Florida has passed a law that will allow some cesarean sections to take place outside of a hospital setting but doctors have warned that it poses serious safety risks to patients.
Governor Ron DeSantis signed the legislation in March to allow “advanced birth centers” to perform planned, low-risk, C-sections as part of an effort to expand access to maternal healthcare in the state.
Some 19 per cent of Florida counties were classed as “maternity care deserts” in a 2023 report after multiple hospitals closed their maternity wards.
But medical professionals are warning of the potential risks of the new scheme, part of Florida’s “Live Healthy” legislation package.
“We have serious concerns about the impact this model has on our collective efforts to improve maternal and infant health,” Mary Mayhew, CEO of the Florida Hospital Association told KFF Health News. “Our hospitals do not see this in the best interest of providing quality and safety in labor and delivery.”
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 per cent in 2022, also slightly higher than the national average of 32 per cent.
Under the new law, an advanced birth center can operate so long as it has a board-certified obstetrician and board-certified anesthesiologist as its medical directors; enters into a written agreement with an emergency blood bank service; has written protocols for managing obstetrical hemorrhaging; and follows the state’s healthcare agency rules.
The law also requires the birth centers to have an obstetrician with admitting privileges at a “nearby hospital” - but does not indictate how close that must be to the center.
Along with low-risk C-sections, an advanced birth center can also perform vaginal deliveries between 37 and 41 weeks gestation, and vaginal deliveries on patients who have previously had C-sections.
Those with high-risk pregnancies are not allowed to use advanced birth centers for C-sections, and could be turned away due to potential complications.
But even low-risk patients “can suddenly need lifesaving care”, Dr Cole Greves, chair of the Florida chapter of the American College of Obstetricians and Gynecologists told KFF Health News.
“Even with increased regulation, [advanced birth centers] cannot guarantee the level of safety patients would receive within a hospital,” he said.
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.
Freestanding birth centers are becoming a more popular option for low-risk pregnant individuals to give birth in the US, offering an in-between experience of a home birth and hospital birth.
