Private equity is getting into the c-section game in Florida; we have questions

A new Florida law allows doctors to perform c-sections and other maternal health care at outpatient facilities called Advanced Birthing Centers. It is the first state to do so. This move was driven by private equity owned physicians groups who claim the law will reduce costs and increase patient satisfaction. Advanced Birthing Centers are different from traditional birth centers, which are staffed by midwives and have operated for decades.

In Florida, seventeen hospitals have closed their maternity units since 2019, sometimes resulting in maternity care deserts. So having more sites available for maternity care could be beneficial for Floridian families.

However, there are reasons to be wary. Private equity firms are generally focused on maximizing profits over the short-term, which can lead to financial peril for the clinics or hospitals acquired.

Private equity has a questionable track record with clinical outcomes. Will maternity care be different?

Profit motive may have a negative impact on outcomes, as private equity-owned hospitals seek to cut costs by reducing staff and supplies. A study published in JAMA earlier this year found that rates of adverse events like falls and surgical site infections increased at hospitals acquired by private equity. And the impact of private equity’s takeover in the Steward Health System in Massachusetts is well-documented. One new mother even died since a medical device needed for her emergency care had been repossessed and was therefore unavailable.

As American mothers already face high rates of maternal mortality and complications, quality of care is a huge concern. While the new Advanced Birthing Centers in Florida are focused on insured, low-risk patients, doctors note that dangerous complications can occur with any patient. Cole Greves, an Orlando perinatologist, told KFF Health News, “A pregnant patient that is considered low-risk in one moment can suddenly need lifesaving care in the next…even with increased regulation, [these Advanced Birthing Centers] cannot guarantee the level of safety patients would receive within a hospital.” 

Will private equity bring more c-section overuse?

Private equity-owned practices in cardiology, dermatology, gastroenterology, ophthalmology, and dentistry have been known to increase their profits by churning out tests and procedures, some of which may be unnecessary. Will we see the same thing happen in maternity care? For example, c-sections put mothers at great risk and are already commonly overused.

C-sections make up around one third of births in the U.S., and can be life-saving in certain cases–but they come with risks. Women who have c-sections are 80% more likely to develop complications, and pregnant women over age 35 (a growing trend) face particularly high rates of severe complications. They can also increase the risk of complications in future pregnancies, meaning that the use of unnecessary c-sections can prohibit mothers from having more children without risk to their lives. Reasons like these factor into why the U.S. Department of Health and Human Services has made reducing the rates of cesarean births a goal for the past few decades.

C-sections, on average, are 15% more profitable for clinics than vaginal births, and some research shows that when there’s no profit incentive, the rate of c-sections goes down.

Given that most c-sections can be both scheduled and profitable, it makes sense that private equity would want to maximize this line of revenue. That should worry patients and providers, who want to ensure the most appropriate and safest care possible is provided.

So, will private equity’s entrance into maternity care help or hurt pregnant Floridians? Given the high need for maternal care services, these Advanced Birthing Centers may benefit families who otherwise lack convenient access to care. However, if the historical behavior of private equity in health care tells us anything, it’s that we should be keeping a close eye on the potential for overuse and the danger it represents to patients.

Brenna Miller is a Health Communications Specialist at the Lown Institute. She holds a masters degree in public health from Tufts University School of Medicine.

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