in doctor-run clinics will increase the risks for women and babies when complications arise. The many risks associated with C-sections—particularly hemorrhaging and birth injuries—make this concept especially dangerous, hospital professionals argue.
“A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next,” Orlando perinatologist and chair of the Florida chapter of the American College of Obstetricians and Gynecologists Cole Greves said in an email to KFF Health News. “Even with increased regulation, [advanced birth centers] cannot guarantee the level of safety patients would receive within a hospital.”
“What this looks like is a poor substitute for quality obstetrical care effectively being billed as something that gives people more choices,” Alice Abernathy, an assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine, told KFF Health News. “This feels like a bad band-aid on a chronic issue that will make outcomes worse rather than better.”
Medical Malpractice Risks
A C-section is the surgical delivery of a baby through an incision made in the birth parent’s abdomen and uterus. This method is used when health care providers believe it’s safer for the birth parent, baby, or both than performing a vaginal birth. Conditions that make a Cesarean delivery more likely include abnormal fetal distress, fetal heart rate, abnormal fetal position, problems with labor, size of the fetus, placenta problems, health issues in the mother, twins or multiples, and having a previous C-section.
C-sections come with risks, including reactions to medicines used during surgery, bleeding, abnormal separation of the placenta, injury to the bladder or bowel, infection in the uterus, wound infection, trouble urinating, delayed return of bowel function, blood clots, and associated consequences, including death. These complications are more likely in non-hospital settings, meaning the new birth clinics also increase the likelihood of medical malpractice.
Impact on Maternal and Infant Health
Studies have shown that women who have C-sections may be as high as 80 percent more likely to develop complications, and that number could be even higher for women who have C-sections in non-hospital settings. Now hospital professionals are worried they may become overused in the name of profit since a C-section is about 15% more profitable for the hospital than a vaginal birth, according to research published in BMC Pregnancy Childbirth.
According to Kate Bauer, executive director of the American Association of Birth Centers, there are currently 31 licensed birth centers in Florida. These licensed facilities are neither outpatient surgical centers nor hospitals. Births at these facilities occur following a normal, uncomplicated, low-risk pregnancy. The law requires Periodic Life Safety Code inspections of these facilities. On the other hand, outpatient surgery centers have the primary purpose of providing elective surgical care.
Regulatory and Compliance Details
Under the newly passed legislation, advanced birth centers must do the following:
- Be operated and staffed 24/7
- Employ two medical directors—one obstetrician and one anesthesiologist
- Employ at least one registered nurse
- Have at least one dedicated surgical suite
- Maintain a Medicaid provider agreement
Additionally, the centers must enter written agreements with blood banks for emergency blood bank services and agreements with obstetricians and hospitals for emergency transfers. Patients who receive emergency blood transfusions at an advanced birth center must immediately be transferred to a hospital for further care.
Under the law, Florida’s Agency for Health Care Administration has authorization to develop additional requirements and standards for advanced birth centers. The agency is primarily responsible for the state’s Medicaid program, the licensure of medical facilities, and the sharing of health care data.
Insurance and Medicaid Coverage
It’s unclear whether private insurers will cover services at advanced birth centers, though most insurers, including Medicaid, cover care at midwife-run birth centers. As it stands, Medicaid reimburses licensed birth centers and midwives that provide obstetrical services for beneficiaries with low-risk pregnancies. The advanced birth centers will not accept emergency walk-ins and will only treat patients with in-network providers, so uninsured pregnant people may still have difficulty finding care.
Contact FHVG if You’ve Experienced Outpatient C-Section Malpractice or Other Birth-Related Injuries to Your Child
There’s a fine line between innovation in health care and endangering patients. It’s critical to stay informed about the law and any changes governing advanced birth centers and consider the legal implications when weighing options for your baby’s birth.
If you’ve experienced a birth injury at an outpatient birth center, the medical malpractice lawyers at Freedland Harwin Valori Gander can help you seek justice. We’ve been litigating medical malpractice cases for over 20 years and have recovered more than $2.6 billion for our clients. Contact us today for a free consultation.
