Medical experts are unsettled by a Florida law that allows clinics outside hospitals to perform risky C-sections, which can lead to fatal bleeding and problems in future pregnancies.
Gov. Ron DeSantis in March signed a law creating “advanced birth centers,” new facilities that would be allowed to perform C-sections in outpatient settings where staff may not be able to quickly mobilize in the event of an emergency or may not have the expertise to handle one emergency.
The legislation was heralded as a panacea for the state’s rapidly shrinking supply of maternity care, caused by low federal reimbursement rates for people on Medicaid.
Seventeen hospital maternity centers in Florida have closed since 2019, turning several parts of the state, especially rural ones, into a maternity desert.
Now medical experts are warning that the procedures should only be performed in hospitals to reduce the risk of life-threatening maternal bleeding, infections and birth problems in the future. It can also, in rare cases, lead to the death of the baby.
Advanced birth centers are allowed to perform C-sections, which carry the risk of severe bleeding, death and problems with future pregnancies
A cesarean section (C-section) is performed by cutting into the woman’s uterus to remove the baby. About a third of babies are born this way, but women who undergo the procedure are 80 percent more likely to experience some kind of complication.
Dr. Cole Greves, an Orlando perinatologist and president of the Florida chapter of the American College of Obstetricians and Gynecologists, said KFF Health News : ‘A pregnant patient who is considered low risk one moment may suddenly need life-saving care the next.’
He added that the new birth clinics “even with stricter regulations cannot guarantee the level of safety that patients would receive in a hospital.”
Cesarean sections are becoming more common and can seem appealing, in part because they can be planned, taking the guesswork out of when labor will begin. It may also prove to be a safer option for women who are at higher risk of complications from vaginal delivery, such as tears in the tissue between the vagina and the anus, infection, nerve damage, or excessive bleeding.
But women who take this route risk infections in the uterine lining after childbirth, blood loss, reactions to anesthesia, blood clotting, especially in the legs or pelvis, and complications for a future pregnancy, such as an attachment of the placenta to the uterus. wall of the uterus.
Mary Mayhew, the CEO of the Florida Hospital Association, told DailyMail.com that the organization strongly opposes these clinics, which are “absolutely contrary to the goals that we have been working on with government agencies” to reduce maternal mortality. .
She added, “These new advanced birth centers will do nothing to address the OB/GYN deserts we have around Florida and the underserved areas around Florida for labor and delivery services.
“And worse, these advanced birth centers are likely to make the problems worse by drawing gynecologists and anesthesiologists away from the hospital setting and into these centers.”
Globally, women who had a caesarean section were 80 percent more likely to have complications than those who gave birth vaginally. For women aged 35 and older, the risk of serious complications was almost three times greater, the study said American action forum.
Governor DeSantis’ latest move to approve the implementation of outpatient centers where C-sections are performed will increase the risk of more women experiencing these negative side effects, according to medical experts and leading physician organizations.
Dr. Aaron Elkin, a Florida obstetrician, told the New York Times, “The uterus gets 20 percent of the blood that the heart pumps when you’re at full term. You can lose your entire blood supply in minutes.”
Despite groundbreaking medical innovations, the US is among the most dangerous places in the world to give birth.
A 2023 study JAMA found that U.S. maternal mortality — defined as death during pregnancy or within a year afterward — more than doubled between 1999 and 2019.
Although deaths increased among all racial and ethnic groups, disparities persisted. Black individuals consistently experienced higher maternal mortality rates, and Native American and Alaska Native communities saw particularly alarming increases, with average rates more than tripling.
The reasons for high maternal mortality range from high rates of pre-existing conditions that make pregnancy risky, such as diabetes and obesity, low access to care, especially in maternity care deserts, and variable quality of care based on where someone lives, to high rates. of risky medical interventions such as caesarean sections and inadequate postpartum care
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The above shows the number of obstetricians and obstetricians per patient, with the US having the second lowest number among rich countries
Maternity care in the US is becoming increasingly scarce because the units are expensive to administer and receive little reimbursement from the federal insurance program.
Staffing shortages have also led to more than 200 hospitals across the country closing labor and delivery units since 2011.
Ms Mayhew said: ‘We cannot ignore the reality of such a service, which could potentially draw staff away from a 24/7 hospital environment to these boutique, state-of-the-art birth centres, and will address the healthcare workforce shortage we already have worsen. that we are dealing with in the hospitals.’
Women’s Care Enterprises, owned by London investment firm BC Partners, has lobbied hard for the legislation, according to KFF Health News.
The company is likely to benefit from the deal because it will accept women with health insurance in place of Medicaid, the government program for poor Americans that the state has not expanded to cover more people.
Dr. Alice Abernathy, assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine, said: ‘This seems like a poor substitute for high-quality obstetric care, which is in fact portrayed as something that gives people more options.
“This feels like a bad band-aid for a chronic problem that will make the outcome worse rather than better.”