Florida approves law change on where c-sections can be performed

Florida has become the first state to allow doctors to perform cesarean sections outside of hospitals after a private equity-owned physicians group argued the change would reduce costs and provide pregnant women with a more homelike birthing environment.

However, the hospital industry and the nation’s leading obstetricians’ association say that despite the closure of some Florida hospital maternity wards in recent years, performing C-sections in doctor-run clinics will increase risks for women and babies when complications arise.

Nearly one-third of U.S. births occur via C-section, a surgical procedure involving an incision in the mother’s abdomen and uterus. Doctors generally resort to C-sections when they consider it safer than vaginal delivery for the parent, baby, or both, making such decisions either months before birth or in emergencies.

This spring, a new law was enacted allowing “advanced birth centres,” where physicians can deliver babies vaginally or by C-section to women considered at low risk of complications. These centres will also permit overnight stays for the women.

Women’s Care Enterprises, a private equity-owned physicians group with locations primarily in Florida, as well as in California and Kentucky, lobbied for this legislative change. In 2020, BC Partners, a London-based investment firm, acquired Women’s Care.

“We have patients who don’t want to deliver in a hospital, and that breaks our heart,” said Stephen Snow, a recently retired OB-GYN with Women’s Care who testified before the Florida Legislature in favour of the change in 2018.

Florida state Sen. Gayle Harrell, the Republican sponsor of the birth centre bill, compared the shift to the establishment of outpatient surgery centres in the late 1980s, a change initially viewed as radical. Harrell, who managed her husband’s OB-GYN practice, emphasised that birth centres will need to adhere to the same high standards for staffing, infection control, and other aspects as outpatient surgery centres.

Since 2019, 17 hospitals in Florida have closed their maternity units, often citing low insurance reimbursement and high malpractice costs, according to the Florida Hospital Association.

The new Florida law mandates that advanced birth centres must have a transfer agreement with a hospital but does not specify the locations of these facilities or their proximity to a hospital.