NY State Senate Bill 2023-S311B

Senate Bill S311B

2023-2024 Legislative Session

Establishes a duty to inform maternity patients about the risks associated with cesarean section for patients undergoing a primary cesarean section

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Current Bill Status - In Senate Committee Women's Issues Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 17, 2024	print number 311b
Jan 17, 2024	amend and recommit to women's issues
Jan 03, 2024	referred to women's issues
Feb 14, 2023	print number 311a
Feb 14, 2023	amend (t) and recommit to women's issues
Jan 04, 2023	referred to women's issues

Bill Amendments

Original

B (Active)

co-Sponsors

View additional co-sponsors

2023-S311 - Details

See Assembly Version of this Bill:: A4927
Current Committee:: Senate Women's Issues
Law Section:: Public Health Law
Laws Affected:: Add §2500-m, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2017-2018: A10809
2019-2020: S2888, A318
2021-2022: S2736, A217

2023-S311 - Summary

Establishes a duty to inform maternity patients about the risks associated with cesarean section for patients undergoing a primary cesarean section; establishes a duty to inform maternity patients about the reason for performing a primary cesarean section delivery.

2023-S311 - Sponsor Memo

                                 
BILL NUMBER: S311

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to informing materni-
ty 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 this bill.

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
delivery that 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 the 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 deliveries may
be dangerous. Because of this, Cesarean delivery may be recommended in
the future. (However, vaginal birth after Cesarean (VBAC) may be possi-
ble, depending upon health characteristics).

In future pregnancies, there is risk of the Cesarean section scar break-
ing during pregnancy or labor (uterine rupture). Additionally, a preg-
nant persons' risk of developing placenta previa or accreta in future
pregnancies is higher after Cesarean deliveries than vaginal births. As
a result, it is important that all pregnant individuals who plan to have
a Cesarean delivery be informed about the risks, both immediately and in
the future. It is also important that pregnant individuals who experi-
ence unplanned Cesarean sections be informed as soon as is possible
about how having a Cesarean section may impact their maternal health in
the future.

As described in the NYS Taskforce on Maternal Mortality and Disparate
Racial Outcomes March 2019 report, and numerous peer-reviewed studies,
the high rate of maternal mortality in the U.S. is partially explained
by the high rate of Cesarean deliveries, which carry overall higher
rates of maternal mortality. The Taskforce report also documented an
almost three times higher rate of maternal mortality for Black women as
compared with white women and noted the clear linkage between poverty,
racism, and power imbalances faced by Black women and other women of
color in regard to poorer maternal outcomes.

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 pregnancies cannot be guaran-
teed to occur at the time of informed consent and may, in fact, be
detrimental as there might not be time for such discussions.

This bill requires maternal health care providers, defined as any physi-
cian, midwife, nurse practitioner, or physician assistant, or other
maternal health care practitioner acting within his or her lawful scope
of practice attending a pregnant person, 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 asso-
ciated 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.


The written communication required by this bill will be developed by the
CoMmissioner of Health in consultation with health care professionals,
providers, consumers, educators, patients or organizations representing
them, and, specifically including ACOG and the NYS Association of
Licensed Midwives and will provide standardized information about risks
associated with Cesarean section delivery and about the potential impact
of the Cesarean on future pregnancies.

Significantly, this bill would not require that the written communi-
cation mandated be provided in advance to a pregnant person for whom a
medical determination is made that an emergency and unplanned cesarean
section is necessary. This provision ensures that the mandate of this
bill will not interfere with or jeopardize the health or safety of the
woman or the child in such emergency situations.

 
RACIAL JUSTICE IMPACT

According to the World Health Organization (WHO), many Cesarean sections
are undertaken unnecessarily which can put the lives and well-being of
pregnant people and their babies at risk - both in the short and long-
term. African American Women in particular are significantly more likely
to have a cesarean delivery than other women.

See: https://www.marchofdimes.org/Peristats/ViewSubtopic.aspx?
reg=99&top=8&stop=35 5&lev=l&slev=l&obj=1

This bill would enhance racial justice as there are significant racial
disparities in maternal mortality and morbidity and infant and child
health. The mandate for providing full information to maternity patients
about risks associated with cesarean deliveries is consistent with WHO
recommendations and -will help to reduce maternal and infant mortality
and the racial disparities that exist.

