Inform Moms on C-Section Risks

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.