COVID-19 Infection as a Barrier to Postpartum Tubal Ligation [ID: 1355689

Abstract

INTRODUCTION: About half of patients who do not obtain a requested postpartum tubal ligation experience pregnancy within the following year. There are many challenges to fulfilling postpartum tubal requests. Obstacles are exacerbated for those without private insurance, including Medicaid consent form requirements. Our institution considers postpartum tubal ligations “elective” and created policy prohibiting them for COVID-positive patients. We aimed to study how this creates additional barriers and delays to care for our patients. METHODS: This retrospective study identified patients with documented COVID infection at time of vaginal delivery who were unable to receive a requested postpartum tubal ligation at our institution between February 2020 and February 2022. Sociodemographic information, documented contraception ultimately obtained, and documented future unintended pregnancy were evaluated. Institutional review board approval was obtained. RESULTS: In a 2-year period, 24 patients were unable to receive requested postpartum tubal ligations at our institution because of COVID infection. 42% (n=10) of such patients were uninsured and 54% (n=13) had Medicaid. 92% (n=22) were Hispanic/Latinx. Average age was 33, and average number of prior pregnancies was 5. Only 21% (n=5) received an interval tubal ligation after delivery; no uninsured patients received an interval tubal ligation. Of the remaining patients (n=19), 37% (n=7) never received any contraception, 37% (n=7) received long-acting reversible contraceptives, and 26% (n=5) received another type of contraception. One patient had a future documented unintended pregnancy. CONCLUSION: Our institution's policy not to perform postpartum tubal ligations for COVID-positive patients prevented about 80% of patients requesting permanent sterilization after vaginal delivery from ever accessing this procedure.