 
GENDER JUSTICE IMPACT

To reduce unnecessary Cesarians, the World Health Organization (WHO)
recommends educational intervention for women and families to support
meaningful dialogue with providers on modes of delivery and informed
decision making. This bill would enhance gender justice by improving
informed decision-making by women and improving health outcomes overall.

 
PRIOR LEGISLATIVE HISTORY:

SENATE:

2019: S2888 (Salazar) - Reported out of the Women's Issues Committee,
amended

2020: Referred to Women's Issues Committee

2021-2022: S2736 (Salazar)- Referred to Women's Issues Committee

ASSEMBLY:

2018: A10809B (Paulin)- Died in Assembly.

2019: A318 (Paulin)- Passed Assembly, amended, repassed Assembly

2020: A318 - Passed Assembly

2021-2022: A217 (Paulin)- Passed Assembly

 
FISCAL IMPLICATION:

No negative fiscal implications to the state. On average, cesarean
births costs more than typical vaginal deliveries thus driving up the
cost of care. It is likely this bill would result in fiscal savings as
the reduction in maternal mortality and morbidity would result in
reduced health-care costs to governmental entities providing health-care
funding (such as Medicaid)as well as overall reductions in costs to
medical providers.

 
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.

2023-S311 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    311
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 4, 2023
                                ___________
 
 Introduced  by  Sens. SALAZAR, ADDABBO, BAILEY, BORRELLO, BRESLIN, BRIS-
   PORT, BROUK, CLEARE, COMRIE,  COONEY,  GOUNARDES,  HARCKHAM,  HINCHEY,
   HOYLMAN,  JACKSON,  LIU,  MAY, MYRIE, PERSAUD, RAMOS, RIVERA, SANDERS,
   SEPULVEDA, SERRANO, STAVISKY, WEIK -- read twice and ordered  printed,
   and when printed to be committed to the Committee on Women's Issues
 
 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:
 
   Section 1. The public health law is amended by adding  a  new  section
 2500-l to read as follows:
   §  2500-L.  DUTY  OF  PROVIDERS  OF PRIMARY CESAREAN SECTION MATERNITY
 SERVICES TO INFORM. 1. (A) EVERY MATERNAL  HEALTH  CARE  PROVIDER  SHALL
 PROVIDE THE WRITTEN COMMUNICATION ESTABLISHED IN SUBDIVISION TWO OF THIS
 SECTION  PRIOR  TO  DELIVERY  TO EACH PREGNANT WOMAN FOR WHOM A CESAREAN
 SECTION DELIVERY IS PLANNED.
   (B) EVERY MATERNAL  HEALTH  CARE  PROVIDER  WHO  PERFORMS  A  CESAREAN
 SECTION  WHICH  WAS  NOT  PLANNED  PRENATALLY  SHALL PROVIDE THE WRITTEN
 COMMUNICATION ESTABLISHED IN SUBDIVISION TWO  OF  THIS  SECTION  TO  THE
 PATIENT FOLLOWING DELIVERY.
   (C)  AS  USED  IN  THIS  SECTION:   "MATERNAL HEALTH CARE PROVIDER" OR
 "PROVIDER" SHALL MEAN  A  PHYSICIAN,  MIDWIFE,  NURSE  PRACTITIONER,  OR
 PHYSICIAN  ASSISTANT, ACTING WITHIN HIS OR HER SCOPE OF PRACTICE, MANAG-
 ING THE PREGNANCY OF A PREGNANT WOMAN.
   2. (A) THE COMMISSIONER  SHALL  DEVELOP  A  WRITTEN  COMMUNICATION  OR
 COMMUNICATIONS  FOR  MATERNAL  HEALTH  CARE  PROVIDERS  TO DISTRIBUTE TO
 MATERNITY PATIENTS AS REQUIRED IN SUBDIVISION ONE OF THIS SECTION, WHICH
 CONTAINS INFORMATION ABOUT CESAREAN SECTION DELIVERY.  THE  COMMISSIONER
 SHALL  CONSULT  WITH  APPROPRIATE  HEALTH CARE PROFESSIONALS, PROVIDERS,
 CONSUMERS, EDUCATORS AND PATIENTS OR  ORGANIZATIONS  REPRESENTING  THEM,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00291-01-3
 S. 311                              2
 
