Florida allows C-sections outside hospitals amid controversy over safety, cost

Editor's Note

Florida became the first US state to permit doctors to perform cesarean sections (C-sections) outside hospitals, siding with a private equity-owned physicians group advocating for cost reduction and a homier birthing environment, KFF Health News and HealthLeaders May 28 reports. However, the hospital industry and the American College of Obstetricians and Gynecologists warn that this could increase risks for women and babies during complications.

The new state law is giving way to the creation of “advanced birth centers,” where women presenting low-risk pregnancies can deliver babies vaginally or by C-section and stay overnight. Critics argue these clinics cannot match the safety of hospitals, citing potential staff shortages, inadequate training, and curtailed access to immediate lifesaving care because of lack of emergency walk-ins acceptance. Despite this, Florida's legislation was influenced by Women’s Care Enterprises, a private equity-owned group that lobbied for the change. The group argues many patients prefer not to deliver in hospitals.

Supporters, including Florida state Senator Gayle Harrell, believe these centers will address maternity care shortages, especially in areas where hospitals have closed maternity wards due to financial constraints. Senator Harrell compared this move to the opening of outpatient surgery centers, saying "birth centers will have to meet the same high standards for staffing, infection control, and other aspects as those at outpatient surgery centers."

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. Still, concerns remain about whether these centers will adequately improve maternal and infant health outcomes, particularly in underserved rural areas. The advanced birth centers must have hospital transfer agreements but their proximity to hospitals is not regulated, raising further safety concerns.