Peter Schorsch
Facing rising costs of childbirth in the United States, a pair of Florida lawmakers are offering expectant mothers at minimal risk of labor complications an alternative to expensive hospital visits.
On Tuesday, the House Health Care Appropriations Committee will consider HB 1099, which opens the door for advanced birthing centers (ABCs) — free-standing, non-hospital facilities that supply a variety of obstetrics, labor and delivery services, including low-risk traditional births, selected Caesarean births, vaginal births after cesarean section, and related procedures.
Sponsoring HB 1099 in the House is Palm Beach Republican MaryLynn Magar; Republican Denise Grimsley of Lake Placid has filed the Senate companion (SB 1564).
Using the latest techniques from highly specialized staff, ABCs offer pregnant women and their families a specially designed setting, one that is relaxed, comfortable and idealized for childbirth.
Such facilities would practice exclusively in obstetrics and delivery — handling carefully screened maternity patients who have already received proper prenatal care.
According to HB 1099, an ABC would perform no other major surgeries and will care for patients with both private and government insurance, including Medicaid.
The goal of an ABC is to supply professional services beyond those offered in traditional hospital births, serving as an alternative to exceedingly expensive hospital stays for low-risk expectant mothers.
However, in a statement released Monday, the Florida Hospital Association opposes the bill, primarily based on a newly released study by the American Academy of Pediatrics.
Based on controversial studies, the United States may rank as high as 60th in the world in maternal mortality. The AAP estimates 10 percent of babies born need some level of neonatal resuscitation at birth, with 1 percent needing extensive resuscitation measures to survive. A recent American College of Obstetrics and Gynecology estimate shows 140,000 maternal deaths occur worldwide every year — 1 woman every four minutes. Since 2000, U.S. maternal mortality rates may have increased, the ACOG adds. Evaluation of maternal mortality rates in the U.S. is made difficult by newer methods of reporting death statistics designed to more accurately measure the number of women dying in childbirth.
Speaking to the concerns of the FHA, the bill’s sponsors and supporters of advanced birthing centers — a group that includes Florida obstetricians and other health care professionals — offer assurances that HB 1099 will completely address all those matters.
Also, they point out that the ACOG mortality numbers are, in fact, for all births globally, despite childbirth procedures in the United States rising to become the most expensive worldwide by far — demonstrating an overwhelming need for safe and more affordable alternatives.
HB 1099 also mandates that any ABC must meet or exceed transparency requirements set by state, federal, or certifying bodies which involve quality and safety data.
Under the bill, the staff of an advanced birthing center must include experts in neonatal resuscitation. Arrangements will be available for immediate transfer to a newborn infant care center, if necessary.
Before accepting a patient — HB 1099 requires birthing centers to perform a thorough screening, taking only patients that show a minimal risk. And if an unexpected complication occurs during labor or delivery, the center must be able to handle emergency transfusions, imaging, ultrasounds as well as having an in-house urgent cesarean section capability and prearranged transfer to a hospital for further care.
These added safety features are currently unavailable (or not allowed for) in birthing centers under existing Florida statutes.
Obstetricians also strongly back another bill introduced in the 2018 Session to require adverse incident reporting for out-of-hospital births — including those in ABCs.
The Florida Agency for Health Care Administration will regulate ABC construction, and surgical suites must meet federal rules. Physician owners, if any, will be required to show financial interests, keeping with state and federal requirements.
HB 1099 also seeks to ensure the safety of both mother and newborn in advanced birthing centers by following or exceed the ACOG “Level 1, Basic Care” rules, which are currently recommended as basic standards in hospitals offering obstetrics care.
The offices of both Magar and Grimsley say they are working with the FHA to address any concerns over the bill, and plan to file amendments to include such requirements for ABCs as established transfer agreements with a hospital; that at least two professionals attend every birth and have capabilities for rapid transfer, blood transfusion and emergency release of blood products.
In addition, obstetrics providers with privileges to perform emergency cesarean sections must participate in all deliveries in a birthing center, as well as have nurses on hand who are expert in perinatal nursing care.
