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 sterilisations (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.