Pittsburgh maternity experts skeptical of Florida law allowing out-of-hospital C-sections

Pittsburgh-area childbirth experts say they are skeptical of a new Florida law that would allow the creation of “advanced birth centers” in the state, where doctors could deliver babies vaginally or by C-section outside of a hospital.

Florida’s Gov. Ron DeSantis signed the bill in March, creating a new designation for advanced birth centers, where doctors can perform cesarean or vaginal deliveries for “low-risk” patients.

The centers would be required to have two medical directors overseeing the activities of the center, coordinate with a blood bank for emergency blood bank services and have protocols for other emergencies.

Florida Surgeon General Dr. Joseph Ladapo highlighted the need to increase access to maternal health care.

“Expanding access to care for pregnant moms and Floridians in rural and underserved areas will help make Florida a healthier state,” he said.

Even so, some Pennsylvania care providers aren’t convinced it’s a good idea.

“I have really serious concerns about it,” said midwife Vivian Boyer, who works at Independence Health System. “I know there are a lot of out of hospital services that are done at other surgery centers, but with pregnant women we’re dealing with two patients: mother and baby.

“In the hospital setting, we are equipped for any type of emergency, which gives a much safer environment for women to have a cesarean section,” she added.

Independence OBGYN Dr. Megan Klamerus said the centers presented a good idea in theory, but noted the risks seemed significant.

“C-sections are a very common surgery. I did one this morning; we do multiple in a week,” she said. “But it’s still a major abdominal surgery. With OB, things can go from great to not great in a matter of minutes.”

“Our country still has a huge maternal mortality rate,” she noted. “Why would you want to do anything to jeopardize that further?”

In 2022, 35.9% of births in Florida were delivered by C-section, according to Florida Department of Health data. In Pennsylvania, for the same year period, just under 31% of births were by C-section, according to state department of health data.

Klamerus also was concerned the centers might not be able to provide the same continuity of care, or services before or after the birth, that a hospital might.

“We try to make it so that it isn’t scary,” she said. “I think it takes a lot of stress off of moms, too: knowing, seeing a familiar face, and having familiar surroundings.”

Small, community hospital closures are definitely an issue, she noted, hearkening to the closure of WVU Medicine Uniontown Hospital’s labor and delivery unit. The unit shut down in 2019, prior to its management takeover by WVU Medicine in January 2020, and is expected to reopen in January 2025.

“When they closed their labor and delivery unit, those patients are definitely patients who can’t get around town. Their choices were to come to us, which is a far drive, go to Jefferson which is a far drive, or cross the border into West Virginia,” she said. “That was a huge blow to the small, underserved community. That was a great resource to those patients, and the population still got hit.”

Birth outside of hospitals

Dr. Kailee Venzin is a physical therapy doctor and founder of Resilient Women’s Health, which has clinics in Greensburg and in Pine in Allegheny County that offer pregnancy and postpartum care. She has mixed feelings about the idea of advanced birth centers that could perform surgeries.

“I think that it is great that they’re trying to increase availability of places to give birth. I didn’t realize how bad it was in Florida, but it’s pretty bad here too with access,” she said. “But, I think that having that option onsite could potentially increase the amount of c-sections performed, and we know that that is one of the biggest risks for maternal mortality.”

Having more birth centers in general would be a good idea, she said, but also important is the care that comes before and after birth.

“I would want to see more education for women throughout pregnancy, I’d love to see more physical therapy because that can help to decrease complications,” she said.

Lily Johnson, a doula and director of Golden Lotus Doula Services, said that while more birth centers for low-risk patients are needed, the advanced birth center concept isn’t as necessary in western Pennsylvania.

“While I’m sure they would figure out the logistics of opening a surgical suite in freestanding birth centers, I don’t necessarily see the need for it in our community,” she said. “If the goal is more options that are safer for birthing people, I think the answer is more midwives and birth centers that are focused on low-risk care, not surgical centers.”

As many look for outside-the-hospital birth options, Kristina Smouse, an Independence Health System midwife, says hospitals should focus on offering patients what they need and the birth experience they’re seeking.

“There’s already a population of people that have a fear of hospitals, and are seeking care outside of a hospital. I wish we could push and focus on why, what could we do better for you as a population, what could we do better for you to make it a safer environment,” she said. “I feel like we can give that to them. I just wish we would focus more on that instead of saying, well, we are going to add more services to these outside things.”