Establishes a duty to inform certain patients about the risks associated with cesarean section for patients undergoing a planned or unplanned primary cesarean section.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1039A
SPONSOR: Paulin 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 communi-
cation 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
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 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:
A.4927A of 2023 and 2024, passed assembly both years / Same as S.311B,
amend and recommit to women's issues.
A.217 of 2021 and 2022, passed assembly both years / Same as 5.2736,
referred to women's issues/
A.318A of 2019 and 2020, passed Assembly both years / S.2888A, referred
to Women's Issues.
A.10809 of 2018, referred to health.
FISCAL IMPLICATIONS:
None to the state.
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.
STATE OF NEW YORK
________________________________________________________________________
1039--A
2025-2026 Regular Sessions
IN ASSEMBLY
January 8, 2025
___________
Introduced by M. of A. PAULIN, GONZALEZ-ROJAS, SEAWRIGHT, SIMON,
BICHOTTE HERMELYN, CLARK, LEVENBERG, JACOBSON, ZACCARO, SANTABARBARA,
OTIS -- read once and referred to the Committee on Health -- recommit-
ted to the Committee on Health in accordance with Assembly Rule 3,
sec. 2 -- 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
certain patients about the risks associated with cesarean section for
patients undergoing planned and unplanned primary cesarean sections
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. Duty of providers of primary cesarean section services to
4 inform. 1. The commissioner shall require that every health care provid-
5 er, licensed pursuant to title eight of the education law and acting
6 within such health care provider's scope of practice and attending a
7 pregnant person, to provide written communication to each pregnant
8 person for whom a primary cesarean section delivery, defined as first
9 lifetime delivery via cesarean section, is planned.
10 2. In the event that the primary cesarean section is not planned
11 prenatally, the commissioner shall require that the health care provider
12 who performed the cesarean section provide written communication to each
13 person who delivered via primary cesarean section the reason for the
14 unplanned cesarean section after the delivery.
15 3. The provider shall provide communication to the patient with a
16 planned cesarean section. Such communication shall include, but not be
17 limited to the following information:
18 "Cesarean birth can be life-saving for the fetus, the birthing parent,
19 or both in some cases. However, in the absence of maternal or fetal
20 indications for cesarean delivery, a vaginal birth is preferable. Vagi-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00513-02-6
A. 1039--A 2
1 nal delivery is associated with shorter recovery times, reduced risk of
2 infection, decreased maternal morbidity, and decreased risk of compli-
3 cations in future pregnancies. In no instance should you ever request a
4 cesarean delivery. Potential injuries to the birthing parent associated
5 with cesarean birth include, but are not limited to, heavy blood loss
6 that results in hysterectomy or a blood transfusion, ruptured uterus,
7 injury to other organs including the bladder, and other complications
8 from a major surgery. Additionally, the risk of developing placenta
9 previa or accreta is higher after cesarean delivery than vaginal birth.
10 Some providers may recommend a cesarean due to maternal age, size of the
11 fetus, or breech presentation, although this is widely debated among
12 providers. After a cesarean delivery, future vaginal deliveries may
13 result in uterine rupture. Because of this, cesarean delivery may be
14 recommended in the future. However, vaginal birth after cesarean (VBAC)
15 may be possible, depending upon your health characteristics. Speak to
16 your health care provider about your options and any questions you may
17 have."
18 4. The provider shall provide written communication to the patient
19 with an unplanned cesarean section that shall include, but not be limit-
20 ed to, the written communication required pursuant to subdivision two of
21 this section and the following information:
22 "Your most recent delivery was via cesarean section. Cesarean delivery
23 can be life-saving for the fetus, the birthing parent, or both in some
24 cases. After a cesarean delivery, future vaginal deliveries may result
25 in uterine rupture. Because of this, cesarean delivery may be recom-
26 mended in the future. However, vaginal birth after cesarean (VBAC) may
27 be possible, depending upon your health characteristics. Vaginal birth
28 after cesarean (VBAC) requires no abdominal surgery, shorter recovery
29 periods, lower risk of infection and may prevent certain health problems
30 linked to multiple cesarean deliveries. The risk of developing placenta
31 previa or accreta increases with each subsequent cesarean delivery. Not
32 all providers and hospitals perform VBACs. Speak to your health care
33 provider about your options and any questions you may have."
34 § 2. This act shall take effect on the one hundred eightieth day after
35 it shall have become a law. Effective immediately, the addition, amend-
36 ment and/or repeal of any rule or regulation necessary for the implemen-
37 tation of this act on its effective date are authorized to be made and
38 completed on or before such effective date.
