NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A318A
SPONSOR: Paulin (MS)
TITLE OF BILL: An act to amend the public health law, in relation to
informing maternity patients about the risks associated with cesarean
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:
Section one amends the public health law is amended by adding a new
section § 2500-1.
Subdivision one provides definitions and establishes a procedure for a
maternal health provider to provide a written communication to each
pregnant woman for whom a Cesarean section delivery is planned and to
each patient following an unplanned Cesarean delivery.
Subdivision two provides that the Commissioner of Health shall consult
with the American College of Obstetricians and Gynecologists and the New
York State Association of Licensed Midwives to develop a written commu-
nication or communications for maternal health care providers to
distribute to patients as required under this section.
Section two provides the effective date.
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
hysterectomy 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 deliv-
eries may be risky. Because of this, Cesarean delivery may be recom-
mended 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 breaking during
pregnancy or labor (uterine rupture). Additionally, women's risk of
developing placenta previa or accrete 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 delivery 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. Addi-
tionally, in emergency situations, lengthy discussions about the impact
of the Cesarean delivery on future pregnancies 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 directs the Commissioner of Health to establish a formal writ-
ten communication or communications 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 plans to deliver via Cesarean section or
delivered via Cesarean section to inform them about risks associated
with Cesarean section delivery, as well as how having a Cesarean section
may impact future pregnancies.
The Commissioner has the option to develop more than one version of the
communication, tailored to specific situations such as pregnant women
who have a primary Cesarean section planned or women who have already
undergone a prior Cesarean section. For example, a version of the commu-
nication geared towards women who have already had a prior Cesarean
section may include information about vaginal birth after Cesarean
(VBAC) and the specific risks associated with having multiple Cesarean
PRIOR LEGISLATIVE HISTORY:
A.10809B of 2018, amended on third reading
None to the state.
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.
STATE OF NEW YORK
Cal. No. 5
2019-2020 Regular Sessions
January 9, 2019
Introduced by M. of A. PAULIN, GOTTFRIED, GALEF, ARROYO, BARRON, BLAKE,
DICKENS, D'URSO, COLTON, COOK, EPSTEIN, SEAWRIGHT, TAYLOR, WOERNER,
McDONOUGH, JEAN-PIERRE, FERNANDEZ, WALKER, HYNDMAN, WRIGHT, BUTTENS-
CHON, SIMOTAS, JACOBSON, GRIFFIN -- Multi-Sponsored by -- M. of A.
THIELE -- read once and referred to the Committee on Health --
advanced to a third reading, passed by Assembly and delivered to the
Senate, recalled from the Senate, vote reconsidered, bill amended,
ordered reprinted, retaining its place on the order of third reading
AN ACT to amend the public health law, in relation to informing materni-
ty patients about the risks associated with cesarean section
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new section
2 2500-l to read as follows:
3 § 2500-l. Duty of providers of primary cesarean section maternity
4 services to inform. 1. (a) Every maternal health care provider shall
5 provide the written communication established in subdivision two of this
6 section prior to delivery to each pregnant woman for whom a cesarean
7 section delivery is planned.
8 (b) Every maternal health care provider who performs a cesarean
9 section which was not planned prenatally shall provide the written
10 communication established in subdivision two of this section to the
11 patient following delivery.
12 (c) As used in this section: "maternal health care provider" or
13 "provider" shall mean a physician, midwife, nurse practitioner, or
14 physician assistant, acting within his or her scope of practice, manag-
15 ing the pregnancy of a pregnant woman.
16 2. (a) The commissioner shall develop a written communication or
17 communications for maternal health care providers to distribute to
18 maternity patients as required in subdivision one of this section, which
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 is old law to be omitted.
A. 318--A 2
1 contains information about cesarean section delivery. The commissioner
2 shall consult with appropriate health care professionals, providers,
3 consumers, educators and patients or organizations representing them,
4 including but not limited to the American College of Obstetricians and
5 Gynecologists and the New York State Association of Licensed Midwives to
6 develop such written communication or communications.
7 (b) Such written communication or communications shall include, but
8 not be limited to information on:
9 i. potential maternal injuries associated with cesarean delivery; and
10 ii. potential risks to the fetus; and
11 iii. the impact a cesarean delivery may have on future pregnancies and
12 deliveries; and
13 iv. circumstances in which cesarean delivery may be necessary to save
14 the life of the mother or fetus.
15 (c) The commissioner shall ensure that all information included in the
16 written communication or communications are maintained and updated to
17 reflect current clinical guidelines.
18 § 2. This act shall take effect on the one hundred eightieth day after
19 it shall have become a law. Effective immediately, the department of
20 health may make regulations and take other actions necessary for the
21 timely implementation of this act on its effective date.