 INCLUDING  BUT  NOT LIMITED TO THE AMERICAN COLLEGE OF OBSTETRICIANS AND
 GYNECOLOGISTS AND THE NEW YORK STATE ASSOCIATION OF LICENSED MIDWIVES TO
 DEVELOP SUCH WRITTEN COMMUNICATION OR COMMUNICATIONS.
   (B)  SUCH  WRITTEN  COMMUNICATION OR COMMUNICATIONS SHALL INCLUDE, BUT
 NOT BE LIMITED TO INFORMATION ON:
   I. POTENTIAL MATERNAL INJURIES ASSOCIATED WITH CESAREAN DELIVERY; AND
   II. POTENTIAL RISKS TO THE FETUS; AND
   III. THE IMPACT A CESAREAN DELIVERY MAY HAVE ON FUTURE PREGNANCIES AND
 DELIVERIES; AND
   IV. CIRCUMSTANCES IN WHICH CESAREAN DELIVERY MAY BE NECESSARY TO  SAVE
 THE LIFE OF THE MOTHER OR FETUS.
   (C) THE COMMISSIONER SHALL ENSURE THAT ALL INFORMATION INCLUDED IN THE
 WRITTEN  COMMUNICATION  OR  COMMUNICATIONS ARE MAINTAINED AND UPDATED TO
 REFLECT CURRENT CLINICAL GUIDELINES.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.  Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation by the department of health
 necessary for the implementation of this act on its effective  date  are
 authorized to be made and completed on or before such effective date.

co-Sponsors

View additional co-sponsors

2023-S311A - Details

See Assembly Version of this Bill:: A4927
Current Committee:: Senate Women's Issues
Law Section:: Public Health Law
Laws Affected:: Add §2500-m, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2017-2018: A10809
2019-2020: S2888, A318
2021-2022: S2736, A217

2023-S311A - Summary

2023-S311A - Sponsor Memo

                                 
BILL NUMBER: S311A

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to the duty to inform
maternity patients about the risks associated with cesarean section for
patients undergoing a primary cesarean section and to inform maternity
patients about the reason for performing primary cesarean section deliv-
ery

 
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 this bill.

For primary cesarean sections planned based on medical necessity, the
basis for such recommendation must be provided prior to delivery.

For planned primary cesarean sections requested by the patient, the
provider must provide information indicating that the primary cesarean
section is not medically necessary and to explain the risks associated
prior to the delivery.

For primary cesarean sections not planned prenatally, the provider who
performed the cesarean section must provide information in writing to
the patient after the delivery explaining the reason for the unplanned
cesarean section.

In all cases, the information provided - either prior to delivery for a
planned primary cesarean section or after for an unplanned primary cesa-
rean section - the bill sets out information regarding risks associated
with cesarean sections.

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 the 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 deliveries may
be dangerous. Because of this, cesarean delivery may be recommended in
the future. (However, vaginal birth after cesarean (VBAC) may be possi-
ble, depending upon health characteristics).

In future pregnancies, there is risk of the cesarean section scar break-
ing during pregnancy or labor (uterine rupture). Additionally, a preg-
nant persons' risk of developing placenta previa or accreta in future
pregnancies is higher after cesarean deliveries than vaginal births. As
a result, it is important that all pregnant individuals who plan to have
a cesarean delivery be informed about the risks, both immediately and in
the future. It is also important that pregnant individuals who experi-
ence unplanned cesarean sections be informed as soon as is possible
about how having a cesarean section may impact their maternal health in
the future.

As described in the NYS Taskforce on Maternal Mortality and Disparate
Racial Outcomes March 2019 report, and numerous peer-reviewed studies,
the high rate of maternal mortality in the U.S. is partially explained
by the high rate of cesarean deliveries, which carry overall higher
rates of maternal mortality. The Taskforce report also documented an
almost three times higher rate of maternal mortality for Black women as
compared with white women and noted the clear linkage between poverty,
racism, and power imbalances faced by Black women and other women of
color in regard to poorer maternal outcomes.

