Florida's new law will let women have C-sections outside of hospitals, but doctors warn of deadly complications

Medical experts are unsettled by a Florida law that allows non-hospital clinics to perform risky C-sections, which can lead to fatal bleeding and problems in future pregnancies.

Gov Ron DeSantis signed a law in March that establishes 'advanced birth centers', new facilities that will be allowed to perform C-sections in outpatient settings where staff could be unable to mobilize quickly in the event of an emergency or lack the expertise to deal with that emergency.

The legislation was billed as a panacea for the state’s rapidly dwindling maternity care offerings, which were driven by low federal reimbursement rates for people on Medicaid. 

Seventeen maternity centers in Florida hospitals have been shuttered since 2019, making several parts of the state, especially rural areas, maternity deserts.

Now, medical experts are warning the procedures should only be done in hospitals to mitigate the risk of life-threatening hemorrhaging in the mother, infection, and problems giving birth in the future. It can also, in rare cases, lead to the death of the baby. 

A cesarean delivery (C-section) is performed by cutting into the woman’s uterus to remove the baby. Around one-third of babies are delivered this way, but women who undergo the procedure are 80 percent more likely to suffer some kind of complication. 

Dr Cole Greves, an Orlando-based perinatologist who chairs the Florida chapter of the American College of Obstetricians and Gynecologists, told KFF Health News : ‘A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next.' 

He added the new birth clinics, ‘even with increased regulation, cannot guarantee the level of safety patients would receive within a hospital.’

C-sections are becoming more common and may seem appealing partly because they can be scheduled, removing the guesswork around when labor will start. It may also prove a safer option for women who may be at higher risk of complications from a vaginal delivery, such tears in the tissue between the vagina and the anus, infection, nerve damage, or excessive bleeding. 

But women who take this route risk infection in the lining of the uterus after giving birth, blood loss, reactions to anesthesia, blood clotting, especially in the legs or pelvis, and complications for future pregnancy, such as an attachment of the placenta to the wall of the uterus.

Mary Mayhew, the chief executive of the Florida Hospital Association, told DailyMail.com that the organization is adamantly opposed to these clinics, which are 'absolutely contrary to the goals that we've been working on collaboratively with state agencies' to reduce maternal mortality. 

She added: 'These new advanced birthing centers will do nothing to address the OB/GYN deserts that we have around Florida and the underserved areas around Florida for labor and delivery services. 

'And worse, these advanced birthing centers will likely exacerbate the challenges by potentially drawing OB/GYN and anesthesiologist away from the hospital setting and into these centers.' 

Worldwide, women who had C-sections were 80 percent more likely to have complications than those who delivered vaginally. For women aged 35 and older, the risk for severe complications was nearly three times greater, according to the American Action Forum.

The latest move by Gov DeSantis approving the implementation of outpatient centers where C-sections are performed will, according to medical experts and leading doctors' organizations, raise the risk of more women experiencing these negative side effects.

Dr Aaron Elkin, a Florida obstetrician, told the New York Times: ‘The uterus gets 20 percent of the blood that the heart is pumping when you are at term pregnancy. In minutes, you can lose your entire blood supply.’

Despite groundbreaking medical innovation, the US is among the most dangerous places to give birth globally. 

A 2023 study in JAMA  found that maternal mortality in the US — defined as death during pregnancy or within a year after — more than doubled between 1999 and 2019.

While deaths increased across all racial and ethnic groups, disparities persisted. Black individuals consistently experienced higher rates of maternal mortality, and Native American and Alaska Native communities saw a particularly alarming increase, with median rates more than tripling.

The reasons for high maternal mortality run the gamut from high rates of preexisting conditions that make pregnancy risky, like diabetes and obesity, low access to care especially in maternity care deserts, and variable quality of care based on where a person lives, to high rates of risky medical interventions like C-sections and inadequate post-partum care  

Maternity care in the US is becoming increasingly scarce because the units are expensive to run and have low 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 can't ignore the reality of any service like that, that could potentially draw staff away from a 24/7 hospital environment to these boutique, advanced birthing centers, will exacerbate the healthcare workforce shortage shortages that we are already contending with in the hospitals.'  

Women’s Care Enterprises, owned by the London-based investment firm BC Partners, lobbied hard for the legislation, according to KFF Health news.

The firm will likely profit from the deal, as it will accept women with health insurance rather than Medicaid, the government program for poor Americans that the state has not expanded to cover more people.

Dr Alice Abernathy, an assistant professor of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine, said: ‘What this looks like is a poor substitute for quality obstetrical care effectively being billed as something that gives people more choices.

‘This feels like a bad band-aid on a chronic issue that will make outcomes worse rather than better.’