A Root Cause Analysis of Logistical and Cultural Barriers to Postpartum Sterilization After Vaginal Delivery at a Tertiary Medical Center

Abstract

Background: Sterilization is an effective form of contraception with approximately 18.6% of women aged 15-49 years relying on this method, however only 39-57% of women who request this procedure prenatally ultimately undergo postpartum sterilization. The implications for incomplete but desired postpartum sterilization procedures negatively impact the health of women. At Penn State Hershey Medical Center (PSHMC), immediate postpartum sterilization after vaginal delivery is not standard practice, so a root cause analysis was done to identify existing barriers to postpartum sterilization after vaginal delivery at PSHMC. Methods: Voluntary one-on-one qualitative interviews were conducted with a multidisciplinary group of stakeholders involved in performing postpartum sterilization. Stakeholders consisted of women’s health attendings, family and community medicine attendings, ob-gyn residents, anesthesiologists, and nursing leadership with the goal of obtaining a comprehensive understanding of this issue. Results: Participants were asked standardized questions that were selected according to participant role in the postpartum sterilization process. Barriers identified were found to be either logistic and/or cultural. A root-cause analysis in the form of a fishbone model was performed to identify barriers and create targeted solutions for the future. Conclusion: Due to the high rates of short-interval pregnancy, dissatisfaction, and associated health consequences, interview participants agreed that postpartum sterilization was an important procedure that patients should be able to obtain. It was also identified that the current model at PSHMC does not adequately provide this service to women who desire it. A sample standard operating procedure was created to begin formulating a framework to help increase the rate of postpartum sterilization to 1 per month at PSHMC, with cyclic re-evaluation.