Establishes the cesarean births review board; provides such board shall be comprised of multidisciplinary experts to review the rate of cesarean births at hospitals in the state; provides reporting requirements.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9714a
TITLE OF BILL:
An act to amend the public health law, in relation to establishing the
cesarean births review board
PURPOSE OR GENERAL IDEA OF BILL:
To create a cesarean births review board for the purpose of lowering
cesarean birth rates and improving maternal health
SUMMARY OF KEY PROVISIONS:
Section one of the bill amends public health law to establish a "cesare-
an births review board." The board will undertake a review of the rate
of cesarean births at hospitals across the state and consider several
factors that may impact the frequency of this procedure. The board will
issue a final report and make recommendations related to the impact
cesarean births have on birthing people and best practices that can be
implemented to reduce the rate of cesarean births and improve overall
maternal health in the state. A copy of the final report must be posted
on the Department of Health website.
Section two provides the effective date.
The rate of cesarean birth in this state, and in this country, is not
nearly spoken about enough. Since the 1970s, the national rate of cesa-
rean births has increased by 500% which translates to about 1 in 3
babies delivered via c-section presently, compared to just 1 in 20
babies in the mid-1970s.* Despite this growing trend, research demon-
strates there is no evidence that cesarean births provide any benefit to
the mother or newborn when the procedure is not required, in fact, it is
quite the opposite.
Currently, New York ranks 12th in the nation, where approximately 33% of
all deliveries in the state are Cesarean. New York's cesarean birth rate
greatly exceeds the World Health Organization's and CDC's ideal rate
which is between 10 and 15 percent. While the state average is around
33%, it is important to note that cesarean birth rates vary greatly
across hospitals, ranging between 7% and 70% depending on what hospital
a birthing person goes to.**
Further, studies have found that cesarean birth rates in hospitals are
directly linked to higher maternal death rates and higher costs for
healthcare. The increase in cesarean rates in the U.S. is linked to an
increase in maternal deaths overall as the procedure can lead to neona-
tal respiratory problems and maternal complications. In fact, cesareans
can account for three of the top six leading causes of maternal mortali-
ty-hemorrhage, complications of anesthesia, and infection. Many of these
maternal deaths are preventable given WHO's recommended rate of cesarean
Additionally, there is an alarming disparity in cesarean birth rates
among different birthing populations. Minority (non-Hispanic black,
Hispanic/Latina, Indigenous, and low socio-economic status) birthing
people receive cesareans at a significantly higher rate than non-Hispan-
ic white birthing people, which is also an indicator of low-quality
maternity care. Moreover, black birthing people are more likely to
receive a cesarean overall and importantly, they are also more likely to
undergo repeated cesareans compared to other birthing people, which
further increases the risk of mortality. In fact, in the U.S., black
birthing people die from pregnancy-related causes at higher rates and
have a four times greater risk of maternal death, more than any other
racial or ethnic group.***
This bill would establish a "cesarean births review board" comprised of
experts in the field of maternal mortality, women's health and public
health, and must include healthcare professionals who are representative
of the racial, ethnic, and socioeconomic diversity of birthing people in
the state. The board will undertake a review of the rate of cesarean
births at hospitals across the state and consider several factors that
may impact the frequency of this procedure. The board will issue a final
report and make recommendations related to the impact cesarean births
have on birthing people and best practices that can be implemented to
reduce the rate of cesarean births and improve overall maternal health
in the state.
This act shall take effect immediately.
* Plough, A.C., Galvin, G., Zhonghe, L., Lipsitz, S.R., Alidina, S.,
Henrich, N.J., Hirschhorn, L.R., Berry, W.R., Gawande, A.A., Peter, D.,
McDonald, R., Caldwell, D.L., Muri, J.H., Bingham, D., Caughey, A.B.,
Declercq, E.R., Shah, N.T., Obstetrics and Gynecology, July 11, 2017.
