Medical Experts Outraged by Florida’s New, First-in-the-Nation C-Section Law

Lawmakers say the new law could help address Florida's maternity care deserts. However, doctors worry that the law endangers patients, as advanced birth centers aren’t equipped for serious C-section complications.

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Medical Experts Outraged by Florida’s New, First-in-the-Nation C-Section Law
The Florida State Capitol in Tallahassee. Photo Illustration: Jezebel/Wikimedia

Last week, Florida became the first state in the nation to allow C-sections to be performed outside of hospitals. Under the new law, SB 7016, certified OB-GYNs working in authorized advanced birth centers can perform planned C-sections for patients who are deemed low-risk for complications. Unsurprisingly, this is largely a product of private equity putting profit above patients and also stems from the state abortion ban’s impact on the medical system. Doctors have a lot of concerns.

The Republican legislators who introduced the bill say it will address a crisis in poor access to pregnancy and maternity care across the state; about 20% of counties in Florida are maternity care deserts, according to the March of Dimes, and 86% of Florida’s rural hospitals do not deliver babies. But expanding the scope of who can perform C-sections isn’t the solution, and critics have raised concerns about the influence of private equity in passing this dangerous bill.

Advanced birth centers are facilities designed to offer a homelike, non-medical setting for birth, and are not part of a hospital. Consequently, these centers don’t always have the resources or trained staff to address the severe complications that can arise with C-sections. NBC reports that Women’s Care Enterprises, a private equity-owned physicians group primarily operating in Florida and California, applied significant pressure to the state legislature to pass the bill. And Florida Republicans sided with the group despite top experts’ warnings, including the executive director of the American Association of Birth Centers, who called the bill “a radical departure from the standard of care” and “a bad idea.”

Dr. Judette Louis, department chair of Obstetrics and Gynecology at the University of South Florida, also questioned Women’s Care Enterprises’ political influence and the harm this bill could carry. “I think we also can’t ignore the fact that the people promoting it and who think it’s a good idea are private equity-based companies,” Louis told Fox 13 last week. “It’s Women’s Care Enterprises, and they are big money in the state of Florida, so you always have to be cautious about whether there is financial gain to be had by allowing a birth center to also do cesarean sections.”

Cole Greves, MD, Florida district chair of the American College of Obstetricians and Gynecologists (ACOG), told Jezebel in a statement that SB 7016 probably won’t help address the maternity care desert crisis and will just endanger patients. “Florida, like many states across the country, is suffering from the effects of maternity ward closures and a shortage of obstetric care professionals,” Greves said. But “advanced birth centers, even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.” Even if patients are deemed “low-risk” to have a C-section, “a pregnant patient that is considered ‘low-risk’ in one moment can suddenly need lifesaving care in the next.” Greves also questioned “how feasible these centers would be in areas that already face difficulty attracting obstetric care clinicians and keeping the few hospitals that do exist operational.” 

Dr. Alice Abernathy, assistant professor in the Department of Obstetrics & Gynecology of the University of Pennsylvania’s Perelman School of Medicine, told Jezebel she questions “who will ultimately be served” by SB 7016. Abernathy said she’s “skeptical of the value” of a bill like this given its risks, and how it won’t address one of the key problems driving maternity care deserts: OBGYNs don’t want to work in Florida since the state’s laws, including a near-total abortion ban, interfere with their ability to do their jobs. (In May, Florida enacted a six-week abortion ban that threatens doctors in violation with up to five years in prison, among other steep penalties.)

“Restricting the ability to provide health care, restricting people’s ability to practice evidence-based medicine, doesn’t create a great environment for attracting and retaining quality health care professionals,” Abernathy said. “And it certainly doesn’t guarantee the best care is delivered to patients.”

Louis similarly told Fox 13 that “OBGYNs are not coming at a rate to replace the ones that are fleeing.” She added that it’s now harder to recruit healthcare professionals” who say they’re “concerned that the legislative environment puts them at odds with the [Hippocratic] oath that they took.” 

To Abernathy and Louis’ point, one study published in May found that American medical students are less likely to apply to residency programs in states with abortion bans. A survey from December showed three out of four future U.S. doctors said abortion bans are a key factor in where they’ll apply for residencies. And in Idaho, where abortion is almost totally banned and doctors in violation are threatened with prison time, the state has been afflicted with a maternal care crisis after dozens of OBGYNs stopped practicing in the state due to fear of its abortion laws. A new analysis by the Association of American Medical Colleges’ think tank shows that doctors are similarly avoiding work in Utah due to the state’s criminal abortion ban.

Further, Abernathy pointed out that it remains “unclear” how advanced birth centers under SB 7016 can adhere to the law’s requirement that they perform only planned C-sections, noting that pregnant patients “come in for unscheduled visits all the time” because “that’s how labor happens. We don’t really control the clock in many cases.” If advanced birth centers aren’t “accepting certain emergency walk-ins, I don’t know how that’s feasible.”

Medical experts agree the state is, indeed, up against a maternal care crisis—but allowing C-sections to be practiced in potentially unsafe settings isn’t going to help anyone. “Maternity care is complex and difficult to legislate even with the best of intentions,” Greves said. “Ultimately, it is critical that any solution that aims to improve access to maternity care not sacrifice quality or safety in the process.”

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