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 pregnancies cannot be guaran-
teed to occur at the time of informed consent and may, in fact, be
detrimental as there might not be time for such discussions.

This bill requires maternal health care providers, defined as any physi-
cian, midwife, nurse practitioner, or physician assistant, or other
maternal health care practitioner acting within his or her lawful scope
of practice attending a pregnant person, to provide to each maternal
patient who a) plans to deliver via primary cesarean section or b)
delivered via primary 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.

Significantly, this bill would not require that the written communi-
cation mandated be provided in advance to a pregnant person for whom a
medical determination is made that an emergency and unplanned cesarean
section is necessary. This provision ensures that the mandate of this

bill will not interfere with or jeopardize the health or safety of the
woman or the child in such emergency situations.

 
RACIAL JUSTICE IMPACT

According to the World Health Organization (WHO), many cesarean sections
are undertaken unnecessarily which can put the lives and well-being of
pregnant people and their babies at risk - both in the short and long-
term. African American Women in particular are significantly more likely
to have a cesarean delivery than other women.

See: https://www.marchofdimes.org/Peristats/Vi.ewSubtopic.as x?
reg=99&top=8&stop=35 5&lev-1&slev=1&ob3=1

This bill would enhance racial justice as there are significant racial
disparities in maternal mortality and morbidity and infant and child
health. The mandate for providing full information to maternity patients
about risks associated with cesarean deliveries is consistent with WHO
recommendations and -will help to reduce maternal and infant mortality
and the racial disparities that exist.

 
GENDER JUSTICE IMPACT

To reduce unnecessary cesarians, the World Health Organization (WHO)
recommends educational intervention for women and families to support
meaningful dialogue with providers on modes of delivery and informed
decision-making. This bill would enhance gender justice by improving
informed decision-making by women and improving health outcomes overall.

 
PRIOR LEGISLATIVE HISTORY:

SENATE:

2019: S2888 (Salazar) - Reported out of the Women's Issues Committee,
amended

2020: Referred to Women's Issues Committee

2021-2022: S2736 (Salazar)- Referred to Women's Issues Committee

ASSEMBLY:

2018: A10809B (Paulin)- Died in Assembly.

2019: A318 (Paulin)- Passed Assembly, amended, repassed Assembly

2020: A318 - Passed Assembly

2021-2022: A217 (Paulin)- Passed Assembly

 
FISCAL IMPLICATION:

No negative fiscal implications to the state. On average, cesarean
births costs more than typical vaginal deliveries thus driving up the
cost of care. It is likely this bill would result in fiscal savings as
the reduction in maternal mortality and morbidity would result in
reduced health-care costs to governmental entities providing health-care

funding (such as Medicaid)as well as overall reductions in costs to
medical providers.

 
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.

2023-S311A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  311--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 4, 2023
                                ___________
 
 Introduced  by  Sens. SALAZAR, ADDABBO, BAILEY, BORRELLO, BRESLIN, BRIS-
   PORT, BROUK, CLEARE, COMRIE,  COONEY,  GOUNARDES,  HARCKHAM,  HINCHEY,
   HOYLMAN-SIGAL,  JACKSON,  LIU,  MAY,  MYRIE,  PERSAUD,  RAMOS, RIVERA,
   SANDERS, SEPULVEDA, SERRANO, STAVISKY, WEIK -- read twice and  ordered
   printed,  and when printed to be committed to the Committee on Women's
   Issues -- committee discharged, bill  amended,  ordered  reprinted  as
   amended and recommitted to said committee
 
