Paulin Advocates to Bring Attention to New York’s High Rate of C-Sections

Assemblymember Amy Paulin and State Senator Julia Salazar rallied at the Capitol on April 26, 2022 to advocate for their bills which address the extremely high rate of c-sections in New York State.

With New York State’s c-section delivery rate at 32%, one of the highest in the nation and significantly above the CDC and World Health Organization ideal range of 10-15%, Assemblymember Paulin and Senator Salazar’s Informed C-section Bill (A217/S2736) is critical to helping women in New York State. There are serious potential consequences from c-section deliveries. Studies have found that cesarian birth rates are directly linked to higher maternal death rates.

April is C-Section Awareness Month, and earlier this month the Department of Health released a Report on Pregnancy-Associated Deaths in New York State which further highlights the link between c-sections and maternal mortality. The report found that there were 41 pregnancy-related deaths in 2018, with hemorrhage and embolism as the two leading causes. The report determined that of the pregnancy-related deaths caused by hemorrhage, all of them were preventable. The report’s findings demonstrate the critical need to reduce the rate of cesarean births, especially for women of color who are four times more likely to die of pregnancy-related deaths than other women.

C-sections also pose additional risks such as ruptured uterus, unplanned hysterectomy, and blood transfusions, which may seriously affect a women’s future health and their ability to have more children.

“It’s imperative that women are informed of the risks, both immediate and in the future, of c-sections,” said Assemblymember Amy Paulin. “While there are scenarios where a cesarean delivery is the safest option, C-sections can pose immediate risks for the mother and baby, and can have negative consequences for women who want to continue to grow their families. We must educate expecting mothers, ensure informed consent for c-sections, and train providers to develop knowledge and skills on approaches that will maximize the likelihood of vaginal birth. New York State can improve the maternal mortality rate and women’s maternal health by taking direct actions to reduce the cesarean birth rate and improve the quality of care that expectant mothers receive — which the bills State Senator Salazar and I have proposed seek to achieve.”

"As last year's Chair of the Women's Issues Committee and a member this year, I know all too well, how necessary the C-section Awareness Month Legislative Package bills are to the 4.3 million women living in New York,” said State Senator Julia Salazar. “This isn't a matter of convenience, it’s a matter of necessity. Our mission is and should continue to improve maternal-child health by reducing preventable cesareans through thoughtful legislation as well as public education. It is well documented that maternal and child health are improved by preventing unnecessary cesareans. We owe it to the countless mothers of New York to have the best informed options at the ready when undergoing childbirth."

They also discussed the following c-section and maternal health-related bills which they seek to pass in the NYS Legislature during the current legislative session:

A9098a/S8751 (Paulin/Brouk) requires hospitals and birth centers to make information on maternity related proceduresavailable on the NYS Department of Health website for the most recent five years for which the data is available. Thiswill help maternity patients make the most informed decision when choosing where to give birth.

A9714a/S8866 (Paulin/Brouk) establishes a cesarean births review board comprised of experts in the field of maternalmortality, women’s health, and public health for the purpose of lowering cesarean birth rates and improving maternal health.

A8392/S3010 (Paulin/Ramos) provides an insurance premium reduction to physicians and licensed midwives whocomplete a risk management strategies course in obstetrics or midwifery. The skills taught in these courses will seek to improve maternal safety, birth outcomes and promote informed consultations from the prenatal through postpartum periods.

A8536/S7628 (Gottfried/Salazar) adds a women's health care provider to the New York State Public Health & Health Planning Council (PHHPC). As the PHHPC reviews applications for health care facilities like birthing centers andreproductive health care clinics, it is essential to have a member that represents providers of women’s health care services.

Many advocates, Assemblymembers and State Senators joined the rally in support.

Helena Grant, New York Midwives President and Director of Midwifery at Woodhall Hospital said “New York Midwives proudly stand with Assemblymembers Paulin and Gottfried and Senators Salazar, Brouk, Ramos, and their colleagues to strongly support legislation to ensure that the birthing people of this great state have transparent information and are empowered to make health care choices grounded in self-advocacy and wellness. Cesarean birth rates and the associated maternal mortality and morbidity related to increased bleeding, infection, longer healing time, and placental implantation issues with subsequent surgical births are too high in NYS and disproportionately affect Black women. Hospitals with practicing midwives have lower rates of cesarean births. A healthcare system that allows medical providers to choose not to offer vaginal births after cesarean births to birthing people who are good candidates deserve further discourse. Hospitals with practicing midwives have higher VBAC rates. Risk management strategies, such as simulation and debriefing training, are essential to ensure health equity and procedural quality. An insurance premium reduction would be beneficial to those who complete such training as they continue to accept the calling to serve the birthing families of NYS at a time when the number of obstetric and primary care providers in the state has decreased. Adding the voice of women’s health care providers to PHHPC would ensure that the care needs of 50% of the population experiencing menarche, birth, menopause, and beyond would be heard and advocated for. Expertise in women’s health issues is vital and must be welcomed to the table. New York Midwives recognize that these bills are rooted in reproductive justice, birth equity, erasing health disparities, ending maternal and infant morbidity and mortality, the prevention of trauma, and the uplifting of the shared-decision making model rooted in Midwifery care. We are proud to stand with and be represented by legislators that are bold enough to create bills that have the power to shift the trajectory of the conversations we are having with one another as healthcare providers and with the clients we serve because they believe that the women of NYS deserve birth experiences that are safe, satisfying, and sacred.”

State Senator Cordell Cleare said, “As Chair of the Senate Standing Committee on Women’s Issues, I am a proud and vocal co-sponsor of every single bill in the C-Section Awareness Month Legislative Package. I will make it my core mission to ensure that we pass the whole package this year and begin to empower mothers, educate patients and reverse the long history of health disparities disproportionately affecting black women.”

“I’m proud to have passed S3010 through the Senate, which provides incentives and support for licensed midwives who complete a risk management strategies course. Equipping practitioners and community-based health providers with all the tools they need to help their patients through critical reproductive health decisions is how we get at the root of racial disparities in maternal health and mortality. With Assembly Member Paulin’s leadership on this issue, this bill, and a full package of legislation directed at improving c-section best practices, will move through the Assembly and to the Governor’s desk,” said State Senator Jessica Ramos (D, WF - SD13)

State Senator Samra Brouk said “When doctors recommend a c-section during active labor, the birthing parent often has little to no time to review data or make an informed decision. That’s why I’m proud to sponsor legislation with Assemblymember Amy Paulin to require hospitals and birthing centers to make information available on their c-section practices, as well as legislation that creates a cesarean births review board to lower cesarean birth rates and improve maternal health. Healthy mothers mean we have healthy babies, healthy families, and healthy communities. We must prioritize meaningful system change to improve the health outcomes for expecting parents of all racial and ethnic backgrounds.”

Assemblymember Michaelle Solage said “Birthing parents should have access to full and complete information on the risks and benefits of a vaginal birth and a cesarean section in order to make informed choices about their healthcare. While a cesarean can be lifesaving for a mother and her baby in certain circumstances, maternal and child health are improved by preventing unnecessary cesareans which can lead to tragic health outcomes, primarily impacting women of color.”

"New York's high prevalence of C-sections, especially among minority populations, has dangerous, avoidable consequences for mothers and babies," said Assembly Health Committee Chair Richard Gottfried. "This bill package will ensure that health care facilities, practitioners, and State policymakers are responsive to the needs of pregnant patients and that patients have appropriate knowledge and protection when deciding how to deliver their babies.”