**Neal Shah. July 2017.
*** Roth, L.M. and Henley, M.M. Unequal Motherhood: Racial-ethnic and
socioeconomic disparities in cesaraean sections in the United States.
Social Problems 2, vol. 59, 2012.
STATE OF NEW YORK
March 28, 2022
Introduced by M. of A. PAULIN, GOTTFRIED, ABINANTI, BURDICK -- read once
and referred to the Committee on Health -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
AN ACT to amend the public health law, in relation to establishing the
cesarean births review board
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-n to read as follows:
3 § 2500-n. Cesarean births review board. 1. There is hereby established
4 in the department the cesarean births review board, hereinafter referred
5 to as the "board". The members of the board shall be comprised of
6 experts in the fields of maternal mortality, maternal health, and public
7 health. The appointment of any member of the board shall be based in
8 part on the objective of ensuring that the board includes experts who
9 are representative of the racial, ethnic, and socioeconomic diversity of
10 the birthing people of the state.
11 2. The board should be composed of twelve members which shall include
12 eight members to be appointed by the governor as follows: two licensed
13 midwives in the state; two licensed and registered nurses specializing
14 in obstetrics in the state; two physicians specializing in obstetrics
15 and gynecology licensed and registered to practice in the state; and two
16 representatives of a women's maternal health organization that operates
17 in the state; and four additional members, two appointed on the recom-
18 mendation of the temporary president of the senate and two appointed on
19 the recommendation of the speaker of the assembly. The governor shall
20 designate the commissioner, or their designee, as chair of the board.
21 Members of the board shall receive no compensation for their services
22 but may be reimbursed for necessary and actual expenses incurred in the
23 performance of their duties hereunder.
24 3. The board shall undertake a review of cesarean births at hospitals
25 in the state. The board shall issue a final report and make recommenda-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 is old law to be omitted.
A. 9714--A 2
1 tions to reduce the rate of cesarean births in the state. The board
2 shall consider factors including, but not limited to:
3 (a) the primary and repeat cesarean birth rates among hospitals in the
5 (b) the hospitals in the state that allow or encourage vaginal births
6 after cesarean births;
7 (c) the rate of vaginal births after cesarean births among hospitals
8 in the state;
9 (d) the rate of vaginal births after cesarean births that were offered
10 by hospitals in the state but declined by the birthing person;
11 (e) the rate of vaginal births after cesarean births that were
12 attempted but failed among hospitals in the state;
13 (f) the time of day unplanned cesarean births occur in hospitals, and
14 whether such correlates with the rate of cesarean births in a hospital;
15 (g) the number of birthing people who elect to have midwives attend
16 labor and delivery in hospitals in the state;
17 (h) the frequency of midwifery care during labor in hospitals across
18 the state and what impact, if any, this has on the rate of cesarean
19 births; and
20 (i) the number of birthing people who were informed by their health
21 care provider about the potential risks, benefits, and alternatives
22 related to cesarean births before labor.
23 4. The board may request and shall receive upon request from any
24 department, division, board, bureau, commission, local health depart-
25 ments or any other agency in the state or political subdivision thereof
26 or any public authority, such information, including but not limited to
27 medical records, birth records, and any other information that will help
28 the department under this section to properly carry out its functions,
29 powers and duties.
30 5. The board shall, within eighteen months of convening, issue a final
31 report on its findings and recommendations to the governor, speaker of
32 the assembly, and temporary president of the senate. The board shall
33 post a copy of such report on the department's website.
34 6. The board shall keep confidential any information collected or
35 received under this section that includes personal identifying informa-
36 tion of the birthing person, health care practitioner or practitioners
37 or anyone else individually named in such information, as well as the
38 hospital or facility that treated the birthing person, and any other
39 information such as geographic location that may inadvertently identify
40 the birthing person, practitioner or facility, and shall use the infor-
41 mation provided or received under this section solely for the purposes
42 of improvement of the quality of maternal health care.
43 § 2. This act shall take effect immediately.