 AN ACT to amend the public health law, in relation to the duty to inform
   maternity  patients  about  the risks associated with cesarean section
   for patients undergoing a  primary  cesarean  section  and  to  inform
   maternity  patients  about  the reason for performing primary cesarean
   section delivery
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The  public health law is amended by adding a new section
 2500-l to read as follows:
   § 2500-L. DUTY OF PROVIDERS  OF  PRIMARY  CESAREAN  SECTION  MATERNITY
 SERVICES  TO INFORM. 1. THE COMMISSIONER SHALL REQUIRE THAT EVERY MATER-
 NAL HEALTH CARE PROVIDER, DEFINED AS ANY PHYSICIAN, MIDWIFE, NURSE PRAC-
 TITIONER, OR PHYSICIAN ASSISTANT, OR OTHER MATERNAL HEALTH CARE  PRACTI-
 TIONER  ACTING  WITHIN  HIS  OR HER LAWFUL SCOPE OF PRACTICE ATTENDING A
 PREGNANT WOMAN, TO PROVIDE WRITTEN COMMUNICATION TO EACH PREGNANT  WOMAN
 FOR  WHOM A PRIMARY CESAREAN SECTION DELIVERY, DEFINED AS FIRST LIFETIME
 DELIVERY VIA CESAREAN SECTION, IS  RECOMMENDED  AS  A  PLANNED  CESAREAN
 SECTION  DELIVERY  BASED ON MEDICAL NECESSITY, THAT THE PRIMARY CESAREAN
 SECTION IS RECOMMENDED AND TO PROVIDE THE JUSTIFICATION FOR THE  PRIMARY
 CESAREAN SECTION PRIOR TO THE DELIVERY.
   2.  IN  THE  EVENT  THAT  A  PRIMARY  CESAREAN  SECTION  IS NOT DEEMED
 MEDICALLY NECESSARY BY THE PROVIDER BUT THE PATIENT REQUESTS  A  PLANNED
 CESAREAN  SECTION  DELIVERY,  THE  COMMISSIONER  SHALL  REQUIRE THAT THE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00291-02-3
 S. 311--A                           2
 
 MATERNAL HEALTH CARE PROVIDER PROVIDE WRITTEN COMMUNICATION TO THE PREG-
 NANT WOMAN REQUESTING THE PRIMARY CESAREAN SECTION INDICATING  THAT  THE
 PRIMARY  CESAREAN  SECTION IS NOT MEDICALLY NECESSARY AND TO EXPLAIN THE
 RISKS ASSOCIATED WITH THE CESAREAN SECTION PRIOR TO THE DELIVERY.
   3.  IN  THE  EVENT  THAT  THE  PRIMARY CESAREAN SECTION IS NOT PLANNED
 PRENATALLY, THE COMMISSIONER SHALL REQUIRE THAT THE MATERNAL HEALTH CARE
 PROVIDER WHO PERFORMED THE CESAREAN  SECTION  PROVIDE  COMMUNICATION  IN
 WRITING  TO  EACH  WOMAN  WHO DELIVERED VIA PRIMARY CESAREAN SECTION THE
 REASON FOR THE UNPLANNED CESAREAN SECTION AFTER THE DELIVERY.
   4. THE PROVIDER SHALL PROVIDE COMMUNICATION  TO  THE  PATIENT  WITH  A
 PLANNED  CESAREAN SECTION THAT SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
 FOLLOWING INFORMATION, IN THE SUMMARY OF THE REPORT SENT TO THE PATIENT:
   "CESAREAN BIRTH CAN BE LIFE-SAVING FOR THE FETUS, THE MOTHER, OR  BOTH
 IN  SOME  CASES.  HOWEVER,  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). 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 POSSI-
 BLE, 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 CESARE-
 AN  DELIVERIES  THAN  VAGINAL BIRTHS. SPEAK TO YOUR HEALTH CARE PROVIDER
 ABOUT YOUR OPTIONS AND ANY QUESTIONS YOU MAY HAVE."
   5. THE PROVIDER SHALL PROVIDE COMMUNICATION TO  THE  PATIENT  WITH  AN
 UNPLANNED  CESAREAN  SECTION  THAT SHALL INCLUDE, BUT NOT BE LIMITED TO,
 THE FOLLOWING INFORMATION, IN THE SUMMARY OF  THE  REPORT  SENT  TO  THE
 PATIENT:
   "YOUR MOST RECENT DELIVERY WAS VIA CESAREAN SECTION. CESAREAN DELIVERY
 CAN  BE  LIFE-SAVING  FOR  THE FETUS, THE MOTHER, OR BOTH IN SOME CASES.
 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 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. SPEAK TO YOUR HEALTH CARE PROVIDER  ABOUT  YOUR  OPTIONS
 AND ANY QUESTIONS YOU MAY HAVE."
   § 2. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become  a law. Effective immediately, the department of
 health may promulgate any rule or regulation necessary  for  the  timely
 implementation of this act on its effective date.

