Establishes a duty to inform certain patients about the risks associated with cesarean section for patients undergoing a primary cesarean section; establishes a duty to inform certain patients about the reason for performing a primary cesarean section delivery.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1039
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 a primary cesarean section and to inform certain
patients about the reason for performing primary cesarean section deliv-
ery
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-m. Subdivision one provides definitions and establishes a procedure
for a maternal health provider 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. In the event a primary c-section is not
deemed medically necessary, but the pregnant person requests a planned
c-section, the health care provider must provide written communication
indicating the procedure is not medically necessary and why. A new
subdivision is added to establish a procedure for a maternal health
provider to provide written communication to each woman after an
unplanned Cesarean delivery including the reason for the Cesarean deliv-
ery.
Subdivision four establishes a formal message for maternal health care
providers to share with each pregnant person undergoing a planned cesa-
rean section. Lastly subdivision five establishes a formal message for
maternal health care providers to share with for which a primary c-sec-
tion is not deemed medically necessary by the provider.
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 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 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 maternal health care
provider, defined as any physician, midwife, nurse practitioner, or
physician assistant, or other maternal health care practitioner acting
within their 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.
LEGISLATIVE HISTORY:
A4927A 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 S.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 shall take effect on the one hundred and eightieth
day after it shall become a law. Effective immediately, the department
of health may promulgate any rule or regulation necessary for the timely
implementations of this act on its effective date.
STATE OF NEW YORK
________________________________________________________________________
1039
2025-2026 Regular Sessions
IN ASSEMBLY
January 8, 2025
___________
Introduced by M. of A. PAULIN, GONZALEZ-ROJAS, SEAWRIGHT, SIMON,
BICHOTTE HERMELYN, CLARK, LEVENBERG, EPSTEIN, JACOBSON, ZACCARO,
SANTABARBARA, OTIS -- read once and referred to the Committee on
Health
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
delivery
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, defined as any physician, midwife, nurse practitioner, or physician
6 assistant, or other health care practitioner acting within such practi-
7 tioner's lawful scope of practice attending a pregnant person, to
8 provide written communication to each pregnant person for whom a primary
9 cesarean section delivery, defined as first lifetime delivery via cesa-
10 rean section, is recommended as a planned cesarean section delivery
11 based on medical necessity, that the primary cesarean section is recom-
12 mended and to provide the justification for the primary cesarean section
13 prior to the delivery.
14 2. In the event that a primary cesarean section is not deemed
15 medically necessary by the provider but the patient requests a planned
16 cesarean section delivery, the commissioner shall require that the
17 health care provider provide written communication to the pregnant
18 person requesting the primary cesarean section indicating that the
19 primary cesarean section is not medically necessary and to explain the
20 risks associated with the cesarean section prior to the delivery.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00513-01-5
A. 1039 2
1 3. In the event that the primary cesarean section is not planned
2 prenatally, the commissioner shall require that the health care provider
3 who performed the cesarean section provide communication in writing to
4 each person who delivered via primary cesarean section the reason for
5 the unplanned cesarean section after the delivery.
6 4. The provider shall provide communication to the patient with a
7 planned cesarean section that shall include, but not be limited to, the
8 following information, in the summary of the report sent to the patient:
9 "Cesarean birth can be life-saving for the fetus, the birthing parent,
10 or both in some cases. However, potential injuries to the birthing
11 parent associated with cesarean delivery include but are not limited to:
12 heavy blood loss that results in hysterectomy or a blood transfusion,
13 ruptured uterus, injury to other organs including the bladder, and other
14 complications from a major surgery. Cesarean delivery also carries high-
15 er risk of infant injury and can result in situations requiring the
16 neonatal intensive care unit (NICU). After a cesarean delivery, future
17 vaginal deliveries may be risky. Because of this, cesarean delivery may
18 be recommended in the future. However, vaginal birth after cesarean
19 (VBAC) may be possible, depending upon your health characteristics. In
20 future pregnancies, there is risk of the cesarean section scar breaking
21 during pregnancy or labor (uterine rupture). Additionally, people's risk
22 of developing placenta previa or accrete in future pregnancies is higher
23 after cesarean deliveries than vaginal births. Speak to your health care
24 provider about your options and any questions you may have."
25 5. The provider shall provide communication to the patient with an
26 unplanned cesarean section that shall include, but not be limited to,
27 the following information, in the summary of the report sent to the
28 patient:
29 "Your most recent delivery was via cesarean section. Cesarean delivery
30 can be life-saving for the fetus, the birthing parent , or both in some
31 cases. After a cesarean delivery, future vaginal deliveries may be
32 risky. Because of this, cesarean delivery may be recommended in the
33 future. However, vaginal birth after cesarean (VBAC) may be possible,
34 depending upon your health characteristics. In future pregnancies, there
35 is risk of the cesarean section scar breaking during pregnancy or labor
36 (uterine rupture). Additionally, people's risk of developing placenta
37 previa or accrete in future pregnancies is higher after cesarean deliv-
38 eries than vaginal births. Speak to your health care provider about your
39 options and any questions you may have."
40 § 2. This act shall take effect on the one hundred eightieth day after
41 it shall have become a law. Effective immediately, the department of
42 health may promulgate any rule or regulation necessary for the timely
43 implementation of this act on its effective date.
