Advertisement
  1. Health

Florida considers a new option for moms who don't want to give birth in a hospital

Legislation moving through the Florida House and Senate would create “advanced birthing centers” that would be able to perform caesarean sections and administer anesthesia, and would allow mothers to stay longer for recovery. Supporters say there’s a market for the service, as many parents are opting for births outside a hospital. [iStockphoto.com]
Published Mar. 29

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."

RELATED: Cameras offer peace of mind to parents of babies in intensive care

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.

RELATED: 'Pregnancy centers' draw scrutiny as lawmakers seek to elevate their status

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 jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.

ALSO IN THIS SECTION

  1. FILE  - In this Aug. 28, 2019, file photo, a man exhales while smoking an e-cigarette in Portland, Maine. Walmart says it will stop selling electronic cigarettes at its namesake stores and Sam's Clubs following a string of illnesses and deaths related to vaping.  The nation's largest retailer said Friday, Sept. 20 that it will complete its exit from e-cigarettes after selling through current inventory. It cited growing federal, state and local regulatory complexity regarding vaping products. ROBERT F. BUKATY  |  AP
    The nation’s largest retailer said Friday that it will complete its exit from e-cigarettes after selling through current inventory.
  2. Erik Maltais took an unconventional path to becoming CEO of Immertec, a virtual reality company aimed at training physicians remotely. He dropped out of school as a teenager, served in Iraq in the Marine Corps and eventually found his way to Tampa. OCTAVIO JONES   |   TIMES  |  Times
    Software from Immertec can bring physicians into an operating room thousands of miles away.
  3. Homeowner Cheryl Murdoch, 59, explains the workings of the Philips Smart Mirror in her bathroom. Murdoch and her husband live in the Epperson neighborhood in Wesley Chapel, home of the Crystal Lagoon, where some residents are piloting new health technologies inside their homes. SCOTT KEELER  |   Times
    In Pasco’s Crystal Lagoon community, AdventHealth and Metro Development Group are testing in-home technology aimed at keeping people away from the hospital.
  4. Dr. Paul McRae was the first black chief of staff at Bayfront Medical Center in St. Petersburg. Dr. McRae died on September 13, 2019. He was photographed here in the Tampa Bay Times photo studio for the 2008 Dr. Carter G Woodson Museum's "Legends Honorees" gala. BOYZELL HOSEY  |  BOYZELL HOSEY  |  Times
    ‘His extraordinary example paved the way for so many others.’
  5. Michael Jenkins spent seven days at North Tampa Behavioral Health last July. Since then, he says his three children have been afraid he’ll leave and not come home. JOHN PENDYGRAFT   |   Times
    The patients have no choice, and the hospital is making millions.
  6. Samantha Perez takes a call for someone in need of counseling at the Crisis Center of Tampa Bay earlier this year. The center handles calls dealing with suicide, sexual assault, homelessness and other traumatic situations. They also do outreach and counseling, and operate Transcare, an ambulance service. JONES, OCTAVIO  |  Tampa Bay Times
    Florida’s mental health care system saves lives.
  7. The Florida Department of Health in Hillsborough County identified a positive case of hepatitis A in a food service worker at Hamburger Mary's in Ybor City on Oct. 22, 2018. [JOSH FIALLO | Times] JOSH FIALLO | TIMES  |  JOSH FIALLO | Times
    Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018.
  8. FILE - In this Feb. 20, 2014, file photo, a patron exhales vapor from an e-cigarette at a store in New York. Under the Trump administration, former FDA commissioner Scott Gottlieb kicked off his tenure in 2017 with the goal of making cigarettes less addictive by drastically cutting nicotine levels. He also rebooted the agency’s effort to ban menthol flavoring in cigarettes. But those efforts have been largely eclipsed by the need to respond to an unexpected explosion in e-cigarette use by teens. AP
    Hundreds of people nationwide have come down with lung illness related to vaping.
  9. This May 2018, photo provided by Joseph Jenkins shows his son, Jay, in the emergency room of the Lexington Medical Center in Lexington, S.C. Jay Jenkins suffered acute respiratory failure and drifted into a coma, according to his medical records, after he says he vaped a product labeled as a smokable form of the cannabis extract CBD. Lab testing commissioned as part of an Associated Press investigation into CBD vapes showed the cartridge that Jenkins says he puffed contained a synthetic marijuana compound blamed for at least 11 deaths in Europe. JOSEPH JENKINS  |  AP
    The vapor that Jenkins inhaled didn’t relax him. After two puffs, he ended up in a coma.
  10. H. Lee Moffitt Cancer Center & Research Institute is the centerpiece of Project Arthur, an 800-acre corporate park that could include up 24 million square feet of office and industrial space on nearly 7,000 acres of what is now ranch land, but targeted for development in central Pasco. Times
    The H. Lee Moffitt facility is the centerpiece of an economic development effort in a proposed 800-acre corporate park.
Advertisement
Advertisement
Advertisement