co-Sponsors

View additional co-sponsors

2023-S311B (ACTIVE) - Details

See Assembly Version of this Bill:: A4927
Current Committee:: Senate Women's Issues
Law Section:: Public Health Law
Laws Affected:: Add §2500-m, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2017-2018: A10809
2019-2020: S2888, A318
2021-2022: S2736, A217

2023-S311B (ACTIVE) - Summary

2023-S311B (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S311B

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to the duty to inform
maternity patients about the risks associated with cesarean section for
patients undergoing a primary cesarean section and to inform maternity
patients about the reason for performing primary cesarean section deliv-
ery

 
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-m as
follows:

Section one adds a new section 2500-m, which establishes a duty on the

part of maternal health providers of primary cesarean section maternity
services to provide written communications as defined in this bill.

For primary cesarean sections planned based on medical necessity, the
basis for such recommendation must be provided prior to delivery.  For
planned primary cesarean sections requested by the patient, the provider
must provide information indicating that the primary cesarean section is
not medically necessary and to explain the risks associated prior to the
delivery.

For primary cesarean sections not planned prenatally, the provider who
performed the cesarean section must provide information in writing to
the patient after the delivery explaining the reason for the unplanned
cesarean section.

In all cases, the information provided - either prior to delivery for a
planned primary cesarean section or after for an unplanned primary cesa-
rean section - the bill sets out information regarding risks associated
with cesarean sections.

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 the 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 deliveries may
be dangerous. Because of this, cesarean delivery may be recommended in
the future. (However, vaginal birth after cesarean (VBAC) may be possi-
ble, depending upon health characteristics).

In future pregnancies, there is risk of the cesarean section scar break-
ing during pregnancy or labor (uterine rupture). Additionally, a preg-
nant persons' risk of developing placenta previa or accreta in future
pregnancies is higher after cesarean deliveries than vaginal births. As
a result, it is important that all pregnant individuals who plan to have
a cesarean delivery be informed about the risks, both immediately and in
the future. It is also important that pregnant individuals who experi-
ence unplanned cesarean sections be informed as soon as is possible
about how having a cesarean section may impact their maternal health in
the future.

As described in the NYS Taskforce on Maternal Mortality and Disparate
Racial Outcomes March 2019 report, and numerous peer-reviewed studies,
the high rate of maternal mortality in the U.S. is partially explained
by the high rate of cesarean deliveries, which carry overall higher
rates of maternal mortality. The Taskforce report also documented an
almost three times higher rate of maternal mortality for Black women as
compared with white women and noted the clear linkage between poverty,
racism, and power imbalances faced by Black women and other women of
color in regard to poorer maternal outcomes.

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 pregnancies cannot be guaran-
teed to occur at the time of informed consent and may, in fact, be
detrimental as there might not be time for such discussions.

This bill requires maternal health care providers, defined as any physi-
cian, midwife, nurse practitioner, or physician assistant, or other
maternal health care practitioner acting within his or her lawful scope
of practice attending a pregnant person, to provide to each maternal
patient who a) plans to deliver via primary cesarean section or b)
delivered via primary 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.

Significantly, this bill would not require that the written communi-
cation mandated be provided in advance to a pregnant person for whom a
medical determination is made that an emergency and unplanned cesarean
section is necessary. This provision ensures that the mandate of this

bill will not interfere with or jeopardize the health or safety of the
woman or the child in such emergency situations.

 
RACIAL JUSTICE IMPACT

According to the World Health Organization (WHO), many cesarean sections
are undertaken unnecessarily which can put the lives and well-being of
pregnant people and their babies at risk - both in the short and long-
term. African American Women in particular are significantly more likely
to have a cesarean delivery than other women.

See: https://www.marchofdimes.org/Peristats/Vi.ewSubtopic.as x?
reg=99&top=8&stop=35 5&lev-l&slev=l&ob3=1

This bill would enhance racial justice as there are significant racial
disparities in maternal mortality and morbidity and infant and child
health. The mandate for providing full information to maternity patients
about risks associated with cesarean deliveries is consistent with WHO
recommendations and -will help to reduce maternal and infant mortality
and the racial disparities that exist.

