A2655

An Act concerning postpartum care and supplementing Title 26 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. The Legislature finds and declares that:

a. Pregnancy is a significant health event in the lives of many women that presents unique physical, mental, and medical issues, many of which a woman will not encounter at any other point in her life.

b. Women experiencing pregnancy, particularly a first pregnancy, frequently lack information and guidance concerning many of the physical symptoms encountered during and after pregnancy. Because so many aspects of a woman’s body change during pregnancy, it can be difficult to determine when a particular symptom is normal or may be a sign of an adverse complication that requires medical attention, particularly with regard to symptoms occurring during the postpartum period.

c. Maternal mortality and morbidity rates have increased over the last 20 years both in New Jersey and nationwide, which increased rates have disproportionately affected minority communities. In many cases, the common causes of maternal mortality, including high blood pressure, excessive bleeding, and infection, are preventable if diagnosed and treated in a timely manner. Moreover, postpartum issues that are not typically fatal, such as postpartum depression, can seriously affect a woman’s quality of life if left untreated.

d. Frequently, postpartum issues cannot be detected before the woman is discharged from the hospital. Many symptoms do not manifest until after the woman has returned home, and issues may occur up to one year after birth. It is estimated that between one-third and one-half of pregnancy-associated deaths occur during the postpartum period. All women are susceptible to postpartum complications, not just those identified as “high risk” for complications during pregnancy.

e. As many as 40 percent of women never seek out or receive postpartum care, which represents a missed opportunity to screen for postpartum issues and provide necessary medical care.

f. Although New Jersey has taken significant steps to improve the provision of maternity care in this State, more needs to be done to ensure that women have the information and resources necessary to enable them to identify and seek treatment for potentially fatal postpartum issues.

g. Therefore, it is essential that women have the opportunity to develop an individualized postpartum treatment plan in the course of prenatal care and that they be provided with postpartum care information prior to discharge, including information about normal and abnormal postpartum symptoms, to enable them to make informed observations about their postpartum experiences and seek out medical care when needed.

2. a. Health care professionals, including physicians, advanced practice nurses, certified nurse midwives, and midwives, who provide prenatal maternity care to a woman shall ensure that the woman has the opportunity to develop a comprehensive personalized postpartum care plan that is consistent with her anticipated postpartum needs and plans. At a minimum, each plan shall include the designation of a medical home where the woman may access care and support during the period between the end of the pregnancy and the comprehensive postpartum visit. If the woman does not have a plan in place, the health care professional shall offer to consult with the woman to develop a plan.

b. Each general hospital, ambulatory care facility, and birthing center licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) that provides maternity care services shall ensure that, prior to discharge following the end of a pregnancy, each woman receiving maternity care services is provided with postpartum care information, including information concerning the potential health issues that may occur during the postpartum period and a description of the risks, warning signs, and symptoms of medically-significant complications that may occur during the postpartum period, including severe bleeding, high blood pressure, infection, and depression. For the purposes of providing postpartum care information pursuant to this subsection, hospitals, ambulatory care facilities, and birthing centers that provide maternity care services shall adopt uniform policies, procedures, and protocols, including standardized educational modules and training materials, that are consistent with best practices and national standards for postpartum care and the recognition and prevention of postpartum complications.

3. This act shall take effect 180 days after the date of enactment.

STATEMENT

This bill requires health care professionals providing prenatal care to ensure that each pregnant woman has the opportunity to develop a comprehensive personalized postpartum care plan that is consistent with her anticipated postpartum needs and plans. At a minimum, the plan is to include the designation of a medical home where the woman may access care and support during the period between the end of the pregnancy and the comprehensive postpartum visit. If the woman does not have a plan in place, the health care professional will be required to offer to consult with the woman to develop a plan.

The bill additionally requires facilities providing maternity care services, including general hospitals, ambulatory care facilities, and birthing centers, to ensure that, prior to discharge following the end of a pregnancy, all women receiving maternity care services are provided with postpartum care information, including information concerning the potential health issues that may occur during the postpartum period and details as to the specific signs and symptoms to watch for. For the purposes of providing postpartum care information, the facilities will be required to adopt uniform policies, procedures, and protocols, including standardized educational modules and training materials, that are consistent with best practices and national standards for postpartum care and the recognition and prevention of postpartum complications.

Pregnancy is a unique event in a woman’s life that involves significant bodily changes that often do not occur at any other time in life. Because so much of what a woman experiences during and after a pregnancy is new and different, it can be difficult for women to identify when a particular symptom is normal or if it requires a follow-up visit with a health care professional. Maternal mortality rates have increased over the past 20 years, which increase may be attributed in part to treatable postpartum complications, including high blood pressure, excessive bleeding, and infection. It is the sponsor’s belief that ensuring that women have the tools necessary to identify when they are experiencing a potentially serious complication following a pregnancy will help improve the quality of maternity care in New Jersey and reduce the number of preventable pregnancy-related deaths across all populations.