Senate Bill S7879B

                                 
BILL NUMBER: S7879

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to the duty to inform
certain patients about the risks associated with cesarean section for
patients undergoing a primary cesarean section and to inform certain
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-n as
follows:

Section one adds a new section 2500-n, 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
8t 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 accrete 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.

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:

2023-2024: S311B (Salazar) - Referred to Women's Issues Committee

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

2020: S2888A (Salazar) - Referred to Women's Issues Committee

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

ASSEMBLY:

2023: A4927 (Paulin)- Passed Assembly

2021-2022: A217 (Paulin)- Passed Assembly

2020: A318 (Paulin) - Passed Assembly

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

2018: A10809B (Paulin)- Died in 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.

                                 
BILL NUMBER: S7879A

SPONSOR: SALAZAR
 
TITLE OF BILL:

An act to amend the public health law, in relation to the duty to inform
certain patients about the risks associated with cesarean section for
patients undergoing planned and unplanned primary cesarean sections

 
PURPOSE:

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

 
SUMMARY OF PROVISIONS:

Section one amends the public health law by adding a new section 2500-n.

Subdivision one provides definitions and establishes a procedure for a
health care provider, licensed pursuant to title eight of the education
law and acting within such health care provider's scope of practice and
attending a pregnant person, to provide written communication to each
              

pregnant person for whom a Cesarean section delivery is recommended,
explaining the justification for the recommendation, including risks and
benefits of the procedure.

Subdivision two provides that in the event that a primary c-section is
not planned prenatally, the health care provider must provide written
communication with the reason for the unplanned cesarean section.
Subdivision three requires the provider to provide communication to the
patient with a planned cesarean section, establishing a formal message
to be shared with each pregnant person undergoing a planned cesarean
section.

Subdivision four requires the provider to provide communication to the
patient with an unplanned cesarean section, establishing a formal
message to be shared with each pregnant person undergoing an unplanned
cesarean section.

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 (AGOG), Cesarean delivery is recom-
mended 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 a 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 preg-
nancies, 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. Additionally, in emergency
situations, lengthy discussions about the impact of the Cesarean deliv-
ery 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 informa-
tion 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 health care provider,
licensed pursuant to title eight of the education law and acting within
such health care provider's scope of practice and attending a pregnant
person, to provide to each maternal patient who plans to deliver via
Cesarean section or delivered via an unplanned Cesarean section a stand-
ardized 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 communi-
cation from their provider after a mammography exam.

 
LEGISLATIVE HISTORY:

Senate:

SENATE:

2025: S7879 (Salazar)- Referred to Women's Issues Committee

2023-2024: S311B (Salazar) - Referred to Women's Issues Committee

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

2020: S2888A (Salazar) - Referred to Women's Issues Committee

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

ASSEMBLY:

2025: S4927B (Paulin)- Passed Assembly

2023-2024: A4927 (Paulin)- Passed Assembly

2021-2022: A217 (Paulin)- Passed Assembly

2020: A318 (Paulin) - Passed

Assembly

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

2018: A10809B (Paulin)- Died in Assembly.

 
FISCAL IMPLICATIONS:

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 on the one hundred eightieth day after it
shall have become a law. Effective immediately, the addition, amendment
and/or repeal of any rule or regulation necessary for the implementation
of this act on its effective date are authorized to be made and
completed on or before such effective date.