Dr. Stephen Snow has spent 40 years as a practicing obstetrician and gynecologist in Florida. And he's noticed a trend that's becoming more common among soon-to-be mothers.
"Patients come to me and say, 'I don't want to give birth in a hospital,'" Snow said. "They are looking for something outside of the hospital experience, something that would bridge the gap between home birth, which is not safe, and a hospital setting, which isn't always comfortable and is full of sick people."
Florida lawmakers are considering legislation this spring that aims to meet that demand.
Two pairs of bills (SB 448, HB 25, H 1147 and S 1026) would create a new level of licensing for "advanced birthing centers," free-standing clinical offices that would specialize in labor and delivery. They also would be capable of performing caesarean sections and administering anesthesia, and would allow mothers to stay longer for recovery.
If approved, they would be first such facilities in the nation. But some hospital officials and doctors contend they could put patients in danger.
"We already have such a high infant and maternal mortality rate in the country, and Florida is among the worst infant mortality rates," said Dr. Cherie Foster, a neonatologist with the BayCare hospital system in Tampa Bay. "Unexpected things happen in labor and delivery, and this legislation, in the current form, doesn't provide for the care needed in those instances."
Under current law, expecting mothers can deliver babies at home, at hospitals or in licensed "birth centers," which can treat only low-risk pregnancies and operate under other restrictions.
The legislation would create a new class of "advanced" centers to perform cesarean sections and keep mothers for up to 72 hours afterwards. Those with vaginal deliveries would be able to stay up to 48 hours.
"Most transfers from birth centers are for pain control because they cannot administer anesthesia under current law," said Snow, who is the Florida legislative chair for the American College of Obstetricians and Gynecologists, which supports the legislation. "The other reasons are for C-sections, when the baby is too big or the labor is prolonged."
But even if the advanced centers are approved, only a select population of low-risk pregnant women would be able to use them, Snow said.
"Less than two-thirds of patients would qualify to give birth at a birthing center," he said. "At least 35 to 40 percent of pregnant women would need to be admitted to a hospital because their pregnancies are deemed too high risk."
The new centers would have ambulance service for mothers and newborns who need to be taken to a hospital for emergency care. But some doctors say the time lost in transit could pose a danger in such situations.
"Those minutes are critical to saving lives," Foster said. "The bill doesn't clarify who is responsible for that transport, either."
Lawmakers who sponsored the bills say their legislation gives women more choices beyond local hospitals and the 34 currently licensed birth centers in the state. Right now, those centers tend to offer alternative options like water births and rely mostly on midwives and doulas. They do not employ licensed physicians, in most cases, and cannot administer medication like epidurals.
"This legislation takes the next step and brings birthing centers really up for a lot of women who would really like the opportunity of not delivering in a hospital setting, which can be Petri dishes for all kinds of infections," state Sen. Gayle Harrell, R-Stuart, said during a recent meeting of the Senate Health Policy Committee.
Harrell chairs the panel and is the sponsor of SB 448.
"This gives women certainly the next option, a whole new level of experience," she said.
Rep. Colleen Burton, R-Lakeland, is the sponsor behind HB 383, which outlines that the Agency for Health Care Administration would be responsible for setting rules to regulate the centers if it passes.
Several senators raised questions about safety and quality — concerns that have been aired in years past when similar bills have been proposed.
Sen. Darryl Rouson, D-St. Petersburg, said the facilities might siphon away patients from hospitals, and asked if they would "allow cherry picking." Other senators pushed for provisions to control the number and location of the centers, and a clear set of standards for deciding the kinds of cases that can be treated in them.
The U.S. has the worst rates of woman dying from pregnancy-related complications of any developed country, and the numbers are rising — a trend that has sparked a national discussion among health care providers.
Florida's infant mortality rate is 6.1 deaths for every 1,000 live births, compared to the national rate of 5.9 deaths, according to the Centers for Disease Control and Prevention. And a report from the Florida Department of Health shows that maternal mortality rates have spiked over the last decade.
No other state operates "birthing centers" as described in the language of the bills. The only place that comes close is a free-standing birth clinic in Kansas, which is connected by a walkway to a hospital.
Most of the lobbying against the bills has come from Florida hospitals, including Johns Hopkins All Children's Hospital in St. Petersburg and the Florida Hospital Association.
But the market for birthing centers is there, said Dr. Judette Louis, a maternal-fetal medicine specialist with Tampa General Hospital.
"For a lot of reasons, there's some mistrust of hospitals and the traditional health care model," she said. "A lot of patients are seeking deliveries in a different setting. They consider birth centers or being at home as way to feel like they have more control."
The problem is that some pregnancies are high-risk.
"Admittedly, when a pregnancy is low-risk, a birth can be safe and a very quick process," Louis said. "But it can be hard to determine when the risk is greater. Patients don't realize how much they didn't know about the process or the decision they've made until it becomes an emergency situation."
The debate continues in Tallahassee, with lawmakers focused on two main bills.
The Senate bill was heard on the floor in March after senators voted unanimously in favor of it in the Health Policy Committee. The House bill also was introduced last month, and is now being heard in the Children, Families and Elder Affairs Committee.
Times/Herald Staff Writer, Elizabeth Koh contributed to this report. Contact Justine Griffin at email@example.com or (727) 893-8467. Follow @SunBizGriffin.