Lower N.Y.’s high C-section rates

As a New York State Assemblymember, my roles as a mother and grandmother have greatly impacted my tenure in the Legislature. My three “babies” are now having babies of their own. So, when I think about maternal health care in this state, it is deeply personal to me.

The Assembly has passed legislation to address the alarmingly high C-section rates in New York State and the correlation that cesareans, especially repeat cesareans, have on the increased likelihood a birthing person will experience severe hemorrhaging — a leading cause of pregnancy-related deaths.

Gov. Hochul, both a mother and a grandmother herself, has unveiled her new proposal to address the maternal mortality crisis in the state. The governor made a critically important point during her announcement when she explained that the maternal mortality rate for millennial women is 230% higher than it was for Gen X and 300% higher than it was for Baby Boomers.

It is more dangerous for my daughters to give birth today than it was when I gave birth to my children more than three decades ago.

We’ve seen the rates of C-sections in this country trend upwards in a very similar way — which the governor aptly noted in her announcement earlier this month.

Since the 1970s, the C-section rate in this country has increased by 500%, where one in three babies are born via C-section today. Further, the C-section rate in New York State exceeds the national average, and the World Health Organization and the Center for Disease Control’s (CDC) ideal rate of 10-15%.

What is perhaps most concerning is the rate of first-time, or primary, C-sections. The CDC recently released a report reviewing the rates of C-sections in the country and found that primary cesarean delivery rates are on the rise in this country. If a woman gives birth via C-section, the report notes more than four out of five women will go on to have another C-section.

While C-sections can be the best and safest method of delivery for high risk first-time mothers, there is no clear evidence that demonstrates the increase in cesarean deliveries has yielded improvements in infant or maternal mortality. Further, C-sections, when compared to vaginal deliveries, are associated with higher risks of complications of anesthesia and severe hemorrhaging that can lead to death.

Research shows us that C-sections impact the baby as well. Babies born via C-section are at an increased likelihood to experience breathing problems and some studies have demonstrated that infant mortality rates are higher among infants born via C-section than those delivered vaginally.

In 2022, the Department of Health released a report on pregnancy-associated deaths in New York State that 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.

I recently traveled to Israel and visited several hospitals and health centers. Israel has one of the lowest C-section rates at about 15%. It also has a significantly lower infant mortality rate than countries with higher C-section rates. This confluence is striking and needs to be studied.

The upwards trend for both maternal mortality and C-sections may be related, but to understand the interplay between the increases in maternal mortality and cesarean procedures we must collect and analyze more granular data.

Throughout my time in the Legislature, I have introduced bills related to reducing the rates of unnecessary C-sections. One of my bills would require expecting mothers to be given information regarding the risks and possible outcomes of having a C-section, and has passed the Assembly year after year before hitting a wall in the state Senate.

Additionally, I have legislation that would require the state’s Maternal Mortality and Morbidity Advisory Council to undertake a review of the cesarean births at hospitals to determine the role the procedure played in the maternal deaths that occur within the state.

My office is working on new legislation geared toward understanding and lowering the C-section rate in the state. First, one will require hospitals to report granular data on C-section procedures within their facilities. The second bill will focus on value-based payments to incentivize providers to perform fewer unnecessary C-sections.

We are enduring a crisis that will continue to get worse unless we act. I am very committed to maternal health, and passing these bills as an important step to addressing this. With the governor’s commitment to this issue, I feel confident we’re going to get there.

Paulin chairs the Assembly Health Committee.