Bilateral Tubal Ligation after Parturition Among Medicaid Patients in West Virginia: An Institutional Experience

Abstract

Postpartum tubal ligation is one of the safest and most effective methods of contraception. Yet, not all women who desire it actually undergo the procedure. We studied clinical and demographic factors that were associated with receipt of tuba ligation among West Virginia Medicaid patients. A retrospective study was performed evaluating Medicaid patients in West Virginia requesting postpartum sterilization from May 2012 to November 2014 (N = 153). Demographic information was obtained on these patients. Clinical factors complicating pregnancy were analyzed. For those patients choosing not to undergo tubal sterilization, contraceptive plan at discharge was also evaluated. Statistical tests included Chi square and Fisher’s Exact Test where appropriate. 71% (n=96) received tubal ligation before discharge. 21% (n = 29) requesting post-partum tubal ligation went unsterilized. Women with a history of cesarean section (83% vs. 61%; p = <0.0007) and those delivering by cesarean section rather than vaginal delivery (86% vs. 55%; p = <0.001) were more likely to receive tubal ligation. All other factors did not significantly influence the completion rate for tubal sterilization. Twenty one percent of patients requesting post-partum tubal sterilization went unfulfilled, indicating that significant barriers remain.