New York State Assembly

 
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A00318 Summary:

A00318 Actions:

A00318 Committee Votes:

Committee:HEALTH   Chair:Gottfried      
DATE:01/15/2019AYE/NAY:25/0  Action: Favorable         
Gottfried
Aye
Raia
Aye
Schimminger
Excused
McDonough
Aye
Galef
Aye
Ra
Aye
Dinowitz
Aye
Garbarino
Aye
Cahill
Aye
Byrne
Aye
Paulin
Aye
Byrnes
Aye
Cymbrowitz
Aye
Ashby
Aye
Gunther
Aye
Rosenthal
Aye
Hevesi
Aye
Jaffee
Aye
Steck
Aye
Abinanti
Aye
Braunstein
Aye
Kim
Aye
Solages
Aye
Bichotte
Aye
Barron
Aye
Sayegh
Aye

A00318 Floor Votes:

A00318 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A318A
 
SPONSOR: Paulin (MS)

 
TITLE OF BILL:  An act to amend the public health law, in relation to
informing maternity 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:
 
Section one amends the public health law is amended by adding a new
section § 2500-1.
 
Subdivision one provides definitions and establishes a procedure for a
maternal health provider to provide a written communication to each
pregnant woman for whom a Cesarean section delivery is planned and to
each patient following an unplanned Cesarean delivery.
 
Subdivision two provides that the Commissioner of Health shall consult
with the American College of Obstetricians and Gynecologists and the New
York State Association of Licensed Midwives to develop a written commu-
nication or communications for maternal health care providers to
distribute to patients as required under this 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 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 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 directs the Commissioner of Health to establish a formal writ-
ten communication or communications 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 plans to deliver via Cesarean section or
delivered via Cesarean section to inform them about risks associated
with Cesarean section delivery, as well as how having a Cesarean section
may impact future pregnancies.
 
The Commissioner has the option to develop more than one version of the
communication, tailored to specific situations such as pregnant women
who have a primary Cesarean section planned or women who have already
undergone a prior Cesarean section. For example, a version of the commu-
nication geared towards women who have already had a prior Cesarean
section may include information about vaginal birth after Cesarean
(VBAC) and the specific risks associated with having multiple Cesarean
sections.
 
 
PRIOR LEGISLATIVE HISTORY:
 
A.10809B of 2018, amended on third reading
 
 
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.

A00318 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         318--A
                                                                  Cal. No. 5
 
                               2019-2020 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2019
                                       ___________
 
        Introduced  by M. of A. PAULIN, GOTTFRIED, GALEF, ARROYO, BARRON, BLAKE,
          DICKENS, D'URSO, COLTON, COOK, EPSTEIN,  SEAWRIGHT,  TAYLOR,  WOERNER,
          McDONOUGH,  JEAN-PIERRE,  FERNANDEZ, WALKER, HYNDMAN, WRIGHT, BUTTENS-
          CHON, SIMOTAS, JACOBSON, GRIFFIN -- Multi-Sponsored by  --  M.  of  A.
          THIELE  --  read  once  and  referred  to  the  Committee on Health --
          advanced to a third reading, passed by Assembly and delivered  to  the
          Senate,  recalled  from  the  Senate, vote reconsidered, bill amended,
          ordered reprinted, retaining its place on the order of third reading
 
        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:
 
     1    Section  1.  The  public health law is amended by adding a new section
     2  2500-l to read as follows:
     3    § 2500-l. Duty of providers  of  primary  cesarean  section  maternity
     4  services  to  inform.  1.  (a) Every maternal health care provider shall
     5  provide the written communication established in subdivision two of this
     6  section prior to delivery to each pregnant woman  for  whom  a  cesarean
     7  section delivery is planned.
     8    (b)  Every  maternal  health  care  provider  who  performs a cesarean
     9  section which was not  planned  prenatally  shall  provide  the  written
    10  communication  established  in  subdivision  two  of this section to the
    11  patient following delivery.
    12    (c) As used in this section:    "maternal  health  care  provider"  or
    13  "provider"  shall  mean  a  physician,  midwife,  nurse practitioner, or
    14  physician assistant, acting within his or her scope of practice,  manag-
    15  ing the pregnancy of a pregnant woman.
    16    2.  (a)  The  commissioner  shall  develop  a written communication or
    17  communications for maternal  health  care  providers  to  distribute  to
    18  maternity patients as required in subdivision one of this section, which
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01662-04-9
        A. 318--A                           2
 
     1  contains  information  about cesarean section delivery. The commissioner
     2  shall consult with appropriate  health  care  professionals,  providers,
     3  consumers,  educators  and  patients or organizations representing them,
     4  including  but  not limited to the American College of Obstetricians and
     5  Gynecologists and the New York State Association of Licensed Midwives to
     6  develop such written communication or communications.
     7    (b) Such written communication or communications  shall  include,  but
     8  not be limited to information on:
     9    i. potential maternal injuries associated with cesarean delivery; and
    10    ii. potential risks to the fetus; and
    11    iii. the impact a cesarean delivery may have on future pregnancies and
    12  deliveries; and
    13    iv.  circumstances in which cesarean delivery may be necessary to save
    14  the life of the mother or fetus.
    15    (c) The commissioner shall ensure that all information included in the
    16  written communication or communications are maintained  and  updated  to
    17  reflect current clinical guidelines.
    18    § 2. This act shall take effect on the one hundred eightieth day after
    19  it  shall  have  become a law.  Effective immediately, the department of
    20  health may make regulations and take other  actions  necessary  for  the
    21  timely implementation of this act on its effective date.

A00318 LFIN:

 
NO LFIN

A00318 Chamber Video/Transcript: