Sterilisation during unplanned caesarean sections for women likely to have a completed family--should they be offered? Experience in a country with limited health resources

Abstract

Objective: To determine if it is proper to give a woman of higher parity who needs at short notice a caesarean section the option of a tubal ligation.

Design: Retrospective study.

Setting: Maternity unit of a tertiary hospital in Bulawayo, Zimbabwe.

Population: Women of higher parity who were delivered by an emergency caesarean section, by an elective caesarean section or vaginally and who had been asked or not asked whether they wanted a tubal ligation.

Methods: A postal questionnaire and visits to the participants.

Main outcome measures: Satisfaction with (in)fertility after having had, or not had, the option of a tubal ligation with the last delivery.

Results: In women who had an emergency caesarean section and who were successfully followed up, 301/418 (72.0%) had been offered a tubal ligation and 241/301 (80.1%) accepted. Of the 301 women, 269 (89.4%) were happy with the outcome. Thirty-two women were unhappy (of whom 6 had tubal ligation, 24 had declined a sterilisation and in 2 cases the doctor forgot to do the sterilisation). Of the 117/418 women not offered a tubal ligation, 75/117 (64.1%) regretted not having had one. The relative risk of being unhappy with the consequences of not being offered tubal ligation compared with being given this option was 6.0 (95% CI 4.2-8.6, P < 0.001). Tubal ligations performed during emergency caesarean sections had no higher regret rate (2.5%) in this setting than those performed during elective caesarean sections (3.2%) and not much higher than postpartum sterilizations (0.5%). Women who did not have a tubal ligation during an emergency caesarean section regretted this (56.4%) significantly more often than women who did not have a tubal ligation with an elective caesarean section (34.6%) or after vaginal delivery (45.0%) (P < 0.01 and P < 0.02, respectively).

Conclusions: We found no evidence that the need to take an urgent decision resulted in more regret following tubal ligation. Women were far more likely to regret declining a tubal ligation (40%) than regret accepting one (2.5%). In this setting, some women are more likely to die of the next pregnancy than to regret an emergency tubal ligation.