 
GENDER JUSTICE IMPACT

To reduce unnecessary cesarians, the World Health Organization (WHO)
recommends educational intervention for women and families to support
meaningful dialogue with providers on modes of delivery and informed
decision-making. This bill would enhance gender justice by improving
informed decision-making by women and improving health outcomes overall.

 
AMENDED BILL

The "B" print of this bill simply makes a technical correction, changing
the section number of the new section from public health law 2500-1 to
2500-m.

 
PRIOR LEGISLATIVE HISTORY:

SENATE:

2019: S2888 (Salazar) - Reported out of the Women's Issues Committee,
amended

2020: Referred to Women's Issues Committee

2021-2022: 52736 (Salazar)- Referred to Women's Issues Committee

ASSEMBLY:

2018: A10809B (Paulin)- Died in Assembly.

2019: A318 (Paulin)- Passed Assembly, amended, repassed Assembly

2020: A318 (Paulin) - Passed Assembly

2021-2022: A217 (Paulin)- Passed Assembly

2023: A4927 (Paulin)- Passed Assembly

 
FISCAL IMPLICATION:

No negative fiscal implications to the state. On average, cesarean
births costs more than typical vaginal deliveries thus driving up the
cost of care. It is likely this bill would result in fiscal savings as
the reduction in maternal mortality and morbidity would result in
reduced health-care costs to governmental entities providing health-care
funding (such as Medicaid) as well as overall reductions in costs to
medical providers.

 
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.

2023-S311B (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  311--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 4, 2023
                                ___________
 
 Introduced  by  Sens. SALAZAR, ADDABBO, BAILEY, BORRELLO, BRESLIN, BRIS-
   PORT, BROUK, CLEARE, COMRIE,  COONEY,  GOUNARDES,  HARCKHAM,  HINCHEY,
   HOYLMAN-SIGAL,  JACKSON,  LIU,  MAY,  MYRIE,  PERSAUD,  RAMOS, RIVERA,
   SANDERS, SCARCELLA-SPANTON, SEPULVEDA, SERRANO, STAVISKY,  WEBB,  WEIK
   -- read twice and ordered printed, and when printed to be committed to
   the Committee on Women's Issues -- committee discharged, bill amended,
   ordered  reprinted  as  amended  and  recommitted to said committee --
   recommitted to the Committee on  Women's  Issues  in  accordance  with
   Senate  Rule  6, sec. 8 -- committee discharged, bill amended, ordered
   reprinted as amended and recommitted to said committee
 
 AN ACT to amend the public health law, in relation to the duty to inform
   maternity patients about the risks associated  with  cesarean  section
   for  patients  undergoing  a  primary  cesarean  section and to inform
   maternity patients about the reason for  performing  primary  cesarean
   section delivery
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The public health law is amended by adding  a  new  section
 2500-m to read as follows:
   §  2500-M.  DUTY  OF  PROVIDERS  OF PRIMARY CESAREAN SECTION MATERNITY
 SERVICES TO INFORM. 1. THE COMMISSIONER SHALL REQUIRE THAT EVERY  MATER-
 NAL HEALTH CARE PROVIDER, DEFINED AS ANY PHYSICIAN, MIDWIFE, NURSE PRAC-
 TITIONER,  OR PHYSICIAN ASSISTANT, OR OTHER MATERNAL HEALTH CARE PRACTI-
 TIONER ACTING WITHIN HIS OR HER LAWFUL SCOPE  OF  PRACTICE  ATTENDING  A
 PREGNANT  WOMAN, TO PROVIDE WRITTEN COMMUNICATION TO EACH PREGNANT WOMAN
 FOR WHOM A PRIMARY CESAREAN SECTION DELIVERY, DEFINED AS FIRST  LIFETIME
 DELIVERY  VIA  CESAREAN  SECTION,  IS  RECOMMENDED AS A PLANNED CESAREAN
 SECTION DELIVERY BASED ON MEDICAL NECESSITY, THAT THE  PRIMARY  CESAREAN
 SECTION  IS RECOMMENDED AND TO PROVIDE THE JUSTIFICATION FOR THE PRIMARY
 CESAREAN SECTION PRIOR TO THE DELIVERY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00291-03-4
 S. 311--B                           2
 
