Gov. Kathy Hochul will consider signing two pieces of legislation that would help improve New York's elevated maternal mortality rate and ensure pregnant New Yorkers whose fetuses have died get the treatment they need.

Lawmakers are pushing to improve maternal care in the state as a Capital Region maternity ward is expected to shutter due to significant financial losses.

The state Legislature passed a bill that would require hospitals to update protocols for treating patients pregnant with a dead or dying fetus, and transfer those patients to a different facility if treatment goes against the hospital's religious beliefs.

Called Mickie's Law, the bill is named for a baby that died in the second trimester, but the hospital treating the mother refused to perform the needed procedure to remove the fetus. The hospital considered the procedure to be equivelant to an abortion.

"We, in the United States, are facing a worsening maternal mortality crisis, especially one that is disproportionately affecting the Black community, Black expectant mothers or Black expectant persons," sponsor Assemblywoman Rodneyse Bichotte Hermelyn said.

The child's parents searched for a facility that could remove the fetus, but the mother was told she would have to wait for two weeks. A mother can carry a dead fetus for a few weeks before it begins to decompose, but the mental trauma can be life-threatening. 

Bichotte Hermelyn sponsored the bill after her son, Jonah, died while 22-and-a-half weeks premature in 2016. She also nearly lost her life.

It would also require labor be induced in a reasonable time in the case of an emergency.

"A person who was looking to have a baby, and unfortunately, had to go through this tragedy should not have to continue to be in despair for another two, three weeks," the assemblywoman said. "And that, in many cases, that can be suicidal. It could be mentally draining on the patient. And there's health implications that goes along with that. So we felt that Mickey's Law was something that could not wait, especially at the height of overturning Roe v. Wade."

Hochul will also consider signing a bill passed this session that would require the state Health Department to create a directory of doulas to improve maternal care, including information about those that accept Medicaid. 

The state's Maternal Mortality Review Board and Maternal Mortality and Morbidity Advisory Council held listening sessions statewide over the last several months and will release a report with recommendations by the end of the year.

"We did listening sessions with persons who had recently given birth, persons of color, people who had bad outcomes, to hear what they, what their perceptions were of their experience," said Dr. Marilyn Kacica, medical director of the state Health Department's Family Health Division. "From that, we learned... people don't feel heard, they don't feel like they're part of their decisions, that they're not taken seriously."

New York has a maternal mortality rate of 18.2 pregnancy-related deaths per 100,000 live births, according to the latest released Health Department data. It's lower than the national rate of 32.9 pregnancy-related deaths per 100,000 births, according to U.S. Centers for Disease Control & Prevention, but the U.S. rate is more than three times higher than most other industrialized nations across the world — and it continues to rise.

Black women in the state are nine times more likely to die from a pregnancy-related death compared to white New Yorkers, and about five times more likely on average nationally, according to the CDC.

Officials with the Health Department and state Office of Mental Health are working on a study to examine screening tools for postpartum depression and issues that could vary by race.

"We want to make sure that all people are treated equitably, and that's that is really the focus of all these projects ... [is] that people recognize how people are treated in order to change what they're doing," Kacica said.

State hospitals and birthing centers work together as part of the state's Perinatal Quality Collaborative, which sets care standards while focusing on issues that contribute to maternal deaths, including preventing obstetric hemorrhage.

But hospitals will need to work together as financially strapped organizations look to cut maternal services. 

St. Peter's Health Partners is seeking state approval to close the Burdett Birth Center at Samaritan Hospital in Rensselaer County. The center has submitted a Certificate of Need, but has not yet filed a closure request, according to the Health Department on Monday night.

State Sen. Jake Ashby sent a letter last week to discourage the Health Department from allowing its closure after he received calls from concerned constituents. 

"In terms of what's going to be lost is a level of care that I don't think is as prevalent in other parts of the area in the state and in terms of maternity care," he said. "There are constraints and challenges that the health care industry is facing, especially in this in this sector. So it's amazing to me that we would attempt to be closing a service so vital to our community to a population that is already struggling."

If it closes, other area hospitals will have to provide care for hundreds of live births that take place at the Troy center annually.

The state Health Department does not track the number of birthing centers in New York within private practices. Three centers in the state are licensed by the department.

"When a hospital is closing, there are a lot of steps they go through in order to ensure that their patients can still get care, and the receiving places of their patients work with us as well as the hospital that's closing to figure out what that is," Kacica said. "We don't want anyone ever to be abandoned."

Four Level 1 hospitals located in Western New York, Central New York and northeastern New York have closed their labor and delivery units in the last three to five years, according to DOH.

Sen. Ashby, a Republican from Castleton, is pushing to further increase Medicaid reimbursement rates for health providers, including to rebase rates for hospitals, as well as EMS and ambulance services.

It's something lawmakers would likely negotiate in next year's budget, but the senator says the Legislature should return to Albany and take action now, as a slow, surgical approach will only exacerbate maternal mortality and cause more patient suffering.

"This is a reason we should come back to session," he said. "When we think about the strain on our health care system and what our hospitals and our outpatient facilities are telling us, what our nursing homes are telling us across the board, why would we not come back now and try to address this? This is an emergent issue."

Earlier this month, the state Centers for Medicare and Medicaid Services approved an extension of comprehensive Medicaid coverage for postpartum individuals for 12 months, making 26,000 New Yorkers eligible for Medicaid for one year after pregnancy.

The final 2023-24 budget also featured better Medicaid coverage and higher reimbursement for doula and midwifery services, screenings for congenital syphilis in late-term pregnancy, improved access to prenatal and postnatal care and expanded paid parental leave for state employees, according to the state Budget Division.

Greater state Medicaid investments took effect last summer and fall that include expanded coverage for nutrition and lactation counseling, prenatal testing and perinatal care, according to the Health Department.

"I've been fighting for this crisis, against this crisis, as a priority," Bichotte Hermelyn said. "But I'm not alone in this. A number of legislators are also fighting alongside with me."

Other legislation to improve maternal care in the state died in committee this session, including proposals to increase compensation for costs associated with a stillbirth, and to require insurance policies to cover transvaginal ultrasounds during pregnancy and pre-term labor hospitalizations.