BILL NUMBER: S2888A

SPONSOR: SALAZAR
 
TITLE OF BILL:  An act to amend the public health law, in relation to
informing maternity patients about the risks associated with cesarean
section

 
PURPOSE OR GENERAL IDEA OF BILL:

To amend the public health law, in relation to informing maternity
patients about the risks associated with Cesarean section.

 
SUMMARY OF SPECIFIC PROVISIONS:

This act amends the public health law by adding a new section 2500-1 as
follows:

Section one adds a new section 2500-1, which establishes a duty on the
part of maternal health providers of primary cesarean section maternity
services to provide written communications as defined in section 2.

              

Section 2500-1(1)(a) requires such communication to be provided by
maternal health providers prior to delivery to pregnant women for whom a
cesarean section delivery is planned.

Section 2500-1(1)(b) requires such communication to be provided by
maternal health providers following delivery in the case of a cesarean
section was performed, but had not been planned prenatally.

Section 2500-1(1)(c )defines "maternal health care provider".

Section 2500-1(2)(a) provides that the written communication required by
section one will be developed by the Commissioner based on consultations
with appropriate health care professionals, providers, consumers, educa-
tors, and patients, including the American College of Obstetricians and
Gynecologists and the NYS Association of Licensed Midwives.

Section 2500-1(2)(b) provides that such written communications shall
include, but not be limited to, potential maternal injuries, potential
injuries to the fetus, the impact of a cesarean delivery may have on
future pregnancies and deliveries, and the circumstances in which cesa-
rean delivery may be necessary to save the life of the mother or fetus.

Section 2500-1(2)(c ) requires that the information provided be updated
as necessary to reflect current clinical guidance.

Section two provides the effective date.

 
JUSTIFICATION:

In New York State, nearly 20% of babies are delivered via Cesarean
section, with the rate of use of Cesarean section delivery ranging from
8% to 32%, depending on facility. According to the American College of
Obstetricians and Gynecologists (ACOG), Cesarean delivery is recommended
for certain medical conditions to prevent maternal and infant morbidity
and mortality. However, for low-risk pregnancies, Cesarean delivery
increases the risk of maternal mortality and morbidity and infant
morbidity. Potential maternal injuries associated with Cesarean delivery
include but are not limited to: heavy blood loss that results in hyster-
ectomy or a blood transfusion, ruptured uterus, injury to other organs
including the bladder, and other complications from a major surgery.
Cesarean delivery also carries higher risk of infant injury and can
result in situations requiring the neonatal intensive care unit (NICU).
Additionally, after a Cesarean delivery, future vaginal deliveries may
be risky. Because of this, Cesarean delivery may be recommended in the
future. However, vaginal birth after Cesarean (VBAC) may be possible,
depending upon your health characteristics.

In future pregnancies, there is risk of the Cesarean section scar break-
ing during pregnancy or labor (uterine rupture). Additionally, women's
risk of developing placenta previa or accreta in future pregnancies is
higher after Cesarean deliveries than vaginal births.  Because of these
risks, it is important that all women who plan to have a Cesarean deliv-
ery be informed about the risks, both immediate and in the future. It is
also important that women who experience unplanned Cesarean sections be
informed about how having a Cesarean section may impact their maternal
health in the future.

While it is customary for informed consent to be given before a Cesarean
section, informed consent documents are not standardized and may contain
medical jargon. Additionally, in emergency situations, lengthy
discussions about the impact of the Cesarean delivery on future pregnan-
cies cannot be guaranteed to occur at the time of informed consent and
informed consent may focus solely on the Cesarean surgery. This written
communication will provide standardized information in plain, English
about risks associated with Cesarean section delivery and about the
potential impact of the Cesarean on future pregnancies, based on ACOG
guidance.

This act establishes a formal message for a maternal health care provid-
er, defined as any physician, midwife, nurse practitioner, or physician
assistant, or other maternal health care practitioner acting within his
or her lawful scope of practice attending a pregnant woman, to provide
to each maternal patient who a) plans to deliver via Cesarean section or
b) delivered via Cesarean section a standardized message to inform them
about risks associated with Cesarean section delivery, as well as how
having a Cesarean section may impact future pregnancies. This bill is
modeled after the law that requires patients with dense breast tissue be
informed through a written communication from their provider after a
mammography exam.

 
PRIOR LEGISLATIVE HISTORY:

A.10809B of 2018, amended on third reading.

A.318 of 2018:
1/23/19 passed assembly
01/23/19 delivered to senate
01/23/19 REFERRED TO HEALTH
05/07/19 recalled from senate
05/07/19 RETURNED TO ASSEMBLY
05/07/19 vote reconsidered - restored to third reading
05/07/19 amended on third reading 318a

 
FISCAL IMPLICATION:

None to the state.
 
EFFECTIVE DATE:
This act shall take effect 180 days after it shall become a law.  Effec-
tive immediately, the department of health may make regulations and take
other actions reasonably necessary for the timely implementation of this
act on that date.