   2. IN THE  EVENT  THAT  A  PRIMARY  CESAREAN  SECTION  IS  NOT  DEEMED
 MEDICALLY  NECESSARY  BY THE PROVIDER BUT THE PATIENT REQUESTS A PLANNED
 CESAREAN SECTION DELIVERY,  THE  COMMISSIONER  SHALL  REQUIRE  THAT  THE
 MATERNAL HEALTH CARE PROVIDER PROVIDE WRITTEN COMMUNICATION TO THE PREG-
 NANT  WOMAN  REQUESTING THE PRIMARY CESAREAN SECTION INDICATING THAT THE
 PRIMARY CESAREAN SECTION IS NOT MEDICALLY NECESSARY AND TO  EXPLAIN  THE
 RISKS ASSOCIATED WITH THE CESAREAN SECTION PRIOR TO THE DELIVERY.
   3.  IN  THE  EVENT  THAT  THE  PRIMARY CESAREAN SECTION IS NOT PLANNED
 PRENATALLY, THE COMMISSIONER SHALL REQUIRE THAT THE MATERNAL HEALTH CARE
 PROVIDER WHO PERFORMED THE CESAREAN  SECTION  PROVIDE  COMMUNICATION  IN
 WRITING  TO  EACH  WOMAN  WHO DELIVERED VIA PRIMARY CESAREAN SECTION THE
 REASON FOR THE UNPLANNED CESAREAN SECTION AFTER THE DELIVERY.
   4. THE PROVIDER SHALL PROVIDE COMMUNICATION  TO  THE  PATIENT  WITH  A
 PLANNED  CESAREAN SECTION THAT SHALL INCLUDE, BUT NOT BE LIMITED TO, THE
 FOLLOWING INFORMATION, IN THE SUMMARY OF THE REPORT SENT TO THE PATIENT:
   "CESAREAN BIRTH CAN BE LIFE-SAVING FOR THE FETUS, THE MOTHER, OR  BOTH
 IN  SOME  CASES.  HOWEVER,  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). 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 POSSI-
 BLE, 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 CESARE-
 AN  DELIVERIES  THAN  VAGINAL BIRTHS. SPEAK TO YOUR HEALTH CARE PROVIDER
 ABOUT YOUR OPTIONS AND ANY QUESTIONS YOU MAY HAVE."
   5. THE PROVIDER SHALL PROVIDE COMMUNICATION TO  THE  PATIENT  WITH  AN
 UNPLANNED  CESAREAN  SECTION  THAT SHALL INCLUDE, BUT NOT BE LIMITED TO,
 THE FOLLOWING INFORMATION, IN THE SUMMARY OF  THE  REPORT  SENT  TO  THE
 PATIENT:
   "YOUR MOST RECENT DELIVERY WAS VIA CESAREAN SECTION. CESAREAN DELIVERY
 CAN  BE  LIFE-SAVING  FOR  THE FETUS, THE MOTHER, OR BOTH IN SOME CASES.
 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 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. SPEAK TO YOUR HEALTH CARE PROVIDER  ABOUT  YOUR  OPTIONS
 AND ANY QUESTIONS YOU MAY HAVE."
   § 2. This act shall take effect on the one hundred eightieth day after
 it  shall  have  become  a law. Effective immediately, the department of
 health may promulgate any rule or regulation necessary  for  the  timely
 implementation of this act on its effective date.

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Senate Bill S311B

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Sponsored By

Current Bill Status - In Senate Committee Women's Issues Committee

Bill Amendments

co-Sponsors

2023-S311 - Details

2023-S311 - Summary

2023-S311 - Sponsor Memo

2023-S311 - Bill Text download pdf

co-Sponsors

2023-S311A - Details

2023-S311A - Summary

2023-S311A - Sponsor Memo

2023-S311A - Bill Text download pdf

co-Sponsors

2023-S311B (ACTIVE) - Details

2023-S311B (ACTIVE) - Summary

2023-S311B (ACTIVE) - Sponsor Memo

2023-S311B (ACTIVE) - Bill Text download pdf

Comments