Florida’s New C-Section Factories Will Put Moms and Babies at Risk

(Bloomberg Opinion) -- A new law makes Florida the first state to let pregnant women receive C-sections outside of hospitals. It’s a fraught solution to improving access to maternity care in the state — and a rule change that puts women’s lives on the line.

Like many US states, Florida is grappling with a shortage of health care for pregnant women. According to the March of Dimes, some 20% of Florida counties are considered a maternity desert, meaning services are limited or nonexistent, and several other counties have low access. Some women would need to travel nearly 50 miles to get to the nearest birthing hospital. 

The new law allows stand-alone facilities called “advanced birthing centers” to offer for the first time both vaginal deliveries and C-sections. That might seem like a good step toward addressing a gap in health care infrastructure. And, of course, the ever-shrinking number of hospitals offering maternity care in Florida must be addressed. But the new bill raises too many concerns — the most critical being that it could ultimately do more harm than good.

The biggest worry is that the law could put pregnant women’s health at risk. While medically necessary for most women who get them, C-sections are associated with a higher risk of complications that include heavy bleeding, blood clots and infections. Yet the law doesn’t require these birthing centers to be near enough to a hospital equipped to deal with a serious problem.Proponents of these birthing centers believe those concerns can be mitigated by only allowing women at low risk of complications to deliver via C-section. But “a pregnant patient that is considered ‘low-risk’ in one moment can suddenly need lifesaving care in the next,” Cole Greves, Florida District Chair for the American College of Obstetricians and Gynecologists, said in an email. “Advanced birth centers, even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.”

Another major concern is that the bill was reportedly pushed by a private equity-backed physicians’ group. That should give Floridians pause. Although the group argued that stand-alone centers would lower health-care costs and offer women a more welcoming setting for childbirth, the consequences of private equity’s charge into health care suggest otherwise. In PE-owned hospitals, patients have more complications, care can become more expensive, and bankruptcies, cutbacks and closures can follow — losses that too often fall on poor and rural patients.

The push to build dedicated, private-equity backed C-section centers could be part of a larger trend I recently explained: Private investors have taken a keen interest in specialty physician practices where much of the focus is on well-reimbursed procedures, such as skin biopsies or colonoscopies.

The idea, of course, is that there’s short-term money to be made by streamlining the administrative side of the businesses and ramping up the number of procedures performed. But for patients, that strategy has sometimes meant that doctors push costlier drugs or unnecessary services, raising the concern that these centers could lead to unneeded caesarians — major abdominal surgeries that typically require more recovery time than vaginal births. Already, data suggest that more women receive C-sections in hospitals where the profits per procedure are higher. 

That track record should give Floridians reason to be wary of private equity charting new territory in maternal care.

Setting aside concerns about the quality and cost of the health care these facilities might provide, there’s another reality worth considering: There’s no guarantee they will succeed.

These facilities can only be helpful if they have people to staff them. As Mary Mayhew, CEO of the Florida Hospital Association, told KFF, hospitals in Florida already are grappling with a shortage of OB-GYNs. According to a workforce analysis conducted in 2021 on behalf of the Florida Hospital Association, the state will have 500 fewer of those specialists than it needs in 2035 — a gap that will widen the most in regions where the patient population largely relies on Medicaid. Unsurprisingly, those areas are the same ones currently considered maternal care deserts by March of Dimes.

That already bad situation could be made worse by the state’s draconian abortion ban, which went into effect in May. OB-GYNs have been leaving states with strict abortion laws due to confusion over the legality of doing their jobs. And medical students say such bans make it less attractive to move there.  

The urgent need to improve access to maternity care in Florida — and so many other US states — requires creative solutions. But this is a flawed fix that could put profits ahead of safe, quality care.

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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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