Doctors Are Allowed to Perform C-sections Outside of Hospitals In Florida

Florida allows doctors to perform C-sections outside of hospitals
Florida allows doctors to perform C-sections outside of hospitals

Siding with a doctors organization owned by private equity, Florida has become the first state to let doctors to perform caesarean sections outside of hospitals. The group claims the shift would save expenses and provide pregnant women with the more comfortable delivery environment that many prefer.

Although some Florida hospitals have abandoned their maternity wards in recent years, the hospital business and the major obstetricians’ group in the country argue that conducting C-sections in doctor-run clinics will raise the dangers for women and babies when difficulties emerge.

At an email to KFF Health News, Orlando perinatologist Cole Greves, who leads the Florida branch of the American College of Obstetricians and Gynaecologists, stated, “A pregnant patient who is considered low-risk at one moment might suddenly need lifesaving care in the next.” Even with more regulations in place, the new birth clinics “cannot guarantee the degree of safety patients would receive within a hospital.”

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A rule that permits “advanced birth centres” was passed this spring. At these facilities, doctors can perform vaginal births or C-sections on women who are judged to have a low risk of complications. The clinics would allow women to spend the night.

Women’s Care Enterprises, a medical organisation mostly located in Florida but also with offices in California and Kentucky, is controlled by private equity and successfully persuaded the state government to implement the change. Women’s Care was acquired by London-based investment group BC Partners in 2020.

“We have patients who don’t want to deliver in a hospital, and it breaks our heart,” stated Stephen Snow, who spoke in front of the Florida Legislature in 2018 and just retired from Women’s Care as an OB-GYN.

Women’s Care vice president of strategic initiatives Brittany Miller stated that the organisation would not comment on the matter.

Medical professionals are cautious.

“This appears to be a subpar replacement for high-quality obstetric care that is being marketed as offering individuals other options,” stated Alice Abernathy, an assistant professor of obstetrics and gynaecology at the Perelman School of Medicine at the University of Pennsylvania. Abernathy opined, “This feels like a terrible band-aid on a chronic disease that will make results worse instead than better.”

C-sections, which include making an incision in the mother’s abdomen and uterus to deliver the baby surgically, account for about one-third of births in the United States. Doctors often do the treatment when they think it is safer for the mother, the child, or both during vaginal delivery. These kinds of medical decisions might be made in an emergency or months before the baby is born.

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The birth centre bill’s Republican author, Florida state senator Gayle Harrell, noted that while getting a C-section outside of a hospital may seem like a drastic move, so did the establishment of outpatient surgical centres in the late 1980s.

Birth centres will need to adhere to the same strict guidelines as outpatient surgical centres on staffing, infection control, and other areas, according to Harrell, who oversaw her husband’s OB-GYN business.

“This is something that will help us and help moms obtain the greatest care, given where we are with the need and maternity deserts around the state,” the woman stated.

The Florida Hospital Association reports that since 2019, seventeen hospitals in the state have discontinued their maternity units, with many claiming excessive malpractice costs and inadequate insurance reimbursement.

The CEO of the Florida Hospital Association, Mary Mayhew, stated that because to the numerous hazards, including haemorrhaging, that come with C-sections, it is incorrect to equate birth centres to ambulatory surgical centres.

Although advanced birth centres must have a transfer agreement with a hospital, the Florida legislation does not specify the locations of the facilities or how close they must be to hospitals.

Mayhew stated, “We are quite concerned about how this approach would affect our group’s efforts to enhance maternity and newborn health.” “Our hospitals do not believe that this is optimal for delivering safe and high-quality labour and delivery care.”

The Florida Hospital Association opposed the new birth centres, but did not oppose the bill’s approval overall since it featured a significant increase in the amount Medicaid pays hospitals for maternity care.

According to Mayhew, it is improbable that the birth centres will contribute to the scarcity of healthcare. It is unreasonable to expect sophisticated birth centres to operate in rural regions where a big section of the population is on Medicaid, which provides the lowest payment for labour and delivery care, she added, given that hospitals are already grappling with a scarcity of OB-GYNs.

Although most insurers and Medicaid fund treatment at midwife-run birth centres, it is uncertain if insurers would pay the advanced birth centres. The advanced birth centres exclusively treat patients whose insurance contracts with the facilities, meaning they are in-network, and will not take walk-ins in case of emergency.

The organisation intends to construct an advanced birth centre in the Tampa or Orlando region, according to Snow, the retired OB-GYN with Women’s Care.

According to him, the idea of advanced birth centres is an upgrade over midwifery care that permits births outside of hospitals since the centres let women stay overnight and provide anaesthesia and C-sections if needed.

Snow said that the birth centre concept is also about earning money because a private equity group has invested in Women’s Care. However, he noted that hospitals share midwives’ profit-driven motivations and that they probably disagree with the concept of C-section-only centres since it might reduce hospital income.

“We are working to lower the cost of medication, and this would benefit patients more economically and comfortably,” he stated.

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Patients may mistake advanced birth centres for the free-standing, low-risk birth centres that have been in operation for decades and are managed by midwives, according to Kate Bauer, executive director of the American Association of Birth Centres. According to her, there are 411 free-standing birth centres in the US and 31 licenced birth centres in Florida at the moment.

According to Bauer, “this is a dramatic deviation from the standard of treatment.” She called it a “poor idea” as it may put mom and the unborn child at greater risk.

Other than in hospitals, no other state permits C-sections. The only place providing comparable services is a birth clinic in Wichita, Kansas, which is attached to Wesley Medical Centre, a hospital, via a short hallway.

Approximately 100 infants are delivered monthly by staff members in the “hotel-like” maternity suites at the clinic, as opposed to the 500 that are delivered monthly at the hospital.

The idea functions well, according to Morgan Tracy, a maternity nurse navigator at the centre, because patients can be promptly sent to the main hospital in the event of difficulties and staff and medication access can be shared between the hospital and birthing suites.

Tracy remarked, “The best part is that there are teammates on both sides of the road.”

KFF Health News

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